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Burundi civilians have lived through years of struggle, and now they are in a situation of chronic disaster. The healthcare system of Burundi is relatively poor, and health care facilities are limited across the whole country. Although in 2003, there was an agreement on war cessation, the effects of war are still evident, and there is no peace in certain parts of Burundi. The civil wars have continued to be experienced in the country and have adversely affected the health sector. The government of Burundi has made little improvement plan in the health sector is limited. There is a shortage of medical professionals, inadequate security provision and the country's infrastructure is still inferior which limits the accessibility of the health facilities. The rate of Mortality in Burundi is still high although the country has enjoyed a considerable period of political stability. Due to poverty, a large portion of the Burundian population cannot be able to pay for the healthcare services hence they cannot access these services. Most of the patients who are from poor backgrounds cannot afford the medical expenses thus remain in their homes without health care services. There are widespread communicable diseases such as malaria and cholera which mostly affect women and children. These diseases have led to the death of a considerable number of Burundian because they are unable to access the health facilities and the cost of health service is unaffordable to them.
The cost of health increased due to the cost recovery policy that was implemented by the government of Burundi in the year 2002. The policy required that all the patient pay their medical bills in full that they incur in the course of treatment without any government intervention. As a result, patients had to pay the total cost of medicines and other healthcare services offered in the hospitals. The funds allocated to the health sector by the government was inadequate hence there was a need to mobilize extra resources in order to improve the health care services. Up to this point, Burundi has introduced two crucial reforms in the health sector to aid in the improvement of health care. These reforms include performance-based financing reforms for the hospitals that offer health care services and a district health system to enable in disseminating healthcare facilities (Van Lerberghe et al, 2014).
The government of Burundi and private sector are have recently put in place strategies to improve the health sector in Burundi. They have improved the supply of medicine to the public through increasing the quantity and quality of the medication availed to the public. The drugs are distributed to the vast population of Burundi through private and public sector at an affordable price. However, the health sector of Burundi is facing several challenges which include; inadequate infrastructure, low doctor-to-patient ratio, limitation of access and use of health services, and inadequate reference care in health facilities. In addition, the health sector also faces challenges like adequate public funding, shortage of qualified personnel, and limited access to health services due to financial constraint among the poor. Other challenges include inadequate logistics, lack of vital registration system to use for data capturing on the prevailing trends and rate mortality, and also the health centers are inaccessible due to the geographical factors. The government is looking for ways to lower mortality due to communicable diseases, reduced neonatal and maternal care, and reduced child and infant care (Farag et al 2013).
Factors influencingthe healthcare system in Burundi
Several factors affect the healthcare system of Burundi. These factors can be classified as economic, institutional, political and social-cultural factors. Health system in any setting is solely influenced by these factors. The success of the health system greatly depends on the integration of these factors and how careful the stakeholder considers them. These factors are discussed in details in the following section (Swartz et al, 2014).
There is continued use of traditional methods of treatment among the citizens of Burundi. The practices have been generally accepted by the people hence interfering with formal health care delivery. Most patients prefer the traditional methods because they seem to be cheaper and more affordable when compared with the cost of services offered at the health facilities. Only those people who have accessed formal education prefer to go to health facilities to receive treatment though they may also opt to use traditional medications if the illness persists (Falisse et al, 2012).
High population growth rate is another factor affecting the health care of Burundi. The population of Burundi ha rapidly increased to unmanageable numbers which translate to stagnation of healthcare facilities. The capacity of the healthcare facilities is not adequate to adequately accommodate the significant number of patients. As a result, hospitals face the challenge of congestion, inadequate health professionals to provide health care services and the medications available are not adequate.
Health disparities have been witnessed in Burundi due to the issue of poverty. A significant percentage of the population especially the rural dweller is poor and cannot afford the health care services provided at the current cost (Risso-Gill et al, 2013).
The occurrence of civil war in Burundi has dramatically affected health systems in the country. For the last several years Burundi has experienced violence and civil war due to political instability which has profoundly affected the systems of Burundi and hinders efforts to improve the healthcare and the situations of the population. Military suppression has subject most of Burundian history since its independence in 1962 from Belgium. Massacres that occurred for nearly two decades led to the deaths of thousands of innocent people, displacement of a considerable number of individuals and a large number of people were seriously injured (Novignon, Olakojo, and Nonvignon, 2012). This led to congestion in health care facilities. Hence the health care services could not adequately cater for the casualties. The results of years of instability and conflicts have considerably worsened the living conditions Burundians. The continued failure of governance succession is the main reasons why the development of the health system in Burundi is difficult. Due to civil wars and violence poverty has increased to unmanageable levels which also contributes to poor health because people cannot afford to pay for health services (Grasso et al, 2012).
Violence and conflicts in the community interrupt peoples' routine activities, discourage investors from investing in the country and also interferes with the system of education. Consequently, the remains poor hence cannot sustain any development especially in the health sector which requires considerable capital to be developed. There are many problems which are brought about by civil wars which include; an outbreak of communicable diseases due to congestion in camps where internally displaced people settle, overcrowding of health centers, inadequate medications due to the high number of patients and insufficient personnel to adequately attend to the patient. This increases the mortality rate in the country which is undesirable (McGorman et al, 2012).
Political instability has been frequently experienced in Burundi for an extended period and has dramatically affected the health system of the country. Health care policies could not be properly coordination due to the instability of the government. Instead of the resource generated being channeled to the development of health facilities and other essential projects, most of these resources were wasted in political issues. Political instability also discourages investors from other countries who wish to invest in that particular country hence the country will not gain from foreign exchange. This mean resource that could be gained to help in the development of health systems will not be eventually gained (McBain et al, 2012).
Corruption is another prime factor which has adversely affect the health system of Burundi. Projects which have been initiated to improve the health sector do not succeed because government officials who are given the duty of implementing the program misappropriate funds assigned to the project. Corruption cannot be easily noticed if the government does not put in place systems to regulate the vice. Corruption in the country discourages sponsors who may wish to fund the health system because they fear that the money will be misappropriated. Corruption only benefits few people who are in power while the poor remain poor. Most of Burundi health systems lacks accountability, transparency and the official in charge encourage corruption hence they remain underdeveloped. The government needs to come up with ways to eliminate corruption in the health system in order to ensure that the system develops significantly (Makhashvili, and van Voren, 2013).
Health systems of Burundi face a challenge of insufficient and poor infrastructures which hinders effective health care delivery all over the country. The long period of crisis in the country negatively affected the development of health care facilities hence the health sector remains pathetic. Raising of funds to help in the development of the health sector is hectic because the more significant percentage of the Burundi population is comprised of poor people. The allocation that the health sector gets is minimal compared to the what they budget for to affect development in the sector. The country's labor force is young and exceptionally unskilled and young hence service delivery is not up to standard. The training and education that professional receive is not adequate to equip them with sufficient knowledge and skills to deliver quality services (Grigoli, and Kapsoli, 2013).
Most in the individuals go to extremes of obtaining debts in order to pay for consultation fees and other health care services. Due to the high cost of health services patients also resorts in selling their valuable properties in order to pay for these services. In Burundi, it is common that the owners of health centers to run the facility on debt. This is because most patients have little or no income at all hence they lack funds to cater for their health. Also due to lack of finances, some people consult the specialists when they anticipate that the situation may be worse. This practice is dangerous because when patient take a long time before they consult health care providers, their conditions will become worse and difficult to treat (Bosch-Capblanch, 2012).
Establishment of health insurance institutions has assisted in improving health care delivery to the citizens of Burundi. The health insurance has supported the poor people to access the healthcare services by helping the patient to meet the cost of the service through cost pool service. Training institutions have contributed significantly to the advancement of the health system of Burundi. They help in training health personnel to work in healthcare facilities. This has led to the improvement of health care service delivery in hospitals. However, public sector governance in Burundi is still very weak concerning government effectiveness, corruption control, adherence to the rule of law and political stability which have hindered the business development of the health system in the country. In addition, the implementation of health policies and quality delivery of services is significantly affected by the way governance is structured (Bertone, and Meessen, 2012).
Lessons Burundi can learn from other countries
For better health care delivery, the country should put national policies. However, the policies alone are not enough is not enough for effective delivery of primary care. The policies should be realistic, achievable and those that can improve the health care system once and for all. In addition to this, the national government must set strategies and involve teams that are strong and able to implement them at the substantial and national level. For refining and evaluation of policies, the country should invest in information systems. The country should Invest in human resource and education (Bonfrer et al, 2014).
Health care reforms in Burundi
Several health reforms have been initiated in Burundi to assist in improving the health conditions of the people. These reforms include; introduction of financing that is based on the performance of health facility, the introduction of a policy to remove charges for essential health care services, and the establishment of efficient and coordinated health systems to improve service delivery. The reforms have improved the health services and lowered the cost of these services in order to increase their accessibility. In addition, the improvements have motivated the healthcare workforce by refining the working environment and the financial incentives. The effect of these reforms on transforming health system may not be easily assessed because the funding of the projects and other activities take an extended period (Eichler et al, 2013).
Other issues that to the government of Burundi is considering in order to stabilize the health system is regulating the population growth rate. This is another factor which needs be examined for consistency with word bank guidelines. High population growth rate exerts pressure on health care facilities which leads to poor delivery of health services and limited access to necessary infrastructure. The government needs to improve the accessibility of quality healthcare facility by increasing the funding of the health system (Witter et al, 2013). The government of Burundi is establishing a universal health coverage as a priority, by removing the financial barriers to health care access by the patient. An evaluation of the government funding of the health care system and for the implantation indicates that it is not adequate to meet the targets. The Government faces the challenge of integrating the financial systems in order to eliminate overlaps and redundancies and increase the efficiency of these systems (Chi et al, 2015).
Emerging issues inhealthcare system of Burundi
There are some emerging issues in the health sector of Burundi which include, workforce shortage, ransomware, and new technologies. It is a significant problem to find and retain the skilled workforce in the health sector. This challenge raises due to the labor pool and increased need for health care services. Reliance on technology has exposed the health care providers to a risk of cyber-attacks such as breach of data and another kind of malware (Schaaf, and Freedman, 2013). Ransomware is a malware application that is used by nasty individuals to encrypt organization's data demand for payment to encrypt the data. This has been a significant threat on the healthcare sector. To prevent the issue of ransomware, the healthcare facilities need to train their workers to identify suspicious websites, attachments, and emails in order to avoid downloading software that is malicious. The emergence of new technologies has improved service delivery in healthcare facilities. These technologies include; virtual and augmented reality which assist patients and medical professionals to visualize health issues, artificial intelligence that helps specialists to make decisions on medical issues by use of sophisticated algorithms and providing experts opinion, and unmanned aerial vehicles which helps in drug supply when there is a disaster (Bhutta et al, 2013).
The situation of health care in Burundi remain comparatively precarious. The mortality rate is very high, and the healthcare services are below average. The main reason why the healthcare is not up to standard is that there is a burden of contagious diseases, the health system is fragile, tropical diseases are neglected, the vulnerability of women, the impacts of health determinants and chronic non-communicable diseases. The government of Burundi must ensure they address these issues to improve the health system of the country. This is the process and not a one-day event hence the steps to be taken to change the situation need to be well planned in order to ensure their success (Tol et al, 2014).
The government of Burundi needs to major on the set reforms which include; collective access to health care, better quality of treatment, the creation of health districts and promoting health insurance. This will improve the health care services hence ensuring that there is equality in the healthcare sector. It will also aid in ensuring that health services are affordable to all citizens of Burundi.
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