Paper short abstract:

The ‘resilience’ of Burundi health-care centres in the current crisis is explored as being as much a matter of local politics as a matter of managerial capacity and preparedness. The factors leading to increased 'resilience' are studied.

Paper long abstract:

Once a model of peace building, Burundi has become, in the last two years, a deeply unstable and increasingly isolated country. The health system, which was heavily reliant on international aid -in particular for the implementation of its three flagship policies: performance-based financing, the exemption of user fees for expecting mothers and children below 5, and a low fee insurance scheme-, has not been spared: funding has diminished, international support has been drastically cut, and the drugs supply chain has become increasingly unreliable. In this paper, we study the local adaptation to this difficult situation and seek to understand which health centres have displayed a better 'resilience', understood here as maintaining quality affordable services. Beyond the idea of resilience as being simply technical feature dependent on managerial features and preparedness, we explore resilience as a function of the local political landscape and the complex interaction between nurses, chief-nurses, health facility committee members, local religious leaders, and -of course- local political leaders. Field access to Burundian health centres is uneasy and the research mostly relies on secondary data, reports, and field observations from anonymous observers. The situation is compared with the pre-crisis situation, which we documented in previous research.