Field Actions Science Reports (Feb 2013)
The simultaneous introduction of the district health system and performance-based funding: the Burundi experience
Abstract
Burundi recently introduced two fundamental reforms to its health system: a district health system (DHS) and performance-based financing (PBF) of the healthcare facilities. The authors of this article set out the salient points of a trial simultaneous implementation of DHS and PBF. The assessment refers to the six building blocks of health systems proposed by the WHO, and demonstrates that PBF can either have a leverage effect or hinder the following functional elements of the DHS: the group dynamics of the District Health Management Team (DHMT), the way the district hospital functions in relation to the primary health care level , the curative and preventive health services provided by health centers to provide health cover for a target population, the provision of essential medication by a fully-functional district pharmacy, the action-focused on the health management information system (HMIS) and funding that ensures fair provision and guaranteed resupply, supported by a transparent organization. The authors recommend that these aspects receive the attention they deserve as part of initiatives that combine both reforms, especially in the start-up stage. The health system regulator – the Ministry of Health – must remain vigilant to make any necessary adjustments and to avoid negative consequences.
