Burundi

Health
Budget analysis 2023-2024

Key messages

1. In Burundi’s state budget for the 2023/2024 financial 3. The government is continuing to support immunisa-
year, the amount allocated to the Health sector is 337.4 tion, allocating BIF 4.1 billion in 2023/2024, compared
billion Burundi francs (BIF), or 119.3 million US dollars with BIF 3 billion in 2022/2023. Remarkable progress has
(USD), compared with 228.7 billion BIF in 2022/2023 (USD been made in recent years for the health of children and
112.4 million). mothers. For example, 85% of children aged between
It currently represents 8.6% of the national budget, 12 and 23 months have received all the basic vaccines,
compared with 9.6% in 2022/2023. This relative decline is and the proportion of women who have made at least four
explained by the increase in spending in other sectors (in- antenatal visits is increasing. In order to prevent cases of
frastructure, production, defence and security, etc.), which poliomyelitis, three national vaccination campaigns have
has led to a sharp rise in the overall budget and so a re- just been carried out.
duction of the proportion of spending dedicated to Health.
Further efforts are needed to achieve the international tar- 4. Although some progress has been made in the Health
get of 15% of the government budget set out in the “Abuja sector, there are still challenges to be met in order to
Commitment” (Economic Commission for Africa, Briefing Note: achieve the Sustainable Development Goals (SDGs),
10 years after the “Abuja Commitment”). particularly in terms of infrastructure, equipment and cut-
It is only halfway towards this target of 15%. ting-edge technology, and concerning human resources in
sufficient number (today less than one doctor and less
2. The country has a chronic malnutrition rate of at than one midwife per 10,000 inhabitants), in terms of
least 55.8% for children under the age of five, meaning skills (specialist doctors) and in terms of productivity.
that more than one child in two is deprived of nutrition.
We need to ensure an increase in the budget allocated to 5. The Ministry of Public Health and the Fight against AIDS
maternal and child health programmes, including nutrition (MSPLS – Ministère de la Santé Publique et de la Lutte con-
interventions to reduce chronic malnutrition. tre le Sida) has demonstrated a high absorption capacity,
with an implementation rate of 90% or more. This demon-
strates not only the Ministry’s programming capacity, but
also its real funding needs.

1
Budget analysis 2023-2024
Burundi
Health

Recommandations
> In view of the government’s priorities of
universal access to healthcare and the effec-
tive implementation of community hospitals,
an increase in the budget for peripheral
health structures is required, with a strength-
ening of community health structures in the
most vulnerable areas, as well as means
of monitoring. This could include building
the skills of community health workers
(CHWs) in programmes aimed primarily at
improving the health of children and pregnant
or breastfeeding women, as well as repro-
ductive health.

> The government and its partners are encouraged to explore sustainable ways to finance the supply of vaccines
and to meet programme needs, estimated at USD 59 per fully vaccinated child in 2023, in accordance with the
strategy for mobilising internal funds developed in August 2019 by the Ministry in charge of health and its partners
such as WHO, GAVI and UNICEF.
To this end, it is essential to put in place a Vaccine Independence Initiative (VII) aimed at ensuring the permanent
availability of inputs for the Expanded Programme on Immunisation, by putting in place flexible credit conditions
enabling Burundi to ensure payment after receipt of vaccines and inputs linked to immunisation.

Introduction

❚ In February 2022, the Ministry of Public Health and ❚ Through the HSS, the Government of Burundi has reaf-
AIDS Control adopted a Health Sector Strategy - HSS firmed its commitment to improving the health of its
(Stratégie Sectorielle de la Santé - SSS) covering the population and to achieving SDG 3: “Enabling all peo-
period from 2021 to 2027. ple to enjoy a life of good health and promoting well-being
This plan is in line with several strategic planning docu- for all at all ages”. Although considerable progress has
ments, including: been made, Burundi still needs to make further progress
- the Vision of Burundi as an Emerging Country in 2040 to achieve this goal.
and a Developed Country in 2060
- the Burundi National Development Plan (NDP 2018- ❚ Reference should also be made to the TWITEHO
2027) adopted in June 2018 AMAGARA MEZA programme, which promotes access
- the National Programme for Capitalising on Peace, to quality healthcare as a “fundamental right for every-
Social Stability and the Promotion of Economic Growth one”, the Global Fund for financing health products related
(PNCP-SS-PCE), of which public health is one of the pillars to HIV, tuberculosis and malaria, national strategic plans to
- the National Health Policy 2016-2025 combat the three diseases and the Peace Building Fund
- the Sustainable Development Goals (SDGs) (PDF), which provides external financing to improve the
- the Astana Declaration on Sustainable Primary Health use and quality of healthcare services offered to the popu-
Care, etc. lation.

2
Budget analysis 2023-2024
Burundi
Health

❚ As part of the polio vaccine programme, Burundi

continues to publish a daily situation report on the re-
sponse to this disease. In recent years, Burundi has
achieved better results in improving the performance of
its health system, but mortality indicators remain high.

❚ According to the Demographic and Health Survey

(EDS 2016-2017):
• The maternal mortality rate remains high. There are
334 deaths per 100,000 live births, whereas the SDG tar-
get is less than 70 deaths by 2030.
• The neonatal mortality rate is 23 deaths per 1,000 live
births, compared with the SDG target of 12 by 2030. • The level of knowledge of methods for preventing HIV
• The infant and child mortality rate is 78 deaths per 1,000 and sexually transmitted diseases remains low (42% of
live births, whereas the SDG target is 25 deaths per 1,000 girls compared with 50% of boys have a good knowledge
live births by 2030. of prevention methods).
• Young teenagers aged between 15 and 24 represent • Adolescents and young people are exposed to other
19.29% of the population, and their access to healthcare problems such as malnutrition and the consumption of
services remains low (34%). alcohol, tobacco and other psychoactive substances.

Some key health sector indicators

Indicators Values Sources

Maternal mortality rate 334 INSBU, EDS III
per 100,000 live births 2016-2017
Neonatal mortality rate 21% SWOC, 2021
per 1,000 live births
Infant and child mortality rate 56.6 ‰ SOWC, 2021
per 1,000 live births (www.who.int) 56.6 ‰ SWOC, 2021
Accessibility rate to health services 34% EDS 2016-2017
for young people aged 15 to 24
Malaria incidence rate per 1,000 population 537.6 ‰ Statistical
yearbook 2021
Antiretroviral ARV coverage among children 31% Statistical
yearbook 2021
Rate of children aged 6-59 months with anemia 61% SMART 2022
Rate of women aged 15-49 with anemia 39% SMART 2022
Prevalence of stunting in children under 5 years of 55.8% SMART 2022
age
Prevalence of Acute Global Malnutrition (AGM) 4.8% SMART 2022
Prevalence of Severe Acute Malnutrition (SAM) 1.4% SMART 2022
Share of the budget allocated to health 8.6% Finance Act
as a proportion of the total budget 2023-2024
(financial year 2023-2024)
Sources: SSS, MFBPE, Finance Acts 2023-2024, EDS 2016-2017, SMART 2022

3
Budget analysis 2023-2024
Burundi
Health

Trend
in budget allocations Fig. 1 : Trend in budget allocations to the Health sector,
in nominal and real terms, from 2016 to 2023-2024, in billions of BIF
for health (in BIF) 350 337.4

300
Fig. 1 : Trend in budget allocations to the Health sector, 267.1
in nominal and real terms, from 2016 to 2023-2024,
223.9
250 1 : Trend in budget allocations to the Health sector, in billions
228.9 of BIF
228.7
Fig. 213.2 215.9 211.8
in nominal and real terms, from 2016185.3
350 to 2023-2024, in billions of BIF 337.4
200 172.6
350 163.6 168.1 170.3 337.4
300 14.,6 267.1
❚ Budget allocations to Health increased from 2016 to 150
300
250 99.3 93.4 223.9 228.9 228.7 267.1
2023/2024, with rising from BIF 99.3 billion to BIF 337.4 100 213.2 215.9 211.8
250 185.3 223.9 228.9 228.7
billion in nominal terms, representing overall growth over 200 172.6 213.2 215.9 211.8
50 163.6 168.1 170.3185.3
the period of 1.5%. This trend is the same for budget 200 14.,6 172.6
150 163.6 168.1 170.3
allocations in real terms. This situation reflects the govern- 0 14.,6
150 99.3201693.4 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
ment’s determination to implement the measures taken 100
99.3 93.4 Nominal terms Real terms

in the area of health, essentially free care for children 100

Source: Finance Acts 2016 to 2023-24
50
under five and mothers giving birth. 50
0
2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
0 Nominal terms Real terms
❚ The figure 1 shows that the trend in budget allocations 2016 2017
Source: Finance ActsNominal
2016 to 2023-24
2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
terms Real terms
to healthcare is the same in nominal and in real terms over Fig. Finance
Source: 2 : Trend in budget
Acts 2016 to 2023-24allocations for the Health sector,
the period from 2016 to 2023/2024. Budgetasallocations
a % of total
in budget
nominaland asare
terms a %those
of GDP
indicated in relation to a given period. Budget
16 in real terms are those that are adjusted for price increases relative to a base or
allocations
As a proportion of the national budget, budgetary allo- 15
% reference
14 figure.
cations to Health represent 3.3% of GDP in 2023/2024 12.3 12.0 14.2
11.2
compared with 2.8% in 2022/2023, an increase of 0.5 Fig.
122 : Trend in budget allocations for the Health sector,13.4
as a % of total budget and as a % of GDP 9.6
Fig.
10 2 : Trend in budget allocations for the Health sector,
percentage points. However, they remain below 15% of 16 a % of
as 7.9total budget and as a % of GDP 8.6
15
the total budget, a binding commitment to which Burundi % 16
14
8
15 12.3 14.2
12.0
subscribed as part of the Abuja Declaration (Figure 2). % 14
12
6 11.2
13.4
12.3 12.0
2.8 14.2
3.3 3.1 2.8
9.6 3.3
11.2
124
10 2.0
2.9 2.6 13.4
8.6
7.9 9.6
❚ In Burundi, per capita budget allocations to health 10
8
2
8.6
7.9
are BIF 25,512 (USD 9) for the 2023/2024 financial year, 0
68 2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
compared with BIF 17,640 (USD 8.7) for the 2022/2023 total budget2.8
3.3 3.1 2.8 3.3
46 2.0
% of2.9 2.6 %of GDP Spending target
financial year. The calculations were made on the basis of 2016 to 2023-242.8
3.3 3.1 in the
2.8Abuja declaration
3.3
24Source: 2.0
Finance Acts 2.9 2.6
an average official exchange rate of BIF 2,826.95 for USD
02
1 in 2023/2024 compared with BIF 2,033.55 for USD 1 in 2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
0
2022/2023, and an estimated Burundian population of 2016 % of 2017 2018-19 2019-20
total budget 2020-21 2021-22 Spending
%of GDP 2022-23 2023-24
target
in the Abuja declaration
13,225,218 in 2023/2024 compared with 12,967,565 in % of2016
Source: Finance Acts total budget
to 2023-24 %of GDP Spending target
in the Abuja declaration
2022/2023 (INSBU, UNFPA ). Source: Finance Acts 2016 to 2023-24
Fig. 3 : Trend in Healthcare expenditure, per capita, in touthands of BIF

30
25.5 Lorem
25
Fig. 3 : Trend in Healthcare expenditure, per capita, in touthands of BIF 20.2
20 18.0 18.0
Fig. 17.1 in touthands
30 3 : Trend in Healthcare expenditure, per capita, 17.0 17.6 of BIF
16.3
15.2 15.2
30 14.2 14.8 14.0 25.5 Lorem i
15 13.0
25 25.5 Lorem
25 8.9 20.2
10 8.3
20 18.0 18.0
20.2
17.1 17.0 17.6
16.3
20 15.2 15.2 18.0 18.0
5 14.2 14.8 14.0 17.1 17.0 17.6
15 13.0 15.2
16.3
15.2
14.2 14.8 14.0
15 13.0
0
10 8.9 2016
8.3 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
10 8.9 8.3 Nominal terms per capital Real terms per capita
5
Source: Finance Acts 2016 to 2023-24

5
0
2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
0 4
2016 Nominal
2017terms2018-19
per capital2019-20 2020-21
Real terms per capita
2021-22 2022-23 2023-24
Source: Finance Acts 2016 to 2023-24
Nominal terms per capital Real terms per capita
 Fig. 5 : Budget forecasting and execution for the Health sector,
Budget analysis 2023-2024
Burundi
in billions of BIF and in %
Health
250 99.4 % 99.4 % 99.1 % 99.2 % 99.1 %
%
98.2 % 98.4 % 100

200
95

150
90
100

85
50

80
0
2016 2017 2018-19 2019-20 2020-21 2021-2022 2022-23
Forecastings Execution Execution rate
Source: Finance Acts 2016 to 2022-23

Composition
of health sector
allocations
Fig. 6 : Funding sources for the Health sector, in %

100

❚ Budget17.0
allocations
48.6 47.2
are made
45.4
up
53.2
of salaries,
51.7 51.7
goods
48.8
and
services, transfers and subsidies, and investments. The
80
largest part of the Ministry of Health’s budget is devoted
to investment, i.e. 54.4%, of which 89.8% comes from
external
60
resources. Allocations to transfers and subsidies
account for 29.5% of the Ministry’s total expenditure.
Wages and salaries also constitute compulsory expendi-
ture
40 accounting for 13.9%.
Goods and services account for only 2.2% of the Minis-
try’s budget.
83.0 51.4 52.8 54.6 46.8 48.3 48,3 51.2
20
❚ The importance attached to investment is an asset in
meeting the challenge of infrastructure and equipment,
and0ultimately helping to improve the quality of healthcare
2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
and health services.
Domestic resources External resources
Source: Finance Acts 2016 to 2023-24

Fig. 4 : Structure of health budget allocations by economic nature, in %

Salaries

Investments 13,9 Goods & services

2,2
54,4

29,5

Transfers & subsidies

Source: Finance Act 2023-24

5
 Budget analysis 2023-2024
Burundi
Health

Credibility
and budget execution
❚ The Ministry of Public Health and the Fight against Fig. 5 : Budget forecasting and execution for the Health sector,
Trend in budget allocations to the Health sector, in billions of BIF and in %
inal and realAIDS (MSPLS
terms, from - Ministère
2016 to 2023-2024, in billions de
of BIFla Santé Publique et de la
250 99.4 % 99.4 % 99.2 % %
Lutte contre le Sida) has demonstrated 337.4 a high absorption 99.1 % 99.1 % 98.2 % 98.4 % 100
capacity, with an implementation rate of over 90%.
200
This demonstrates not only the programmatic 267.1 capac- 95
228.9 228.7
ity of the Ministry, 223.9
213.2 but also
215.9
the
211.8
real need for funding.
150
The analysis
172.6 of budgetary credibility compares total State
185.3
168.1 170.3 90
163.6 expenditure and the implementation of the budgets allo- Fig. 5 : Budget forecasting and execution for the Health sector,
14.,6 100
Trend in budget allocations to the Health sector, in billions of BIF and in %
minal and realcated to Health.
terms, from 2016 to 2023-2024, in billions of BIF
.3 93.4 250 99.4 % 99.4 % 99.2 % %
85
Analysis of the table reveals the 337.4 existence of budgetary 50
99.1 % 99.1 % 98.2 % 98.4 % 100
credibility in terms of the rate released for the health
200 80
sector. 267.1
0 95
223.9 228.9 228.7 2016 2017 2018-19 2019-20 2020-21 2021-2022 2022-23
2016 2017 Share of the
2018-19 health
2019-20 sector’s
2020-21
213.2 2021-22implemented
215.9 2022-23 budget
211.82023-24 in the total 150 Forecastings Execution Execution rate
Nominal budget.
terms Real terms
185.3
172.6 Source: Finance Acts 2016 to 2022-23
nance Acts 2016 to 2023-24
168.1 170.3 90
163.6 Year Total budget Execution of Rates
14.,6 100
execution Health sector (%)
9.3 93.4 85
(in billions of BIF) budget 50
(in billions of BIF)
80
: Trend in budget allocations for the Health sector,
2016 1,204.0 93.0 7.7% 0 6 : Funding sources for the Health sector, in %
Fig.
% of total budget and as a % of GDP 2016 2017 2018-19 2019-20 2020-21 2021-2022 2022-23
2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 Execution
Real 1,265.6 147.1 11.6% Forecastings
Nominal2017 100 Execution rate
15 terms terms
Source: Finance Acts 2016 to 2022-23
12.32018/2019
inance Acts 2016 to 2023-24
12.0
1,341.2
14.2 151.8 11.3%
11.2 17.0 48.6 47.2 45.4 53.2 51.7 51.7 48.8
13.4
2019/2020 1,436.0 164.5
9.6 11.5%
80
8.6
7.9 2020/2021 1,505.8 217.4 14.4%
2021/2022 1,638.0 221.5 13.5%
60 6 : Funding sources for the Health sector, in %
: Trend in budget allocations for the
2022/2023 Health sector,
2,224.6 220.8 9.9% Fig.
% of total budget
2.9 and2.8 GDP 3.3
as a % of2.6 3.1 2.8 3.3
2.0 Source: MFBPE
15 100

2016
12.3
2017
12.0
Funding14.2
11.2
2018-19 2019-20 2020-21 2021-22
13.4 2022-23 2023-24 40 17.0 48.6 47.2 45.4 53.2 51.7 51.7 48.8

7.9
% of total budget sources
%of GDP
9.6
Spending target
8.6
in the Abuja declaration
80
Finance Acts 2016 to 2023-24
83.0 51.4 52.8 54.6 46.8 48.3 48,3 51.2
20

❚ The2.8Health budget 3.3 comes

3.1 from
2.8 internal
3.3 and external 60
2.9 2.6
2.0 resources (donations/project support). For the 2023/2024
0
financial year, external resources account for 48.8% of 2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24
Trend in Healthcare
the total expenditure, per capita, in touthands of BIF
2016 2017 2018-19health
2019-20 budget, compared
2020-21 2021-22 2022-23 with 2023-24 51.2% for internal 40 Domestic resources External resources
resources.
% of total budget External
%of GDP support Spending
for Health target is made up of pro- Source: Finance Acts 2016 to 2023-24
in the Abuja declaration
e: Finance Acts 2016ject support amounting to BIF 164.8
to 2023-24 25.5 billion, all of which
Lorem ipsum is 83.0 51.4 52.8 54.6 46.8 48.3 48,3 51.2
earmarked for investment. 20
20.2
18.0 18.0
17.1 17.0 17.6
16.3
15.2 15.2
14.2 14.8 14.0
13.0 0
Fig. 4 : 2016
Structure2017 2018-19
of health budget2019-20 2020-21
allocations 2021-22 nature,
by economic 2022-23in %2023-24
Trend in Healthcare expenditure, per capita, in touthands of BIF
9 8.3 Domestic resources ExternalSalaries
resources
Source: Finance Acts 2016 to 2023-24

25.5 Lorem ipsum

Investments 13,9 Goods & services
20.2
2016 Acknowledgment
2017 2018-19 2019-20 2020-21
Nominal terms per capital
18.0
17.1
2021-22
18.0 2022-23 2023-24
17.0 17.6
Real terms per capita 16.3
54,4
2,2

The budget 15.2 analysis

15.2 presented in this document is part of a series of analyses on the social sectors for the 2023-2024 budget year. It is the
nance Acts 14.2 14.8
2016 to 2023-24 14.0
result of close
13.0 collaboration between the Academic Research Center on Economic and Social Development (CURDES - Centre Universi-
Fig. 4 : Structure of health budget allocations by economic nature, in %
taire de Recherche pour le Développement Économique et Social), the Ministry of Finance, Budget, and the Ministry of Public Health and
9 8.3 Salaries
AIDS Control.
29,5
© UNICEF Burundi – 2023- photo credits: Burundi/Barikumutima, Hamburger, E.R. Santamaría, Labelle, K. Prinsloo, JG Uwamahoro
Graphic design: Claire Mabille - ClairmabStudio Investments 13,9 Goods & services
Transfers & subsidies
2016 2017 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 2,2
Nominal terms per capital Real terms per capita
54,4 6
Source: Finance Act 2023-24
inance Acts 2016 to 2023-24