Burundi

Background

Burundi’s total population is 10.2 million with an annual growth rate of 2.4 percent, a total fertility rate of 6.4 children per woman and a contraceptive prevalence of 22% (PRB 2011). As of 2011, the internally displaced population, returned refugee and refugee populations of Burundi (“populations in transition”) were estimated to account for over 190,000 of the country’s inhabitants (UNHCR 2012). Due to poverty, distance to health facilities and lack of official proof of citizenship, access to health services is greatly restricted for these groups.

Due to instability in the country, E2A is no longer working in Burundi. E2A's work in Burundi included the following.

Expanding Provision of Jadelle & Strengthening Service Delivery

E2A successfully helped to expand the contraceptive method mix in Burundi’s Kayanza and Muyinga provinces—home to two of the largest and most vulnerable populations in the country—primarily through improved access to the long-acting, reversible implant Jadelle.

To expand the provision of Jadelle, E2A provided technical assistance to Pathfinder International’s USAID-funded Maternal and Child Health (MCH) Project, which works to strengthen family planning services in Kayanza and Muyinga. From January to June of 2013, uptake of Jadelle rose sharply in both provinces — from virtually no acceptors to more than 5,800 new users in Muyinga and more than 2,900 in Kayanza.

Jadelle is 99 percent effective at preventing pregnancies for a period of five years, and acts similarly to injectables, but requires fewer visits to the health facility. In a country where contraceptive choice, particularly access to long-acting, reversible methods, has historically been limited, some clients have reported favorably that Jadelle is a less invasive method than the intrauterine device because it is implanted in the arm.

After the Jadelle expansion in Kayanza and Muyinga, the Ministry of Health procured 100,000 Jadelle implants for national provision and is supporting several multipronged efforts to generate increased demand for the method.

E2A also worked with the Ministry of Health to train clinicians from five provinces, including Kayanza and Muyinga, on competency-based skills for counseling, insertion and removal of Jadelle, and infection prevention, as well as essential elements of effective health programming, such as planning, implementing, and monitoring and evaluating Jadelle’s introduction. Those trained then went on to train a cadre of service providers who now offer Jadelle.

Funding from E2A helped the MCH Project strengthen the clinic- and community-based provision of family planning interventions in the areas of ensuring voluntary informed choice during counseling sessions, strengthening referral linkages, engaging in supportive supervision, strengthening procurement logistics, and integrating behavior-change interventions.

Enhancing Community-Based Provision

E2A also focused on strengthening the community-based provision of family planning in three provinces: Gitega, Makamba, and Rutana. In these rural provinces, where there is a significant demand unmet need for family planning, E2A worked with the National Reproductive Health Program and UNICEF- and UNFPA-funded projects led by Pathfinder International to scale up community-based family planning services and provision of Jadelle. E2A and its partners applied innovative approaches to leverage existing human resources for health and a task-sharing strategy that allows community-based providers to offer injectables.