Health and Medical Information for Burundi
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Burundi is a small landlocked country located in Central Africa’s Great Lakes region. It is bordered by the Democratic Republic of Congo, Rwanda, and Tanzania. The total land area is 27 834 km2 with an estimated population of 8.9 million people, 90% of them living in rural areas. The country is divided into 17 provinces and 117 communes and Bujumbura is the capital city. Burundi is one of the poorest countries in the world. It ranked 166 out of 169 countries on the 2010 UN Human Development Index. After gaining independence in 1962, the Burundian population has experienced chronic humanitarian crises attributed to ethnic tensions between the dominant Tutsi minority and the Hutu majority. In 1993, the assassination of President Ndadaye triggered a violent civil war that claimed over 300,000 lives and created 800,000 refugees. A rebel faction continued to operate until 2008 despite a cease-fire signed in 2006. Burundi remains a fragile nation in a post-crisis situation, where ethnic tension remains problematic. The new constitution was voted on by the population in 2005 and includes a greater balance of ethnic groups holding public office.
The Burundian Civil War compounded the country’s financial problems, costing the already underdeveloped economy 50% of its GDP, and thus severely damaging the state’s social services. Poverty rates are critical, with nearly 90% of Burundians living on just two dollars a day. Health statistics are similarly unfavorable. Lack of proper nutrition affects two-thirds of the population and more than half of children suffer from moderate or severe stunting. Life expectancy is only around 50 years. Infectious and parasitic diseases, especially malaria, are the leading causes of mortality. Most of the country lacks access to clean water and sanitation, leading to frequent outbreaks of typhoid, cholera, and dysentery. The overall HIV prevalence rate in adults is 2.0% of the population in Burundi.
Burundi’s health care system is in a transitional stage between emergency aid and development aid, after the 13-year civil war that ended in 2005. The institutional capacity of the health care sector remains weak. The civil conflict destroyed most medical infrastructure within the country, causing continued, pronounced shortages in necessary supplies, equipment and healthcare professionals. There in fact remains a very high turnover of health care workers due to poor working conditions and insufficient salaries in public facilities. There are an average of 0.2 physicians per every 10,000 inhabitants, with 1.4 nurses for every 3,000 inhabitants, and 68 pharmacists throughout the entire country. Over 80% of physicians and half of the nurses work in cities even though the vast majority of the population lives in rural areas. The lack of medical personnel negatively impacts on health coverage and the quality of care in the country.
The Burundian government's ability to invest in the health sector remains limited. Total health care expenditures are estimated at 3% of GDP. The failure of the state to offer primary health services because of financial problems led the country in 2002 to implement a direct payment, cost-recovery scheme, for medical services. A user fee is required to be paid for medical consultations, tests and drugs. The scheme was intended to mobilize extra resources for health sector, however placing the burden of medical costs on the patient has had detrimental consequences with fewer people able to afford care. Running up a debt with a health centre is a common practice in Burundi. Some clinics in rural areas remain empty because patients can’t pay their medical bills or are afraid being detained when insolvent. To ameliorate this damage done to vulnerable groups a government health scheme was introduced in 2006, offering children under the age of 5 and expectant mothers access to free medical care. While this program has increased the number of safe in-house births, it has placed further strain on the paltry medical facilities available in Burundi.
The Burundi Ministry of Health organizes the health care system on four levels: a national level, provincial level, district level and at facility level through the primary health care centers. Treatment programs including TB, malaria and immunizations, are conducted through an integrated minimum services package at facility level and coordinated by the provincial or district offices. Since 2002, most of the public facilities, from primary care centers to hospitals, are financially autonomous and rely on user contributions and international aid. The main medical facility is the Hospital Prince Regent Charles in Bujumbura. Private medical clinics are also available in Bujumbura where there are moderately better health facilities for an increased cost.
Until the civil war ended in 2005, the basic health needs of Burundi were supplied by international NGOs specializing in humanitarian aid. These NGOs were then frequently replaced by other aid organizations which focused on long-term development. The leading role played by several NGOs in Burundi, together with a lack of leadership by the central government, resulted in frequent but uncoordinated attempts to ameliorate the healthcare crisis. The main sources of funding for the Burundi health care system are now Global Health Initiatives such as the Global Fund for AIDS, Tuberculosis and Malaria and other international aid donors. By 2006, over three quarters of total health expenditure was externally financed. Without further substantial investment and stable civil conditions Burundi’s healthcare system will be unable to tackle the monumental health problems facing the country.
Expatriates are strongly advised to purchase comprehensive international health insurance before traveling to Burundi. Medical facilities are very limited throughout the country and there are frequent shortages of essential supplies and medications, particularly in rural areas. Medical equipment may not be properly sterilized. In addition to this lack of equipment, supplies, and adequately trained medical personnel, there is also a large patient base, which leads to substantial waiting times for treatment. Serious medical problems will require air evacuation to a country with state-of-the art medical facilities. Any health insurance policy purchased should include emergency evacuation coverage. Ambulance assistance within Burundi is non-existent and emergency services are all but unavailable. A medical evacuation from Burundi could prove very expensive without prior coverage.
Foreign nationals visiting Burundi need to take precaution against diseases that are endemic across the country as well as the potential security risks. Travelers are advised to get their hepatitis A, hepatitis B, typhoid, rabies, and tuberculosis vaccinations before arriving in Burundi. Malaria is rife so take all necessary precautions against insect-bites as well as bringing proper anti-malarial medication. Pharmaceuticals are extremely limited within the country so make sure to bring adequate supplies of personal prescription medicine and supplies. Although there are no longer any recognized rebel groups within Burundi, sporadic violent crime remains a threat. Travel outside the capital Bujumbura, particularly Bujumbura Rural, Bubanza, Citiboke and Ruyigi Provinces as well as the border areas with the Democratic Republic of Congo is strongly discouraged at present.
Full medical insurance, including repatriation, is essential. Medical supplies are limited. In the event of a serious accident, evacuation by air ambulance may be required.
All water should be regarded as being potentially contaminated. Water used for drinking, brushing teeth or making ice should have first been boiled or otherwise sterilised. Milk is unpasteurised and should be boiled. Powdered or tinned milk is available and is advise. Avoid dairy products that are likely to have been made from unboiled milk. Only eat well-cooked meat and fish. Avoid food from street vendors. Vegetables should be cooked and fruit peeled.
Hepatitis E and dysentery are widespread. Hepatitis B is hyperendemic. Meningitis is present all year and vaccination is sometimes advised. Bilharzia (schistosomiasis) is present; avoid swimming and paddling in fresh water. HIV/AIDS is prevalent. Rabies is present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay.
