Health Systems Strenthening Programme

Since 2005 HealthNet TPO has carried out the health system strengthening programme, focusing on (re)building health structures. Activities aim to build capacity of district level health authorities in supervising health service delivery and management and increasing quality and capacity in these services.

2005-2008 period
The TMF programme, funded by the Dutch Ministry of Foreign Affairs, introduced the Performance Based Finance approach. The Ryansore district was the first structure supported in the Gitega province and was one of three pilot areas in the whole country. To the satisfaction of health authorities, health indicators positively increased due to this new approach. At the end of 2008, most of health indicators in Ryansore district were progressively improved. More people have access to health centres and are stimulated by the community to make more use of the public health services. Children were fully immunized and family planning rates increased. This positive evolution is due to community sensitization, capacity building of technical staff, services organization emphasized on quality care, all stimulated by the Performance Based Financing approach.

2009-2010 period
After the TMF programme ended, in 2009 the MFSI programmes started (again funded by the Dutch government). The aim is to improve the infrastructure and performance of the public health sector. Accessibility and capacity of health care should be increased so that everyone, including returning refugees, has access to basic health care. The programme has extended to all four health districts in Gitega province and to Muramvya.

Some activities and results:

• HealthNet TPO focuses particularly on maternal and child health. The team is cooperating with the Provincial Health and District Health directorates in contracting health providers. Strengthening and monitoring of management is one of the key activities.
• In 2008, the ‘Performance Based Financing’ system was launched in Burundi at national level that forces health care providers to improve the quality of care, which of course benefits the populations. HealthNet TPO works closely with the Burundi government to implement this programme in all the health districts of Gitega Province and Muramvya.
• To strengthen the capacity of health service providers multiple trainings are carried out: such as trainings on performance based finance of health service delivery, on obstetric care, Health information system management etc.
• All facilities together with ‘health committees’ elaborate their action plan through which incomes and expenditures are planned. In this way, communities are involved in the use of the resources available and their utilization. HealthNet TPO ensures the capacity and effectiveness of health committees by training them.
• In 2010, community satisfaction surveys have shown that 75% of the population is satisfied and does not encounter barriers to financial access; they also expressed satisfaction with the level of information regarding the various sources of financing for health care.

HealthNet TPO’s involvement with and evaluation of the PBF experience has led to active participation in regional workshops and policy implementation, with a net improvement in health service delivery and quality improvements in health care. Community participation ensures common priority setting for health services focused on the most common diseases. In Burundi, PBF has certainly played a role in mobilizing public funds for the health sector and especially for running costs.