There is nothing new about the SDC's approach in Burundi's health sector – training medical and administrative staff in the health centres and district hospitals and ensuring the continuous supply of medicines at a price that the local population can afford – but it makes even more sense since the country was plunged into a political and humanitarian crisis in spring 2015.
All donors have suspended their budget support to the Burundi government in response to the numerous violations of human rights in the country, confining their assistance to local initiatives. They have now turned their attention to local initiatives. Switzerland is doing the same by pursuing its commitment on the ground, helping local healthcare facilities as well as the local people whose lives are sometimes already precarious due to the chaotic political situation. The SDC is, therefore, aiming to strengthen the national health system but by taking action directly in decentralised institutions, which in this case are situated in two northern provinces of the country, Ngozi and Kayanza.
Democratic management of health facilities
The healthcare support programme established by the SDC in Burundi also includes neighbouring Rwanda, within the framework of a regional project. Set up by the Swiss Tropical and Public Health Institute, it helps to build and renovate facilities, buy equipment and train large numbers of medical and administrative staff. The programme has benefited almost 200 health centres and regional hospitals in Burundi and Rwanda and, indirectly, some 2.5 million inhabitants.
The idea is not only to ensure the population receives better healthcare but also to make sure that health facilities are run in a professional, even democratic manner. In other words, the more local communities are involved in managing health facilities, and the more access they have to transparent information, the easier it is for them to have access to healthcare.
But the men, women and children requiring treatment need to be able to pay for it. With the Swiss Tropical and Public Health Institute, the SDC is helping to set up basic healthcare funding arrangements which are favourable to the majority.
In Rwanda, the SDC's advocacy contributed to the introduction of basic health insurance for the population in the early 2000s. Since then, the SDC has been striving to help the poorest people to pay their annual premiums (approx. CHF 4 per person). In 2015, more than 17,000 households benefited from subsidies. In Burundi, some 14,000 families were able to obtain a healthcare card thanks to the SDC.
The challenge now is for the whole population to be covered by this basic health insurance. The insurance membership rate today ranges from 19% to 77% in areas where the SDC is active. The healthcare support programme that has been set up is trying to make all Burundians and Rwandans aware of the benefits of these insurance schemes. At the same time the SDC takes part in the regular assessment of these schemes, together with the national authorities and local beneficiary committees, in order to improve their day-to-day running.