2008年-世界发展银行全球_Republic_of_Burundi___Health_Financing_Study_130页_8mb

Summary of the Republic of Burundi Health Financing Study

Core Content

This document presents a comprehensive health financing study conducted in the Republic of Burundi, highlighting the challenges and opportunities in improving the health system. It outlines the current state of health expenditure, the impact of the presidential measure to eliminate user fees for health services offered to children under five and women during delivery, and the implications for the country's ability to achieve its health-related development goals.

Main Objectives

• To assess the current health financing landscape in Burundi.
• To evaluate the effectiveness of the presidential measure to eliminate user fees.
• To identify the key challenges in public expenditure management and resource allocation.
• To recommend strategies for improving the efficiency and equity of health financing.

Key Findings

Health Status and Challenges

• The health status of Burundi remains poor, with high infant and maternal mortality rates.
• Communicable diseases such as malaria, diarrhea, and respiratory infections are major causes of mortality and morbidity.
• HIV/AIDS is a significant challenge, with an adult prevalence rate of about 3.3%.
• A large portion of the population (about one-third) cannot access health care due to financial barriers.

Impact of Conflict and Peace

• During the conflict, public health expenditure declined, worsening the health system.
• With peace and stability, health expenditure has increased, but challenges remain in resource mobilization and management.
• The presidential measure to eliminate user fees for children under five and women during delivery has improved service utilization but faces implementation issues.

Expenditure Trends

• Total health expenditure (THE) in 2006 was estimated at US$14.5–18.5 per capita, lower than the SSA average and other post-conflict countries.
• Government expenditure on health was only about US$1 per capita in 2006, one of the lowest in SSA.
• Foreign assistance accounts for about 50% of total health expenditure.
• Private sector expenditure, mainly out-of-pocket (OOP), remains high, especially among the poor.

Public Expenditure Management

• The Ministry of Public Health (MSP) faces challenges in budget planning, execution, and monitoring.
• Delays in disbursement of HIPC funds and reimbursement to health facilities hinder effective resource use.
• The creation of the General Directorate of Resources (DGR) in 2006 improved capacity but did not fully resolve management issues.

Health Facility Resource Management

• Health facilities have limited capacity to manage and report their budgets.
• Many facilities manage two accounts: one for service revenues and another for pharmaceutical sales.
• The lack of a functioning drug revolving fund and the poor condition of infrastructure contribute to service delivery challenges.

Presidential Measure Implications

• The measure to eliminate user fees for children under five and women during delivery has increased utilization but not coverage.
• To achieve 60% effective coverage by 2010, an estimated US$10 per capita would be required.
• To achieve 80% coverage, an estimated US$13 per capita would be needed.
• Infrastructure and equipment represent over 50% of the estimated costs.
• Personnel remuneration accounts for about 12% of the total costs.

Recommendations

• Improve Public Expenditure Management: Strengthen budget planning, execution, and monitoring to ensure efficient use of resources.
• Enhance Coordination: Promote a sector-wide approach (SWAp) to ensure better distribution and use of donor funds.
• Strengthen Health System Capacity: Invest in training, hiring, and equipping health personnel and facilities.
• Ensure Sustainable Funding: Increase government resources for health through debt relief and other mechanisms.
• Improve Transparency: Create a transparent system for tracking all health-related funds and their usage.
• Address Inequities: Ensure equitable distribution of resources across provinces and strategic objectives.
• Strengthen Donor Support: Encourage more predictable and long-term donor funding to support the health sector.

Conclusion

The study emphasizes the need for a more efficient and equitable health financing system in Burundi. While the presidential measure has improved access to health services for vulnerable groups, the lack of adequate resources, poor infrastructure, and inefficiencies in public expenditure management remain major obstacles. Sustainable progress towards the Millennium Development Goals (MDGs) and the National Health Development Plan (NHDP) will require coordinated efforts, improved financial management, and a commitment to long-term investment in the health sector.