Rural populations in Burundi suffer from poor access to quality health care and prevention services, as a high proportion of government health funds are allocated to urban hospitals. This results in much fewer and poorer quality health care facilities in rural areas, leading to poor health outcomes....

Prevention and Treatment in Rutana

Rural populations in Burundi suffer from poor access to quality health care and prevention services, as a high proportion of government health funds are allocated to urban hospitals. This results in much fewer and poorer quality health care facilities in rural areas, leading to poor health outcomes. HIV/AIDS, in particular, is a leading cause of death in Burundi and rural areas like Rutana Province have been most impacted by the disease. In a conflict-affected area with high poverty rates like Rutana, HIV/AIDS takes an even greater economic toll on individuals who suffer from the virus, impacting their ability to provide for themselves and their families.

This Initiative aimed to prevent new HIV cases by providing HIV/AIDS education and sensitisation and by increasing access to testing and counselling services. Providing accurate information on the disease and how it is transmitted plays a major role in successful stigma reduction.


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Strategic Initiative

SECTOR

Health

TOTAL INVESTMENT

US$ 1,489,927

LOCATION

Burundi

LIVES CHANGED

104,119

SOCIAL IMPACT INDEX

54.3 (out of 100)

AVERAGE COST PER LIFE

US$ 14.31

Expand All

SI Breakdown:

Key Achievements

  • Improved access to and use of testing and treatment services – 28 VCT centres were equipped with testing kits and personnel. 43,067 people were tested for HIV/AIDS, and 681 adults received ARV treatments and 73 pregnant HIV-positive women enrolled in a prevention of mother-to-child transmission (PMTCT) programme.
  • Improved economic wellbeing – Income-generating activities (IGAs) improved the wellbeing of at least 25,000 community members. By involving community members in producing food for their own consumption and for resale, this Initiative has reignited the sense of pride lost through years of dependence on aid and relief donations by well-meaning charitable organisations.
  • Education and vocational training – 10,858 orphans and vulnerable children stayed in school thanks to the provision of school fees, uniforms and books. Also, 284 people, mostly youth, were trained in skills such as cooking, catering and carpentry.
  • Equipment for ARV treatment – Rutana Province was provided with a CD4+ T cell count machine – one of only four in the entire country. The machine enables doctors to determine patients’ viral loads and prescribe the appropriate ARV treatment.

The Problem

Rural populations in Burundi suffer from poor access to quality health care and prevention services, as a high proportion of government health funds are allocated to urban hospitals. This results in much fewer and poorer quality health care facilities in rural areas, leading to poor health outcomes. HIV/AIDS, in particular, is a leading cause of death in Burundi and rural areas like Rutana Province have been most impacted by the disease. In a conflict-affected area with high poverty rates like Rutana, HIV/AIDS takes an even greater economic toll on individuals who suffer from the virus, impacting their ability to provide for themselves and their families. Prior to this Initiative, Rutana Province had no governmental or NGO HIV/AIDS-focussed programmes despite its high poverty levels and HIV prevalence rates of 7.3 percent – compared to the national rate of 2.3 percent. In fact, only three health centres, aside from the provincial hospital, were equipped to provide HIV voluntary counselling and testing (VCT) services to Rutana's nearly 300,000 residents. Further barriers to HIV/AIDS prevention included facilities' lack of testing kits and distance to testing centres. Stigmatisation was also a serious barrier for testing, education, and treatment.

Solution

In 2007, the Burundi HIV/AIDS Initiative was created to provide prevention education, improve access to VCT services, provide antiretroviral (ARV) drugs for those infected with HIV/AIDS, and engage community members in income-generating activities (IGAs) to improve their wellbeing and also reduce stigma for people living with HIV/AIDS (PLHA). Ten Burundian organisations were selected to run these programmes and deliver the Initiative’s goals. The Initiative aimed to prevent new HIV cases by providing HIV/AIDS education and sensitisation and increasing access to testing and counselling services. Providing accurate information on the disease and how it is transmitted plays a major role in successful stigma reduction. By providing access to ARV drugs and creating opportunities for HIV-positive people to engage in agricultural IGAs through their support groups, the Initiative aimed to help people living with the disease to positively manage its impact on their families and communities. A farming-collective approach was designed to build social cohesion through group associations that work together in large-scale farming projects. Members of these associations and support groups for PLHA also provide social, emotional, and even financial support for one another. Finally, the Initiative targeted orphans and vulnerable children who had been impacted by HIV/AIDS or years of conflict, providing them with educational support and vocational skills training. With an investment of US $1,489,927, this Initiative was designed to impact a total of 67,618 beneficiaries.

Critical Analysis

At the onset of this Initiative, HIV/AIDS in Rutana Province and in most of Burundi was a taboo subject that required careful language to communicate how it is transmitted. After three years of continuous education and sensitisation, however, discussions of HIV/AIDS are no longer taboo. The provision of ARVs to infected persons has resulted in a reduction in the number of children being orphaned in the province, compared to three years ago, when VCT services were unavailable and ARV treatments were inaccessible. The 28 VCT centres that were equipped through this Initiative will continue to provide services to community members. Pregnant women, if HIV-positive, will have the opportunity to receive ARVs to prevent transmission of the virus to their unborn children. This is an opportunity for Burundi to stem the tide of new infections going forward, particularly among newborns and infants.
 
The Initiative’s presence changed the development landscape of Rutana Province by attracting other NGOs and INGOs to establish programmes in the province. Most of these organisations expressed tremendous support and admiration for the our grant manager’s Strategic Initiative model, due to its enabling of various organisations to work in different districts without duplicating efforts or overlapping interventions.

In 2009, Rutana’s governor presented this Initiative to the government, which resulted in it being lauded as a replicable community development model that could be used across the country. It not only achieved its goals regarding HIV/AIDS, but it also succeeded in creating employment, boosting food production, and improving the region’s agricultural economy through the production of pineapples and rice that were sold in markets beyond the province.

Improved coordination among implementers could have resulted in better care of beneficiaries, better delivery of services and even a reduction of turnover of health personnel.

Lessons Learned

Successes:

Continuous HIV/AIDS community education – In 2007, community leaders, medical personnel and peer educators in all six districts of Rutana Province were trained to provide community education in HIV/AIDS prevention. By the second year, more people were seeking VCT services, and by the third year, the uptake was as high as 90% in some of the income generation groups.

Institutional support – Important stakeholders, including provincial government representatives, religious leaders and health institutions, recognised the importance of HIV/AIDS education and ARV treatment to the survival and socioeconomic wellbeing of the entire household. The provincial governor helped to hold the implementing partners accountable to their commitments, even in the physical absence of a the Legatum Foundation staff member in Burundi.

Economic development – The successful Pineapple Plantation Initiative was created as a group IGA to support families affected by HIV/AIDS and returnees previously displaced by the country’s civil war. This Initiative has resulted in a micro-economy in the host community and along the road to Gitega and Bujumbura, where middlemen purchase the fruits for resale in the larger markets.

Challenges:

Weather and disease – One of the biggest challenges was the unpredictable rain pattern that led to crop failure and drought in Bukemba and Gitenga districts, where Umuryango Association and SAN’s agriculture programmes respectively took place. Additionally, an outbreak of foot and mouth disease led to the loss of goats in Gihoro District.

Repatriation of refugees – In 2008 and 2009, an unexpected influx of Burundians returning from closed refugee camps in Tanzania flooded Rutana Province. Significantly poorer than the already impoverished residents of Rutana, the returnees challenged the implementers’ identification and selection of community members to receive help.

Overwhelmed health personnel and inadequate equipment – Improved HIV sensitisation has increased the amount of people seeking to know their HIV status. The demand for testing has overwhelmed some VCT centre staff, leading them to resign. 

Lack of synergy among implementers – A thriving community of practice in which implementers could share information, apply best practices, and benefit from economies of scale wherever possible would have resulted in better care of beneficiaries and delivery of services in each community.

Burundi HIV/AIDS: Featured Projects

SII ScoreProject NameGrantLives ChangedCost Per LifeSector
80.00 Association Umuryango (Family Association)$159,87913,625$11.73
76.00 Eglise Anglicane - Diocese de Matana (EABU)$172,7365,798$29.79
72.20 Communauté des Eglises de Pentecôte (CEPBU)$220,30540,726$5.41
60.80 Peace Center Burundi$141,58614,342$9.87
54.40 Strategic Action Network-Burundi (SAN)$132,4707,974$16.61
54.00 Gapkome Catholic Parish$47,3802,730$17.36
54.00 Help Channel Burundi$217,68210,408$20.91
51.00 Rutana Catholic Parish$157,5703,200$49.24
46.80 SOS Rutana$116,0092,884$40.23
25.60 Initiative d’Aide pour le Développement (AID)$74,9192,240$33.45
22.40 Appui au Développement Socio– Econ. (ADEC)$44,648192$232.54
Note: The Social Impact Index Score reflects the relative social impact of a given development project. The lowest possible score is 20; the highest possible score is 100.

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