Burundi’s Expanded Programme on Immunization (EPI), established in 1980, is a cornerstone of the country’s public health strategy. Its mission is to protect children and mothers from vaccine-preventable diseases by ensuring equitable access to essential immunization services across all regions.
Country Context: Challenges Shaping Immunization Strategy
Socioeconomic and Political Environment
Decades of civil conflict disrupted healthcare services, displacing populations and leaving 91% of citizens in rural areas with limited access to care. Life expectancy was low, and maternal and infant mortality rates were among the highest in the region.
Impact on Health and Immunization Access
Routine immunization services weakened due to instability, clinic closures, and displaced health workers. Mass campaigns often became necessary to reach children and mothers in affected areas.
Government Structure and Peace Process
Burundi maintained a decentralized system across provinces and communes, allowing community-level mobilization. Peace agreements laid the groundwork for gradual recovery of governance and health services.
Immunization Program Goals & Target Coverage
The 2002–2006 strategic plan aimed to achieve 90% infant coverage, 85% for pregnant women, and 20% for women of childbearing age. New vaccines, including DTP-Hib and HepB, were introduced in phased rollouts, supported by vitamin A supplementation and tetanus protection initiatives.
Financing Overview: EPI Costs and External Support
Funding Landscape
In 2001–2002, external partners funded over 95% of the EPI budget, while government contributions were minimal (under 4%). Reliance on external financing left the program financially vulnerable if support decreased.
Budget Allocation
The majority of costs were for new vaccine introductions, cold chain logistics, personnel, and transport. Routine vaccines made up a small portion of spending, while operational costs such as fuel for cold storage were significant.
Government Budget Trends
The Ministry of Public Health consistently received less than 3.5% of the national budget, and EPI accounted for only 0.46% of that. Limited domestic prioritization underscored the need for stronger local financing.
Program Performance Highlights
Despite resource constraints, Burundi’s EPI achieved significant coverage improvements in 2001–2002:
- DTP3 coverage rose from 64% to 95%
- BCG coverage reached 99.6%
- Measles campaign coverage hit 91%
- Vitamin A supplementation reached 98%
- TT2+ coverage for pregnant women improved from 32% to 42%
Local immunization days (LIDs) helped fill routine service gaps, particularly in conflict-affected and remote areas.
Future Projections and Funding Gaps
Cost Forecasts
Projected EPI expenditures between 2004–2008 ranged from $5.4 million to $6.5 million annually, driven by new vaccine introductions. Routine vaccines remained a small fraction of total costs.
Estimated Funding Gap
Without increased domestic investment, Burundi faced an estimated $3 million annual shortfall starting in 2009. Rising demand and inflation-adjusted procurement costs made sustaining coverage challenging.
Strategies for Sustainable Financing
Government Advocacy and Budget Reforms
The plan recommended increasing the Ministry of Public Health’s budget share to 15% of national expenditure and using a portion of debt relief for immunization funding.
Efficiency Gains
Quarterly vaccine supply cycles and reduced wastage for BCG, measles, and DTP/OPV were projected to save resources. Improved stock management and retraining at provincial levels were also key strategies.
Diversifying Support
Re-engaging international and private-sector partners, along with community contributions, could supplement domestic financing. Clear funding frameworks and stakeholder coordination were essential.
Monitoring and Accountability
Indicators tracked funding composition, efficiency improvements, and program retention outcomes, helping detect gaps and guide resource allocation.
Conclusion
Burundi’s Financial Sustainability Plan demonstrates measurable progress in immunization despite post-conflict challenges. However, heavy reliance on external funding and rising vaccine costs make long-term sustainability fragile. Strengthened domestic investment, efficiency improvements, and strategic partnerships are essential to maintain coverage and protect children and mothers from vaccine-preventable diseases.