Sharing knowhow and joining forces towards Health for All

Burundi, a hopeful time bomb

Archive clinic in Burundi. Photo: Cordaid
Archive clinic in Burundi. Photo: Cordaid

“Despite everything, there’s still hope” proclaimed the headline of a Burundi Saturday paper on 16 February. It’s just a few months since optimistic donors in Genera were saying that the glass was half full. However, there is consensus about the danger posed by the ticking time bomb of demographic growth in Burundi. Just what is going on in this small country on the northeastern tip of Lake Tanganyika? This lake happens to be the largest freshwater reservoir in the world but it was also silent witness to the deaths of over 200,000 people who perished during the bloody conflict between the end of the 1990s and 2005.

My last visits to this country were also during that period so it felt strange to be back on Burundi soil. At the time we worked with mobile clinics that provided medical assistance in the refugee camps and one of our medical teams was kidnapped by the rebels. As a result of subsequent peace talks, these rebels are now part of the government. My own memories of this period are not good ones; I even remember scrambling under my bed at one point because the shots were getting far too close for comfort. We had to contend with the theft of medication, the kidnapping of staff and the constant tension between the Hutus and Tutsis in our own team.  

The objective of my visit is to discuss with current employees and partners what the consequences will be for the office of Cordaid’s changing strategy (social entrepreneurism). Cordaid’s changing role in Burundi is not new. We started operating from Memisa with mobile clinics in camps, then carried out medical programs in the clinics. Then, for some time, we provided mainly technical support for the government and local organizations. As a result of the changing focus our personnel base reduced from almost 100 to just 15 employees. While we were in Burundi we also pioneered the application of Performance-Based Financing (PBF). Payment on the basis of performance has since become national policy and, quite exceptionally really, it’s widely accepted here. This is in stark contrast with many other countries where PBF has met with resistance from people who want to receive the payment without providing the performance. In Burundi, this is indeed a splendid result in which we have been able to contribute. (...)

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