Eight years into the horizon of aspirational maternal and newborn health pledges: a comprehensive exploration of the Burundian EmONC network capacity and budget deficit

Abstract: 

Introduction: Although Burundi formed a “maternity network” of 112 emergency obstetric and neonatal care (EmONC) facilities in 2017 supported by a specific policy, maternal and newborn deaths continue to soar. Our study examined the capacity challenges facing these EmONC facilities and developed alternative investment proposals to improve their readiness paying particular attention to human resources, physical infrastructure, and capital equipment.      

Methods: We examined EmONC policy and guideline documents, consulted 12 maternal and newborn health experts, surveyed all 112 EmONC facilities, and collected cost data from various departments of the ministry of health and from the Burundian market. We developed three context-specific EmONC resource policy standards, estimated resource deficits by facility type and policy perspective, highlighted the distribution of these deficits at provincial level, and estimated the government budget needed to strengthen these EmONC facilities by policy alternative. Finally, we explored relationships between human resources and workloads with morbidity and mortality. The study was supported by 23 stakeholders and policymakers.

Results: We found widespread and severe shortages of EmONC resources with 95% of basic EmONC and all comprehensive EmONC facilities lacking the minimum human resources and 90% of these EmONC facilities needing additional major equipment and physical infrastructure. Specifically, Burundi needs 162 more medical doctors, 1005 midwives and nurses, 132 delivery rooms, 191 delivery tables, 678 and 156 maternity and newborn care beds, and 395 incubators to address EmONC resource deficits linked to the highest policy scenario. This corresponds to an additional United States dollar (US$) 32.9 million budget requirements over the period of five years (5.96% total health budget increase annually).

Conclusion: This study revealed that Burundian EmONC facilities face enormous capacity challenges requiring approximately US$ 32.9 million over the next five years which corresponds to 5.96% total health budget increase annually.

Desire Habonimana

Mike English