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ASSESSMENT OF SOCIAL SAFETY NETS IN BURUNDI

Contribution to the operationalization of the National Social Protection Policy

September 2014

ASSESSMENT OF SOCIAL SAFETY NETS

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PREFACE

The World Bank and UNICEF jointly commissioned this report with the aim of providing the analysis needed to inform programme decisions as Burundi moves forward with the operationalization of its National Social Protection Policy, adopted by the Government in 2011.

The Task Team Leaders for the study were Alex Kamurase (Senior Social Protection Specialist, World Bank) and Souraya Hassan (Social Policy Specialist, UNICEF). Anthony Hodges was the primary author with the assistance of Alain Tribert Nimpagaritse (Consultants). Nadia Belhaj Hassine–Belghith (Senior Economist) and Aurélien Beko (Consultant) of the World Bank Poverty Reduction and Economic Management (PREM) unit provided the data underlying the analysis for the poverty, vulnerability and risks chapter.

The authors would like to thank the Government of Burundi and in particular Her Excellency the Minister of the Civil Service, Labour and Social Security, Mme Annonciate Sendazirasa, for the constant support that they kindly provided for the conduct of this study.

We are especially indebted to Joseph Ntakabanyura, Director General of Social Protection, and Noémie Siniremera, Head of Section in the Directorate General of Social Protection, for facilitating the research, in particular during the field visits to the provinces of Bujumbura Mairie, Bujumbura Rural, Gitega, Kirundo, Ngozi and Makamba. We also extend our thanks to the offices of the World Bank and UNICEF in Bujumbura, and in particular their respective Representatives, Rachidi Radji and Johannes Wedenig, and Lynne Sherburne-Benz (Sector Manager for Social Protection in Africa) who strongly backed the study and provided invaluable support and advice. John Elder, Operations Advisor, Mamadou Ndione, Senior Country Economist, Lucian Pop, Senior Economist, and Bénédicte de la Brière, Senior Economist (World Bank), and Chrystelle Tsafack Temah, Social Policy Specialist (UNICEF), provided useful comments on the report. Finally, a large number of ministries, government agencies, NGOs and development partners provided documentation and data, accorded us in-depth interviews and organized field visits to observe at close hand the implementation of programmes and projects at community level.

We are extremely grateful to all of them for devoting so much of their valuable time to help meet our extensive and often demanding research needs.


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EXECUTIVE SUMMARY

Following the post-conflict transition, Burundi is entering a new phase of its development, during which the social protection system can play an important role in reducing the structural vulnerability of the poorest layers of the population. This challenge is now coming to the fore, as short-term humanitarian/resettlement needs recede. Long-term non-contributory social protection programmes could help to reduce vulnerability and strengthen resilience by increasing the income and consumption of the poorest households, improving their access to basic social services and building their human and productive capital.

Very limited fiscal space makes the prioritization of programmes and efficient targeting essential, despite the extensive nature of various types of deprivation and the weak differentiation (in consumption expenditure and human development) across the poorer deciles of the population. Prioritization of programmes and targeting of the most vulnerable are unavoidable in a country that has extremely limited resources, is heavily dependent on external aid and has many competing priorities for development. Given the human development challenges, which threaten the foundations of the country’s development, social assistance interventions should concentrate on improving the resilience of the poorest and weakest, difficult though the challenges of accurate targeting will be.

Given the fiscal space constraints and the livelihoods and human development challenges facing the poorest, the targeting of safety net programmes will probably need to rely on a combination of methods, including geographical and categorical targeting as well as a set of household-level variables linked to poverty such as demographic structure and ownership of key assets. The population in the first (poorest) quintile is more concentrated in the North and Centre-East regions (the North also performing worse for several human development indicators). Relative to better-off households, households in the poorest quintile are larger and have a higher dependency ratio. They also have smaller land-holdings (with many more households owning less than 0.2 ha) and are less likely to own livestock (especially cows or other large livestock). Further analysis, including multivariate regression analysis, will be needed at the stage of developing the social protection strategic plan to identify more precisely the criteria that would best identify the poorest and most vulnerable households.

Although fiscal space for expanding public expenditure on safety nets will remain quite limited in the coming years, some resources could be freed through the reorientation of humanitarian aid, improvements in domestic revenue mobilization (from what is currently a very low base, relative to GDP, by regional standards), and the phasing out of poorly targeted fuel subsidies. Donors will need to reorient their assistance by moving away from fragmented short-term safety net projects and instead jointly supporting the foundation and construction of a coherent and sustainable national social protection system. Such a shift is particularly important given the degree of aid dependency, for the financing of public expenditure in general and especially in the social sectors.

In 2012, aid accounted for over 85% of non-contributory social protection expenditure, including humanitarian assistance. The current dominant practice by which donors fund a multiplicity of small disconnected short to medium term projects, usually outside government management systems, is not conducive to sustainability and risks leaving no national systems or resources to the country once project financing ends. The adoption of the PNPS has established a policy framework to guide the development of social protection, which should make it easier to move in the direction of programmatic joint support as is done in other countries in the region such as Ethiopia, Rwanda and Tanzania.


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Given the high levels of income poverty, one pillar of a social protection system would probably consist of income support, which could include three types of interventions. To raise the incomes and consumption of the most vulnerable households, consideration could be given to scaling up labour-intensive public works programmes (PWPs). Burundi has gained considerable experience in implementing PWPs, which help to smooth the consumption of vulnerable households during lean seasons through temporary periods of employment and also help to build household and community assets of the poor, for example through water and land conservation works and soil productivity investments.

The current programs are fragmented, implemented through donor projects that are time-bound and small-scale in coverage, providing short-term employment to only 2% of the working age population. The challenge would therefore be to scale up these types of interventions and to ensure their long-term sustainability through nationally led programs in a context of low implementation capacity. Managing the design of large numbers of investment projects, the targeting of works and selection of participants, the procurement of equipment and materials, and sub-project implementation at scale may stretch existing capacity. However, these programmes are conducive to donor and inter-sectoral coordination and may provide one of the pillars of a safety net system.

Another complementary safety net would be the continuation of transfers of agricultural inputs to selected poor rural households, in coordination with rural extension services. These could be delivered as part of broader agricultural or rural development programmes, as has been the practice to date. Several of these programmes have included components that have a social protection or safety net character, although the programmes are aimed more generally at improving productivity and incomes in the agricultural sector. This type of intervention however faces the same challenge of efficient targeting and has high implementation capacity requirements for the procurement and distribution of inputs. They would have to fit in a systemic approach linking social protection and rural poverty reduction.

Cash transfers for ultra-poor households could complement safety nets such as PWPs that are aimed at able-bodied household members. This type of programme does not yet exist in Burundi, except in one small pilot project. Paid on a regular predictable basis, cash transfers would reduce the vulnerability of very poor households. This would be the case, for example, for households with high dependency ratio that may result from existence of the elderly, disabled or children members. A cash transfer programme targeted at these types of households could be another pillar of the operationalization of the PNPS. Recent impact evaluations in Africa have shown that these cash transfers tend to stimulate participating households’ investment in their human capital through increased and more diversified food consumption and increased use of health and education services. Importantly, they also have local economic multiplier effect through the participation of these households in the local retail economy and through the labor market (hiring-in workers and decreasing child labor as in Kenya).

Given the challenges facing human capital accumulation among the poor, another pillar of a social protection system would probably consist of strengthening access to education and health services. This is another priority, given the importance of mortality and human deprivation risks, as well as the role of human capital in long-term poverty reduction and socioeconomic development. The seriousness of these social risks, and the high social returns to investments in nutrition, education, health, justify stimulating the use of these services. Targeted cash transfers can help resolve some of the demand-side barriers facing poor households. On the supply-side, the country would need to consolidate the achievements already realized through the abolition of fees for primary education and for priority health services (for children under 5, pregnant women and the treatment of illnesses such as malaria, HIV/AIDS and tuberculosis). These indirect social transfers, financed by taxation and external aid (linked to the performance-based financing mechanism in the case of health care) are at present by far the largest non-contributory public social assistance mechanisms. Fiscal space permitting, further interventions could include the extension of school fee abolition to the new 4th


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cycle of basic education (grades 7-9), to reduce direct costs and promote transition to this cycle, and the expansion of targeted school feeding or conditional cash transfers, which currently covers about 10% of primary school pupils, as an incentive to get children into school at the correct age and to discourage dropout. In health, consideration should be given to easing documentation requirements in order to ensure access in practice by the most vulnerable to the priority health services that are officially free.

Attention should also be given to improving the procedures for providing targeted fee waivers or cash transfers and to the financing of this mechanism. This could be integrated into the policy dialogue around the broader reform of the CAM, which at present covers 23% of the population but is financially unviable. Given the nutrition challenges facing the country, another set of interventions could be focused on fostering the foundations of human development through support to community-based nutrition interventions, focusing on pregnant women, and pre-school children and other nutrition-sensitive social protection interventions such as conditional cash transfers.

The social protection system should also include measures to address social exclusion and discrimination. This could include measures to combat the social exclusion and extreme vulnerability of the Batwa, covering access to land, employment, education and health care, among other dimensions of economic and social life, as well as measures to ensure women’s access to land ownership.

No matter the mix of interventions, the strategic plan for operationalizing the PNPS should include a strong component on institutional capacity building. This should include measures to strengthen the capacity to plan, coordinate and manage social protection programmes at national level and measures to strengthen the capacity to implement programmes at local level. The only existing government structures for social assistance at local level, the Family Community Development Centers (CDFCs), are weak in terms of both human and financial resources.

The medium term priorities and objectives will be spelled out in a budgeted strategic plan for operationalizing the National Social Protection Policy (PNPS). Although it is expected that this plan, which is already envisaged, will also encompass contributory social security programmes, it is highly likely that contributory risk-pooling mechanisms will mainly benefit the better off, who can afford to contribute to them. As such, the strategic plan should give priority to strengthening non-contributory programmes, which play a critical role for reducing the vulnerability of the poorest. It should focus in particular on transforming the current patchwork of fragmented short-term safety net projects into a core of long-term sustainable programmes reaching a critical mass of the poorest and most vulnerable households. Detailed decisions on the nature, scale, focus, targeting and financing of programmes should take place as part of the process of developing the strategic plan, based on a careful analysis of options and taking into account the fiscal space available for building a strong safety net system. This will be further facilitated by the development partners’ new working group on social protection, set up in 2013, which provides a framework for improved donor harmonization and coordination with the Government of Burundi.


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TABLE OF CONTENTS

Preface i EXECUTIVE SUMMARY ii Table of contents v List of tables, Figures and Boxes vi Abbreviations and Acronyms viii

1 Introduction 1 1.1 Background and purpose of assessment 1 1.2 Conceptual framework 2 1.3 Data Sources 4

2 Deprivation, vulnerability and Risks in Burundi 6 2.1 Mass poverty in the aftermath of a prolonged period of conflict and economic decline 6 2.2 Livelihood shocks 8 2.3 Characteristics of the poor 9 2.4 Ownership of land and livestock 12 2.5 Risks of mortality and human deprivation and the challenge of human capital formation 16 2.6 Conclusion 20

3 Public expenditure on non-contributory social Protection 21 3.1 Data sources 22 3.2 Government expenditures 22 3.3 Donor funded expenditure 24 3.4 Overall expenditures 25 3.5 Conclusion 27

4 The Policy and Institutional Framework 28 4.1 The policy framework 28 4.2 The institutional framework 28 4.3 Conclusion 32

5 Existing Safety net Programmes 33 5.1 Social transfers – from humanitarian response to long-term poverty reduction 33 5.2 Labour-intensive public works 39 5.3 Agricultural input transfers and the livestock solidarity chain 45 5.4 Programmes for specific vulnerable groups 47 5.5 Demand-side education measures 51 5.6 Programmes to improve financial access to health care 56 5.7 Conclusion 65

6 Charting the Way Forward 68 BibliographY 73 Annex A Persons consulted during the Review 81 A.1. List of persons met at national level 81 A.2. Field visits 83 Annex B Supplementary Data Tables 85


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LIST OF TABLES, FIGURES AND BOXES

Figures

Figure 2-1: GDP per capita (BIF) and major political events 6

Figure 2-2: Average per capita monthly consumption by deciles, 2012/2013 (BIF adult equivalent) 8

Figure 2-3: Food price inflation, 1998-2011 (%) 9

Figure 2-4: Distribution of population of consumption expenditure quintiles by demographic characteristics, 2012/2013 10

Figure 2-5: Distribution of population of consumption expenditure quintiles by regions, 2012/2013 (%) 11

Figure 2-6: Distribution of population of consumption expenditure quintiles by education of household head, 2012/2013 (%) 12

Figure 2-7: Distribution of types of farms by landholding and livestock, 2011/12 (%) 13

Figure 2-8: Percentage of farm households cultivating less than 0,25 ha, Saison A, 2011/2012 13

Figure 2-9: Distribution of population of consumption expenditure quintiles by size of landholding, 2012/2013 (%) 14

Figure 2-10: Distribution of population of consumption expenditure quintiles by owenership of livestock, 2012/2013 (%) 15

Figure 2-11: Under-5 and infant mortality by wealth and area of residence, 2010 17

Figure 2-12: Selected human deprivation indicators by consumption expenditure quintiles, 2012/2013 (%) 19

Figure 3-1: Public finance indicators for Burundi and oil-importing Sub-Sahran Africa excluding South Africa, average for 2009-2013 21

Figure 3-2: Composition of non-contributory social protection expenditure, 2010 – 2012 26

Figure 5-1: WFP food transfers, 2008-2012: volume distributed and number of beneficiaries 34

Figure 5-2: Population coverage of health insurance schemes, 2010 and 2012/2013 59


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Tables

Table 2-1: Distribution of farm households ly land area cultivated, Season A, 2011/2012 14 Table 2-2: Mortality and human development indicators 18 Table 3-1: Government expenditures on non-contributory social protection, 2010 – 2012 23 Table 3-2: Composition of executed government expenditure on non-contributroy social

protection, 2010 – 2012 24 Table 3-3: Donor expenditure on non-contributory social protection, 2010 – 2012 25 Table 3-4: Overall expenditure on non-contributory social protection, 2010 – 2012 26 Table 5-1: WFP food distribution (excluding food for assets and school feeding) 36 Table 5-2: Programmes with labour-intensive public work: basic data 40 Table 5-3: Labour-intesive public work: employment created and wage rates 43 Table 5-4: Socioeconomic support for people living with HIV/AIDS (PLHIV) and for orphans and

vulnerable children (OVCs) 50 Table 5-5: Coverage of demand-side education interventions, 2010-2012 54 Table 5-6: Population coverage of health insurance schemes by quintiles, 2012/2013 (%) 59 Table 5-7: Mutual health organizations operational in 2012 61 Table 5-8: MUSCABU performance data (year to 31 August), 2011-2012 65 Table 6-1: Options for strenghtening non-contributory social protection 69

Table B 1: Selected human development indicators by quintiles, 2012/2013 85

Table B 2: Human development indicators by areas of residence and regions, 2012/2013 86 Table B 3: Composition of government expenditure on non-contributory social protection,

2010-2012 (BIF) 87 Table B 4: Composition of government expenditure on non-contributory social protection,

2010-2012 (%) 88 Table B 5: Total internally and externally financed expenditure on non-contributory social

protection 90 Table B 6: Personnel of Ministry of the Civil Service, Labour and Social Security 91 Table B 7: Personnel of Ministry of National Solidarity, Human Rights and Gender 91

Boxes

Box 5-1: Cash transfers in the Terintambwe programme 38 Box 5-2: Maximization of labour intensity for social impacts and economic efficiency:

Lessons from the road paving project in Bujumbura 45


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ABBREVIATIONS AND ACRONYMS

ABUTIP Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public (Burundian Agency for

Implementation of Public Works)

ADISCO Appui au Développement Intégral et à la Solidarité sur les Collines (Support to Integrated

Development and Solidarity on the Hills)

AfDB African Development Bank

APRODIS Appui au Programme de Décentralisation et d'Intensification de la Lutte contre le SIDA

(Support to the Programme for Decentralization and Intensification of the Fight against AIDS)

ART Anti-retroviral therapy

AVSI Association des Volontaires pour le Service International (Association of Volunteers in

International Service)

BIF Burundi franc

CAM Carte d’Assistance Médicale (Medical Assistance Card)

CDFC Centre de Développement Familial et Communautaire (Family and Community Development

Centre), provincial units of the national solidarity ministry

CMAM Community-based management of acute malnutrition

CNAR Centre National d’Appareillage et de Rééducation (National Centre for Equipment and Re-

education)

CNCA Comité National de Coordination des Aides (National Aid Coordination Committee)

CNLS Conseil National pour la Lutte contre le SIDA (National Council for the Fight against AIDS)

CNPS Commission Nationale de la Protection Sociale (National Social Protection Commission)

CNRSP Centre National de Réadaptation Socio-Professionnelle (National Centre for Socio-Professional

Rehabilitation)

CPE Comités pour la Protection de l’Enfant (Child Protection Committees)

CRS Catholic Relief Services

CSB Corn soya blend


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CSLP Cadre Stratégique de Croissance et de Lutte contre la Pauvreté (Strategic Framework for

Growth and the Fight against Poverty)

CTB Agence Belge de Développement (Belgian Development Agency)

CWB Concern Worldwide Burundi

DGPS Directorate General of Social Protection, Ministry of the Civil Service, Labour and Social

Security

ECD Early childhood development

ENAB Enquête Nationale Agricole du Burundi (Burundi National Agricultural Survey)

EU European Union

FAPS Fonds d’Appui à la Protection Sociale (Social Protection Support Fund)

FVS-AMADE Famille pour Vaincre le SIDA – Association Mondiale des Amis de l’Enfant (Family to Defeat

AIDS – World Association of Children’s Friends)

GDP Gross domestic product

IDP Internally displaced person

IFAD International Fund for Agricultural Development

IMF International Monetary Fund

INSS Institut National de Sécurité Sociale (National Social Security Institute)

HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

MAE Ministère de l’Agriculture et de l’Elevage (Ministry of Agriculture and Livestock)

MDGs Millennium Development Goals

MFI Microfinance institution(s)

MFPD Ministère des Finances et de la Planification du Développement (Ministry of Finance and

Development Planning)

MFPTSS Ministère de la Fonction Publique, du Travail et de la Sécurité Sociale (Ministry of the Civil

Service, Labour and Social Security)


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MSN Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre

(Ministry of National Solidarity, Human Rights and Gender)

MUSCABU Mutuelles de Santé des Caféiculteurs du Burundi (Mutual Health Organizations of Coffee

Farmers of Burundi)

MYAP Multi-Year Assistance Programme, of USAID

NGO Non-governmental organization(s)

ONPR Office National des Pensions et Risques Professionnels (National Office for Pensions and

Professional Risks)

ONPRA Office National pour la Protection des Réfugiés et Apatrides (National Office for the

Protection of Refugees and Stateless Persons)

PAIVA-B Projet d'Appui à l'intensification et à la Valorisation Agricoles du Burundi

PAPCE Projet d’Appui au Programme de Création d’Emplois (Project to Support the Employment

Creation Programme)

PARESI Programme d’Appui au Rapatriement et à la Réintégration des Sinistrés (Support

Programme for the Repatriation and Reintegration of Victims of the Conflict)

PARSE Projet d’Appui à la Reconstruction du Secteur de l’Elevage (Support Project for the

Reconstruction of the Livestock Sector)

PBF Performance based financing

PEPFAR President’s Emergency Plan for AIDS Relief

PLHIV People living with HIV/AIDS

PLW Pregnant and lactating women

PMLSAO Projet Multisectoriel de Lutte contre le SIDA et d'Appui aux Orphelins (Multi-sector

Project to Fight against AIDS and Support Orphans)

PMRSE Projet Multisectoriel de Réinsertion Socio-Economique (Multi-sector Socioeconomic

Reintegration Project)

PM2A Preventing Malnutrition in Children under 2


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PNSADR-IM Programme national pour la sécurité alimentaire et le développement rural de l’Imbo et

du Moso

PPCDR Programme Post-Conflit de Développement Rural (Post-Conflict Rural Development

Programme)

PRADECS Programme d'Appui au Développement Communautaire et Social (Support Programme

for Community and Social Development)

PRIDE Programme d'Intensification et de Décentralisation de la Lutte contre le SIDA (Programme

to Intensify and Decentralize the Fight against AIDS)

PRODEFI Programme de Développement des Filières

PRODEMA Projet de Productivité et Développement des Marchés Agricoles (Agricultural Productivity

and Market Development Project)

PRRO Protracted Relief and Recovery Operations (of WFP)

PTPGU Projet de Travaux Publics et de Gestion Urbaine (Public Works and Urban Management

Project)

PTRPC Programme Transitoire de Reconstruction Post Conflit (Post-Conflict Transitional

Reconstruction Programme)

PWP Public works programme(s)

QUIBB Questionnaire Unifié des Indicateurs de Base du Bien-Etre (Core Welfare Indicators

Survey)

RAPHB Réseau des Associations de Personnes Handicapées du Burundi (Network of Associations

of Persons with Disabilities of Burundi)

RESO Rassemblement, Echange et Solutions entre ONG (Coming Together, Exchange and

Solutions among NGOs)

SIGEFI Système Intégré de Gestion des Finances Publiques (Integrated Public Financial

Management System)

ST-PTPCE Secrétariat Technique du Projet de Travaux Publics et de Création d’Emploi (Technical

Secretariat of the Public Works and Employment Creation Project)


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UCODE Union pour la Coopération et le Développement (Union for Cooperation and

Development, peasant federation)

UNHCR United Nations High Commission for Refugees

UN United Nations

UNDP United Nations Development Programme

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

WFP World Food Programme


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ADMINISTRATIVE MAP OF BURUNDI


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1 INTRODUCTION

1.1 Background and purpose of assessment

This review of social safety nets is taking place at a crucial time as Burundi approaches the end of the period of post-conflict transition. One of the main priorities of the Government and its international partners has been to facilitate the return, resettlement and reintegration of hundreds of thousands of refugees, internally displaced persons, ex-combatants and others affected by years of internal conflict. Many of the ‘safety net’ programmes and projects put in place in recent years have been directly linked to this process. As this process comes to an end, attention needs to focus on how social safety nets can help reduce the long-term structural vulnerability of the poorest households. Policy and programmes have already started to move in this direction.

The nature of safety nets has been evolving to adapt to new long-term needs. Although humanitarian assistance remains important, it is increasingly giving way to a stronger emphasis on government policy and partners’ aid on strengthening the productivity and resilience of communities. Substantial resources have been committed to labour-intensive public works to provide additional sources of income for poor households, including returnees, and to increase their productivity. Cattle and other livestock have been distributed to recapitalize households and raise incomes. Various localized schemes have been set up to facilitate savings by poor households and improve their access to credit. All of this has gone alongside efforts to improve access to basic social services, both through supply-side investments in the provision of health and education services, and through demand-side initiatives such as school feeding, the distribution of school kits and health insurance schemes to promote the utilization of these services.

Most of these safety net initiatives have been designed and implemented in an ad hoc, short-term and uncoordinated way. The main financing has been provided by donors, although there has also been some domestic government financing. Many of the existing programmes and projects are geographically limited in scope and may prove unsustainable as donor funded projects come to an end, especially if the envisaged completion of the post-conflict transition period leads also to a general decline in aid flows to Burundi.

The above poses the challenge of how to move forward towards the construction of sustainable nationally led safety nets as part of a national social protection system. Safety nets are needed not only to address short-term humanitarian and post-conflict reintegration needs but to ensure that the most vulnerable have the opportunity to participate in the country’s economic development. The very high level of poverty in Burundi, especially in the rural areas, and the weak capacity of poor and near-poor households to cope with shocks, whether as a result of natural disasters, illness or rises in food prices, mean that a basic social protection system is required for the long term. At present, the formal social protection system is largely limited to insurance coverage for a tiny minority employed in the public sector and large private companies, leaving the rest of the population (including the vast majority of the most vulnerable households) with no protection outside the framework of short-term localized projects.

The National Social Protection Policy, adopted by the Council of Ministers in April 2011, and the poverty reduction strategy (CSLP II) provide a broad framework for the establishment of such a system. The National Social Protection Policy has the overall objective of ‘ensuring that every person, as a member of society, has the right to social protection as a human right’ (République du Burundi, 2011, p. 25). The second CSLP (Cadre Stratégique de Croissance et de Lutte contre la Pauvreté) for the period 2012-2015 has integrated the overall approach set out in the Policy into its 3rd pillar on the ‘improvement of the accessibility and quality of basic social services and strengthening of the social protection floor’. In April 2013, the National Social Protection Commission was inaugurated as the inter-ministerial body responsible for guiding the


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implementation of the National Social Protection Policy. The President of the Republic chairs the Commission, indicating that establishing and strengthening of the social protection system is a priority for public policy at the highest levels of government.

This report aims to contribute to the operationalization of the National Social Protection Policy. There has been no comprehensive review so far of the safety net programmes and projects that have been financed and implemented in recent years in Burundi. By drawing on the experience to date, the present report aims to contribute to a better understanding of the programme options for protecting and strengthening the resilience of the most vulnerable layers of the population as the country moves into a new period of long-term economic and social development. Following this introduction (Chapter 1), the report has the following chapters:

An analysis of poverty, vulnerability and social risks – in other words, an analysis of the conditions to which social safety nets are intended to provide part of an effective response within the framework of CSLP II (Chapter 2);

A review of public expenditure on non-contributory social protection, including safety nets, from domestic and external financing sources (Chapter 3);

An assessment of the policy and institutional framework for the implementation and future strengthening of social protection (Chapter 4);

An analysis of the existing social safety net programmes, focusing in particular on their targeting, coverage, efficiency and effectiveness (Chapter 5);

Conclusions and recommendations (Chapter 6).

The World Bank and UNICEF jointly financed the assessment, which was overseen by the Ministry of the Civil Service, Labour and Social Security, the ministry responsible for the secretariat set up to help coordinate the operationalization of the National Social Protection Commission. The study took place between February 2013 and March 2014.

1.2 Conceptual framework

This study uses the term ‘safety nets’ to refer to non-contributory social protection programmes that transfer resources to the poor or vulnerable. The concept of ‘safety nets’ is therefore synonymous with social transfers. It is sometimes called social assistance, although the latter may be defined more broadly to cover also social care services, which include in particular the preventive and responsive services to address social risks such as violence and abuse. Social protection is a broader concept still, including both social assistance and contributory social insurance. Although usually under the mandate of the same social affairs ministries that are responsible for social transfers, social care services are not generally understood as ‘safety nets’ and are therefore only tangentially discussed in this report. Some indirect types of social transfers, such as consumer subsidies, also lie outside the scope of this study. Since safety nets are transfers, the report does not focus directly on other types of mechanisms to improve the livelihoods of households such as microfinance, although it does note the development of many small community-based savings and credit schemes (the nawe nuze groups) and considers their potential linkages to social transfers.

Social transfers have preventive, protective and promotional functions. The term ‘safety net’ should not be interpreted in the purely passive sense of ‘catching’ those who fall below a certain minimum standard of living. Social transfers also have a preventive and promotional function in so far as they enable the poor and vulnerable to save, to avoid negative risk-management strategies such as selling assets or withdrawing children from school in the event of shocks, and to invest in developing their human and productive capital so that they can reduce their degree of poverty and thereby also strengthen their future capacity to withstand


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shocks and setbacks. This resilience-building dimension of safety nets or social transfers is especially important in countries like Burundi where a large part of the population is living on the margins of survival with very limited capacity to cope with shocks or to improve its wellbeing in a sustainable manner.

There is a blurred dividing line between short-term humanitarian assistance and long-term safety nets. Social transfers or safety nets are generally established as long-term programmes, especially when they are intended to address problems of chronic poverty or vulnerability rather than simply respond to short-term shocks. Relief in the context of disaster management is different in nature and has different objectives. However, in countries such as Burundi, which face protracted and repeated crises, the requirements of post-conflict social reintegration, and an underlying situation of widespread poverty, the distinction becomes difficult to sustain. In this context, humanitarian aid may be provided over many years and the programmes put in place may take similar forms to long-term safety nets. The construction of an effective safety net needs to build partly on the experience of programmes initiated in a humanitarian context. For this reason, the present report takes a broad view and covers many programmes and projects that emerged in Burundi as a response to humanitarian needs and the priorities of post-conflict social reintegration.

Safety nets or direct social transfers aim primarily to increase the household consumption of basic commodities and essential services by the poor and vulnerable. Whatever form transfers take (transfers in kind, cash or vouchers), they enable households to increase their consumption. In Burundi, as Chapter 5 will discuss, most transfers take the form of food rations, although there are also transfers of other types, such as transfers of livestock and agricultural inputs, the provision of equipment and mobility aids to persons with disabilities and, on a very small scale, transfers in cash and vouchers.

Although this has not been the practice to date in Burundi, transfers are sometimes accompanied by conditions, which are intended to add to the income effect by stimulating behavioural changes, creating a substitution effect on the use of resources. In others, the transfer is accompanied by a requirement to work, becoming in effect a source of income, as in labour-intensive public works programmes (PWPs), which have been one of the main safety net approaches employed in Burundi. It should be noted that not all social transfers are delivered directly to households: meals may be provided to children in school, as an incentive to attend school and to improve learning performance, while also indirectly increasing the aggregate consumption of the households from which they come.

Transfers can also take the form of fee waivers, which have been provided on a small scale in Burundi to facilitate access by the very poor to health care and secondary education, and through fee abolition, as in the case of primary school fees and certain priority health services, including services for children under 5 and pregnant women and the treatment of malaria, AIDS and tuberculosis.

This report concentrates on publicly financed social safety nets, clustered in six main types. The assessment focuses on programmes and projects funded by the Government of Burundi or by official international aid, although many programmes are delivered through NGOs working as ‘contractors’ to aid agencies. Expenditure on the programmes is analysed in Chapter 3. The analysis of the existing programmes in Burundi, in Chapter 5, clusters these in six categories, which cover the main types of programmes currently being financed and implemented in the country:

1. Short term in-kind assistance, including humanitarian assistance, programmes to support the return and resettlement of refugees, internally displaced persons and ex-combatants, and programmes for nutritional supplementation;

2. Labour-intensive public works, some of which have been an integral part of humanitarian/reintegration interventions, while others have focused more broadly on employment creation, rural development and poverty reduction;


4

Burundi

3. Distribution of livestock and agricultural inputs to poor rural households, mainly within the framework of larger agricultural development programmes;

4. Programmes and projects for specific vulnerable population groups, including in particular children, women, the elderly, persons with disabilities, persons living with or affected by HIV/AIDS and the Batwa ethnic minority;

5. School feeding, the distribution of school kits and other ‘demand-side’ measures to improve school enrolment and attendance, and to reduce drop-out;

6. Initiatives to facilitate access by the poor and vulnerable to health care services.

1.3 Data Sources

This is the first comprehensive analysis of non-contributory social protection in Burundi, making use of a wide range of up-to-date data sources, including data from national household surveys, government financial data and administrative data on the main safety net programmes and projects. Nonetheless, data deficiencies limit the scope of the analysis in some areas. Information is provided here on the main sources used (for each of the four core chapters) and their respective limitations. The review draws also on relevant lessons from other developing countries, particularly low-income African countries.1

Chapter 2: Analysis of poverty, vulnerability and social risks.

Until very recently, the only national data on monetary poverty came from a survey in 2006, the Core Welfare Indicators Questionnaire (QUIBB – Questionnaire Unifié des Indicateurs de Base du Bien-Etre). Since then, major changes have taken place in Burundi, due to the end of the civil war in 2005, the return and partial reintegration of hundreds of thousands of refugees and ex-combatants, and a modest economic recovery. It was therefore important to use more recent data to assess households’ living standards and the characteristics of the poorest households. For that purpose, the analysis used provisional data from a consumption module included in a recent national household survey on access to health services, the PMS 2012/2013.2 It is important to note that the PMS data used in this report does not allow for a full poverty analysis but provides a picture of the different dimensions of deprivation facing vulnerable households. The analysis in Chapter 2 also draws on other survey sources, in particular the Demographic and Health Survey (DHS) in 2010 and the National Agricultural Survey of Burundi (ENAB) in 2011/2012.

Chapter 3: Review of public expenditure o non-contributory social protection.

Several different data sources were used to construct an integrated database for use in this analysis. These included the official data on allocated and executed expenditures from the financial management system

1 Social safety nets assessments have been undertaken with the support of the World Bank in about 20 countries in Africa (World Bank, 2013) and broad diagnostic studies of national social protection systems have been conducted with the support of UNICEF in several African countries to support national policy development and implementation.

2 The PMS survey is the ‘Enquête ménage pour le suivi et l’évaluation de l’impact de l’appui au système de remboursement du paquet minimum des services de santé au Burundi’. The 2012/2013 round was an expanded version of the PMS survey, which had previously been carried out in 2009 without a consumption module. It was conducted between December 2012 and January 2013 with a sample of 8,220 households.


5

Burundi

(SIGEFI) of the Ministry of Finance, data on foreign financed programme/project expenditure (much of it off-budget) recorded in the database of the National Aid Coordination Committee (CNCA) and data collected directly from the agencies that finance or manage the main non-contributory social protection programmes and projects. Section 3.1 notes several methodological difficulties (in terms of expenditure classification, data comprehensiveness and overlapping of data) that need to be taken into account when interpreting the results of the analysis.

Chapter 4: Assessment of the policy and institutional framework.

The mainly qualitative analysis in this chapter is based on a review of policy and planning documents, legislation, official documents on institutional mandates and structures (including on decentralization) and data on institutional capacity, notably with respect to human resources, supplemented by information obtained through interviews with government officials and other key actors.

Chapter 5: Analysis of existing safety net programmes.

Documentation and data were collected from government ministries, NGOs and external partners on about 80 different programmes and projects that have a safety net character or are related in some way to non-contributory social protection. This was complemented by interviews with these organizations at national level, and by interviews and focus groups during field visits, which took place in the provinces of Bujumbura Mairie, Bujumbura Rural, Gitega, Kirundo, Ngozi and Makamba in April 2013 (see Annex A). These field visits were particularly valuable as an opportunity to see programmes ‘in action’ and to discuss directly with local government officials, programme field staff and beneficiaries.


6

Burundi

2 DEPRIVATION, VULNERABILITY AND RISKS IN BURUNDI

Burundi is one of the poorest countries in the world, with most of its population struggling to survive and extremely vulnerable to adverse shocks. As this chapter will discuss, there has been a quite weak economic recovery since the end of the civil war, which uprooted and impoverished a large part of the population and devastated the economy. Low growth of the agricultural sector, on which the vast majority of the population depends, combined with rapid population growth, suggest that poverty may have increased in recent years, despite the end of the conflict, although comparable data are not available to measure trends in poverty over time. There are also high levels of human deprivation, including in particular one of the highest rates of chronic under-nutrition in the world. This chapter uses the most recent national data to construct a profile of deprivation, vulnerability and risks, providing the essential background and context for the assessment of social safety nets in the rest of the report.

2.1 Mass poverty in the aftermath of a prolonged period of conflict and economic decline

The civil war had a devastating impact on the economy and the population, especially during its most intense period from 1993 to 2000. The war left over 300,000 Burundians dead and displaced 1.2 million people, about a sixth of the population in the 1990s. The economy went into a headlong decline and, during the period from 1991 to 2005, GDP per capita contracted in real terms by more than a third (36%), as can be seen in Figure 2.1.

Figure 2-1: GDP per capita (BIF) and major political events

Source: GDP per capita data from World Bank, World Development Indicators.

158,999

196,8943

207,430

161,903

241,747

165,636

0

50,000

100,000

150,000

200,000

250,000

300,000

1960 1970 1980 1991 2001 2012

Mas

sacr

es o

f 1

97

2

CIVIL WAR


7

Burundi

Despite the restoration of peace and the return of refugees, the recovery in GDP per capita since the early 2000s has been modest. Between 2002 and 2009, over 500,000 refugees returned from exile, mainly from Tanzania, and smaller refugee repatriations continued until 2012. There were still about 157,000 internally displaced persons (IDPs) living in 137 sites as of 2009 (MSNRRRS, 2010), and it appears that most of these IDPs have still not returned to their homes.

Since the early 2000s, there has been a recovery in economic activity, but this has been quite modest. Taking into account the rapid growth in population, GDP per capita remains extremely low. Measured in 2005 constant prices, GDP per capita in 2012 was still 31% lower than in 1991 and was at about the same level as in 1969, more than four decades earlier. In 2012, Burundi had the lowest GDP per capita in the world apart from the Democratic Republic of Congo (DRC), excluding a few countries for which no data are available, such as Somalia and South Sudan.

Population pressures have undermined living standards and contributed to social and political conflict. According to UN population estimates3, population growth fell by 1.4% in 1995-2000 during the period of intense conflict and large refugee movements out of the country, but rose sharply by 3.0% in 2000-2005 and 3.5% in 2005-2010, swollen by the influx of returning refugees. The population is 3.3 times larger than it was at independence. With 388 inhabitants per square kilometre in 2010, Burundi has the highest population density in continental Africa after Rwanda.

Burundi is also by far the most rural country in Sub-Saharan Africa, with only 10.7% of the population living in urban areas in 2011 according to UN estimates (10.1% according to the 2008 national census) – the closest comparator being Malawi with an urbanization rate of 15.7%. With so much of the population living in the rural areas and 88% of the economically active population engaged in the agricultural sector (according to the 2008 census), the rise in population density has led to an acute shortage of land that has depressed living standards and become a prime source of conflict.

Growth in the agricultural sector has been well below rural population growth, probably depressing living standards in the rural areas. Between 2006 and 2013, while GDP growth averaged 4.5% a year, slightly above the population growth rate, this economic expansion was unevenly distributed. While the non-agricultural sector showed a growth rate of 6.3% on average, growth in agriculture, on which the overwhelming majority of the population depends, averaged only 1.2%, well below the rate of rural population growth. It is therefore likely that rural poverty increased in recent years despite the end of the conflict.

Poverty is widespread among the population, creating potentially difficult challenges for the targeting of safety nets. Figure 2.2, which uses data from the 2012/2013 PMS survey, shows that average consumption expenditure per adult equivalent rises by very small increments across most of the consumption expenditure distribution, before rising very steeply in the richest (10th) decile.4 This is a structure that can be described as one of ‘top inequity’, in which a small group of households at the top of the income or consumption distribution is markedly better off, while there is not so much to distinguish the rest. The distribution across the first six deciles is particularly flat, with average consumption expenditure per adult equivalent rising between deciles by an average of only BIF 3,130 (USD 3.90) per month.

3 World population prospects: The 2012 revision, UN Population Division, New York.

4 These deciles group the population into ‘tenths’, rising from the poorest 10% in the 1st decile to the richest 10% in the 10th decile. The deciles have been constructed on the basis of consumption expenditure per adult equivalent, to take into account the lower consumption needs of children compared with adults.


8

Burundi

Figure 2-2: Average per capita monthly consumption by deciles, 2012/2013 (BIF adult equivalent)

Source: PMS survey 2012/2013.

2.2 Livelihood shocks

The main societal shocks have been political in nature, rooted in a cycle of mutual fear within communities and competition over scarce resources that have become increasingly rare. There were major political crises in 1972 and 1993 that triggered large refugee movements and, in the latter case, ignited a conflict that lasted for more than a decade, devastating the economy. Overall, according to the QUIBB survey in 2006, more than half (52%) of the population left their homes at least once because of the war (ISTEEBU, 2006).

Peace accords in 2000 and 2003 between the government and the main rebel groups, the ratification of a new constitution in 2005 and a peace agreement with the one remaining rebel group in 2009 gradually brought the conflict to a halt. The settlement obtained through this process has so far succeeded in re-establishing relative stability. Long-term political stability is likely to hinge, however, on success in building an economic future that benefits all Burundians and helps build a more cohesive social fabric.

Climatic shocks, soil deterioration and crop diseases are additional risks to livelihoods. The high dependence on rain-fed agriculture leaves most farmers exposed to fluctuations in rainfall. Harvests can be severely affected by drought or by heavy rainfall and floods. Plant diseases such as cassava mosaic virus, maize streak virus and banana bacterial wilt can cause large falls in yields. In addition, the intensive cultivation of available land is resulting in a long-term trend of soil fertility deterioration.

Households are also exposed to price shocks, both for cash crops and for food. There is a large national food deficit, with ENAB estimating that national food production in 2011/2012 (1.41 million tons of cereal equivalent) was enough for 280 days of food consumption (ISTEEBU, 2014). Most households, and especially those with very low landholdings or no land, are therefore either partially or totally dependent on purchases of food in markets. These households have been hit hard by food price inflation, especially during the period of soaring global food prices in 2007-2008, when food price inflation reached 33% on an annual basis (see Figure 2.3).

The oscillations in global commodity prices affect cash crop farmers. Coffee is the main cash crop, followed by tea and cotton. Coffee production also experiences large cyclical fluctuations, with production dropping as low as 6,821 tons in 2009-2010 compared with a peak of 61,508 tons in 2005-2006, seriously affecting farmers’ incomes.

4 857 8 376 10 969 13 545 16 93420 530

25 09931 588

44 794

95 452

0

20 000

40 000

60 000

80 000

100 000

120 000

Decile 1 Decile 2 Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10


9

Burundi

Figure 2-3: Food price inflation, 1998-2011 (%)

Source: ISTEEBU, 2013b.

Household vulnerability is accentuated during the lean period before harvests. Burundi has three agricultural seasons: Season A between mid-September and mid-February, Season B from mid-February to mid-June and Season C from mid-June to mid-September. About half of food-crop production is in Season B, with about a quarter each coming from the other two seasons. The ‘lean periods’ in October-November and March-May, before the harvests in the A and B seasons, are the times of year when food tends to be scarce, food prices rise fastest on local markets and household food insecurity is highest. WFP has estimated that household food insecurity, based on a food consumption score, peaks at 40-60% of households annually in April and October, compared with about 10% after the harvests in January and June (WFP, 2012c).

Illness can become a livelihood shock in a country where many health services are fee-paying and health insurance still has limited population coverage. Health services are free for children under 5 and pregnant women, and for a few specific services such as the testing and treatment of HIV/AIDS, tuberculosis and malaria. Health insurance, through the Carte d’Assistance Médicale (CAM), the Mutuelle de la Fonction Publique (MFP), community based mutual health organizations, and indigence certificates, covered only 17.9% of the population in 2012/2013, according to the PMS survey, but may have increased further since then due to the Government’s efforts to expand membership into the CAM scheme.5 The PMS survey asked respondents who had been ill in the previous four weeks and had consulted a health provider how they had paid for health care: While the Government had paid in 30% of cases (presumably for the exempt population groups and services), 38% had used savings, 9% had sold assets and 7% had sold food. Insurance paid for 21.5% of outpatient health consultations but only 14.5% of hospitalizations, which impose a higher financial burden on patients and their families.

2.3 Characteristics of the poor

The poorest households tend to have more children, be of larger size and have a high dependency ratio, as Figure 2.4 shows. Children are by far the largest category of dependents, especially in the poorest quintiles.

5 See Section 3.6 for a detailed analysis of policy measures and programmes undertaken to facilitate financial access to health services.

1,0

29,5

0,6

-5,1

12,6 10,6

17,1

0,1

8,6

33,0

9,2

6,0

11,5

-10

-5

0

5

10

15

20

25

30

35

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011


10

Burundi

Children aged 0-14 make up 55% of the population of the poorest quintile, a proportion that declines to 42% in the richest quintile, according to the PMS data. 73% of the poorest quintile live in households with six or more members, compared with 46% in the richest quintile. And 81% of the population in the poorest quintile live in households with a dependency ratio of 1 or more compared with 60% in the richest quintile.

From a targeting perspective, large household size and high dependency ratio are probably associated with poverty and vulnerability. However, differences between quintiles remain relatively small and there are still a fifth of households with dependency ratio of 0 (i.e. households with no children under 15 or adults above 60) which are in the first quintile.

In general, old people and the disabled reflect the poverty profile of the broader population, although this may mask important disparities within these categories. The proportion of old people (60 years old and above) in the population is very small (less than 4%) and tends to be slightly larger in the richer quintiles, as can be seen in Figure 2.4. However, it is possible that a sub-group of elderly living alone and isolated, with little support from younger family members, are among the most vulnerable, as indicated by WFP in an analysis of food security (WFP, 2012c). Persons with disabilities, who comprise 4.5% of the population, according to the 2008 census, are distributed fairly evenly across quintiles.

Figure 2-4: Distribution of population of consumption expenditure quintiles by demographic characteristics, 2012/2013

55

43

3

52

45

3

5046

3

47 49

4

42

53

5

0

10

20

30

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60

Children 0-14 years Adults 15-59 years Adults 60 years +

Distribution by age groups (%)Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5

5

23

36 37

7

29

3430

11

31 32

26

15

3329

24

19

35

2521

0

5

10

15

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25

30

35

40

1-3 members 4-5 members 6-7 members 8 members +

Distribution by household size (%)

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5


11

Burundi


The most deprived are especially concentrated in the Center-East and North regions, as can be seen in Figure 2.5. According to the provisional PMS survey data, 81% of the 1st quintile population live in these two regions.6 This is broadly consistent with findings of WFP’s Integrated Phase Classification for Food Security (IPC) showing the livelihood zones of the Northern and Eastern Depressions as being in an acute food and livelihoods crisis (phase 3 of the IPC) without interruption since 2008 (WFP, 2012c). Again, however, the differences with other regions are only relative.

Figure 2-5: Distribution of population of consumption expenditure quintiles by regions, 2012/2013 (%)


6 The Centre East region comprises the provinces of Cankuzo, Gitega, Karuzi, Muramvya and Ruyigi. The North region comprises the provinces of Kayanza, Kirundo, Muyinga and Ngozi. The West region comprises the provinces of Bubanza, Bujumbura Rural and Cibitoke. The South region comprises Bururi, Makamba, Mwaro and Rutana. The capital is Bujumbura Mairie region.

19

4338

24

42

34

28

42

3033

38

29

40 38

22

0

10

20

30

40

50

Dependency index < 1 1< Dep. index < 2 Dependency index 2 +

Distribution by household dependency index (%)

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5

45

36

108

3336

15 16

2831

192324

28

19

28

2023

18

38

0

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50

Center-East North South West

Quintile 1

Quintile 2

Quintile 3

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Quintile 5


12

Burundi

The heads of the most deprived households have had very little education. Two fifths (40%) of the population in the first quintile live in households whose heads have no education and a further 23% in households whose heads have only received literacy training, according to the PMS survey. The level of education improves in the subsequent quintiles, but even in the richest quintile 20% of the population lives in households whose heads have no education, as Figure 2.6 shows.

Figure 2-6: Distribution of population of consumption expenditure quintiles by education of household head, 2012/2013 (%)


The proportion of the population living in female-headed households is slightly higher in the poorest quintile. According to the PMS data, approximately 15% of the population of the first quintile live in female-headed households compared with 12-13% in the other quintiles. The National Agricultural Survey of Burundi (ENAB) in 2011/2012 found that farm households headed by men earned on average 1.4 times more than those headed by women. Female-headed households are disadvantaged by the lower access of women to land and other assets and by the lower educational level achieved by women (see below).

2.4 Ownership of land and livestock

Land pressures are a major long-term threat to livelihoods. Population growth has led to land holdings becoming more and more sub-divided (even though inheritance has been limited to males), while a small minority of rural households owns no land at all and depends on occasional work on the farms of others. Returnees whose families fled to neighbouring countries in 1972 have found it almost impossible to reacquire lands lost more than four decades ago (and some do not even know where their families originally came from), although some returnees have been resettled in new ‘integrated rural villages’ created by the cession of state land domains (MSNRRRS, 2010). Due to the small size of landholdings, the rural household economy has become progressively less viable. According to the 2008 census and survey sources, about nine tenths of rural households own at least some land. However, most of these landholdings are very small. The National Agricultural Survey (ENAB) in 2011/2012 found that the average landholding was about 0.52 ha, and classified farm households into four broad types (see Figure 2.7):

Small farms (31.6% of the total), which on average have a land area of 0.2 ha and livestock amounting to 1 goat;

Medium farms (50.9%) with an average land area of 0.5 ha and about 2 goats; Intermediary farms (13.7%) with an average of 1.1 ha of land, 1 cow and 3 goats; Large farms (3.8%) with an average of 2 ha of land, 2 cows and 4 goats.

40

23

35

2

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22

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2

30

18

48

4

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47

9

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0

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None Literacy Primary schooling Secondary or more

Quintile 1

Quintile 2

Quintile 3

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Quintile 5


13

Burundi

Figure 2-7: Distribution of types of farms by landholding and livestock, 2011/12 (%)

Source: National Agricultural Survey (ENAB), 2011/12 (ISTEEBU & MAE, 2014).

The overwhelming majority of rural households have tiny plots of land, upon which it is extremely difficult to build a viable household economy. 60% of farm households cultivate less than 0.25 ha and 87% less than 0.5 ha, according to data from the A season in 2011/2012 on the areas cultivated with crops, i.e. excluding forest, fallow land and land for pasturage (see Table 2.1). The situation is extreme in the northern provinces of Ngozi and Kayanza, where respectively 71% and 80% of farm households cultivate less than 0.25 ha (see Figure 2.8). The situation can only get worse, given the growth in the rural population, unless and until there is a major shift in the structure of employment and the urban-rural distribution of the population.

Figure 2-8: Percentage of farm households cultivating less than 0,25 ha, Saison A, 2011/2012

Source: National Agricultural Survey (ENAB), 2011/12 (ISTEEBU & MAE, 2012a).

SMALL (average 0,2 ha, 1 goats), 31.6%

MEDIUM (average 0,5 ha, goats), 50.9%

INTERMEDIAIRE (average 1,1 ha, 1 cows et 3 goats),

13.7%

LARGE (average 2 ha, 2 cows and 4

goats), 3.8%

42 43 44

55 56 57 58 59 59 63 64 67 68 69 7180

0

10

20

30

40

50

60

70

80

90


14

Burundi

Table 2-1: Distribution of farm households by land area cultivated, Season A, 2011/2012

< 0,10

ha 0,10 - 0,25 ha

0,25-0,50 ha

0,50 - 0,75 ha 0,75 - 1,00 ha > 1,00

ha

Bubanza 16,7 42,2 29,6 10,0 1,5 0,0

Bujumbura Rural 25,9 38,5 25,9 8,0 0,9 0,9

Bururi 26,6 42,5 22,3 4,6 2,1 1,8

Cankuzo 9,0 34,8 35,3 12,3 3,9 4,8

Cibitoke 18,3 36,8 29,3 8,7 3,9 3,2

Gitega 21,8 40,9 28,1 5,9 0,6 2,7

Karuzi 12,9 29,6 35,8 13,3 5,9 2,5

Kayanza 21,9 57,8 12,6 5,8 0,7 1,3

Kirundo 15,3 26,3 29,6 11,6 7,0 10,2

Makamba 18,3 41,0 24,3 7,6 3,8 5,0

Muramvya 13,9 42,8 32,5 5,2 3,0 2,6

Muyinga 19,5 36,0 28,2 11,9 2,6 1,8

Mwaro 25,5 41,9 23,9 7,4 0,0 1,3

Ngozi 27,4 43,7 26,1 2,7 0,1 0,0

Rutana 26,8 41,0 26,0 3,7 0,6 1,8

Ruyigi 23,8 34,2 26,7 10,9 1,7 2,7

Total 20,7 39,2 26,8 8,0 2,4 2,8

Source: National Agricultural Survey (ENAB), 2011/12 (ISTEEBU & MAE, 2012a).

Landholdings are smaller among the poorest, with almost one third of the 1st quintile population (30%) living in households with less than 0.2 ha, according to the PMS data. The proportion living in households with less than 0.2 ha falls to 20-26% in the 2nd to 4th quintiles and to 17% in the fifth quintile (see Figure 2.9). . However, in all quintiles, more than a third of households own more than one hectare, which remain a very small area on which to build a household’s livelihood strategy.

Figure 2-9: Distribution of population of consumption expenditure quintiles by size of landholding, 2012/2013 (%)


30

15

9

35

24

15 14

33

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1412

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20

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< 0.2 ha between 0.2 and 0.5 ha between 0.50 and 1 ha > 1 ha

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5


15

Burundi

The poorest households are also less likely to own livestock, especially cattle. Reflecting the prevalence of rural population, two-thirds of households hold some animals. However, the disparities are more marked for ownership of cattle or other large livestock, as can be seen in Figure 2.10. The proportion of the population living in households with cattle or other large livestock is in the range of 6-9% in the first three quintiles, but rises to 11% in the fourth and 15% in the fifth.

Figure 2-10: Distribution of population of consumption expenditure quintiles by owenership of livestock, 2012/2013 (%)


Unequal access to land disadvantages women. Under both customary and statutory law, women have no right to inheritance of land. Reflection has been taking place on possible legislation to guarantee equality between men and women with respect to inheritance and land, but such a reform is not yet in place. Some rural women have de facto ‘responsibility’ for plots of land, meaning that they farm the land and have a right to the crops produced, but ENAB data show that this is the case for only 32% of women, compared with 68% of men (ISTEEBU & MAE, 2012a).

The Batwa have especially limited access to land. This small ethnic minority, comprising about 1% of the population according to a survey of Batwa conducted in 2006-2008 (UNIPROBA & IWGIA, 2008), lives in a state of extreme vulnerability, with very limited access to land and suffering a situation of social exclusion and unequal access to social services. The Batwa traditionally lived from hunting and gathering in a migratory forest-based economy rather than from crop cultivation or livestock, but they have been severely affected by the reduction of forest cover in the past few decades and have become sedentary, settling on the margins of Hutu and Tutsi communities.

Their traditional artisanal activities (the production and sale of pottery), which were a means of exchange with farm communities, have also been undermined by competition from plastic products. With no customary land rights, the Batwa became completely dependent on the established agricultural communities, under a form of subservience known as ubugererwa, by which they owed personal allegiance and labour services in return for a right of usufruct to small plots of land.

Although this system was officially abolished in 1977 (decree-law no 1/19), the 2006-2008 survey found that in practice it continued to exist, affecting 49% of Batwa households without land, or about 7% of all Batwa households. The survey found that, while 85% of Batwa households owned some land, their landholdings were extremely small, compared even with the small amounts of land owned by non-Batwa households. 79% of households had landholdings of less than 0.1 ha, 61% had less than 0.05 ha and 34% had less than 0.01 ha.

33

7

66

29

6

71

29

9

71

30

11

70

36

15

64

0

10

20

30

40

50

60

70

80

No livestock Cattle or other largelivestock

Any livestock

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5


16

Burundi

2.5 Risks of mortality and human deprivation and the challenge of human capital formation

Risks go far beyond livelihood shocks to include the risks of mortality and human deprivation – dimensions to which social protection needs to give high priority, especially in a developing country like Burundi. Efforts to reduce child and maternal mortality have been a major policy priority in the context of the Millennium Development Goals (MDGs) and will remain so in the post-MDG period after 2015.

Large numbers of Burundians, especially children and women, also face high risks of deprivation with respect to nutrition, health, education and access to water and sanitation. Besides being a denial of basic human rights, these deprivations undermine the accumulation of human capital, especially during childhood, and have serious knock-on effects on productivity, long-term poverty reduction and national development. The ‘promotional’ dimension of social protection puts a strong emphasis on addressing these deficits in human development as a pathway out of poverty, including by breaking the intergenerational transmission of poverty.

Burundian children have a one-in-ten risk of dying before reaching their fifth birthday and one in 30 women risk dying in childbirth during their lifetime. The Demographic and Health Survey (DHS) in 2010 estimated the under-5 mortality rate at 96 per thousand live births, with more than half these deaths (59/1,000) occurring within the first year of life (see Table 2.2).

These figures are close to the averages for Sub-Saharan Africa (98 and 64 respectively) and for least developed countries (85 and 58), according to international estimates for 2012 (UNICEF, 2014). The DHS estimated the maternal mortality ratio at 500 per 100,000 live births, which is equivalent to the international estimate for Sub-Saharan Africa and higher than the estimate for LDCs (430).

Child mortality is higher in the poorest households and in rural areas. Children in the rural areas have a two-thirds higher probability of dying before the age of 5 than children in the urban areas, according to the DHS estimates. The mortality risk in children under 5 also rises as households get poorer, and is almost twice as high in the poorest quintile as in the richest quintile. However, this provides another example of ‘top inequity’ in so far as the inter-quintile difference in mortality rates is much higher between the fourth and fifth quintiles than it is across the rest of the wealth distribution (see Figure 2.11).

Burundi has one of the highest chronic under-nutrition rates in the world. Also known as stunting, chronic under-nutrition amounts to a national crisis. According to the DHS, 57.7% of children under-5 suffers from stunting, which is a higher rate than in any other country in the world apart from Afghanistan. The PMS survey found a somewhat lower but still very high figure of 46.3% -- which is exceeded only by six countries (Afghanistan, Guatemala, India, Madagascar, Timor Leste and Yemen).

By improving household resources and thereby facilitating access to improved food consumption and health care, social safety nets could play an important role in reducing chronic under-nutrition. This must be a top national priority, as stunting has major implications for child survival7, long-term health, cognitive development (especially during the first two years of life when most of brain growth occurs) and later school performance as well as productivity and earnings in adult life. While this cannot be estimated specifically for Burundi with the available data, the World Bank (2006) has calculated that globally the productivity losses in adult life from chronic under-nutrition in early childhood reduce GDP by 2-3%.

7 Due to its synergistic interaction with the main childhood diseases, stunting is estimated worldwide to contribute directly or indirectly to 45% of deaths in children under 5 (The Lancet, 2013).


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Figure 2-11: Under-5 and infant mortality by wealth and area of residence, 2010

Source: DHS 2010.

Improving financial access to health care is important not only for avoiding livelihood shocks but also for improving the health of the population, nutrition and child and maternal mortality. The DHS found that about 40% of pregnant women delivered outside health facilities, increasing their mortality risks due to birth complications or lack of hygiene. About 17% of children aged 12-23 months had not received the full course of basic immunizations (BCG, three pentavalent doses, three polio doses and measles). Only about half of households had an insecticide-treated net (ITN), the best form of protection against malaria, which is the main cause of illness and death in children under 5, and only about two thirds of children under 5 with fever were taken to a health provider.

The PMS data diverge somewhat from the DHS findings, with improvements shown in the proportion of births in health facilities, in ownership of ITNs and in the proportion of children with fever taken to health facilities, but a decline in coverage of immunization (see Table 2.2). The PMS also found a slight improvement in use of improved water sources, but lower use of improved sanitation facilities – key indirect determinants of health risks in Burundi.

In the DHS, lack of money was cited by 77% of women as a problem in accessing health services, although supply-side problems (distance 52%) and sociocultural factors (not wanting to go alone 41% and needing permission 37%) were also important. The role of different types of social protection mechanisms in improving access to health care will be discussed in Section 5.6.

While Burundi has made impressive strides in improving school enrolment, due partly to the abolition of official primary school fees in 2005, many children enter class 1 late and drop out before completing primary school. The PMS data show an improvement in the primary net attendance ratio to 84.6%. However, this implies that 15.4% of children aged 7-12 are still not in primary school, either because they enroll after the official age of 7 (or in a few cases never at all) or because they drop out of primary school before they reach the age of 12. Many more drop out at an older age, before completing primary school.

The gross primary completion rate (the number of children in the last class of primary school as a percentage of the population aged 12) is only 51%, according to administrative data for the 2009/2010 school year. Due to late entry into class 1 and the repetition of classes, primary schools are full of overage children. Many

9686

8175

51 49

81 79

152

137 139

121

80 79

131 127

0

20

40

60

80

100

120

140

160

Q1 Q2 Q3 Q4 Q5 Urban Rural National

Wealth quintiles Area of residence

Infant mortality ratio

Under-5 mortality ratio


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subsequently drop out, partly because the opportunity cost of remaining in school (competition with work) rises as children get older, especially when they reach adolescence. Social safety nets (in particular school feeding) can make a contribution here by incentivizing correct age enrolment and by offsetting the opportunity costs of continued school attendance.

Table 2-2: Mortality and human development indicators

Sources: DHS 2010 and PMS survey 2012/2013.

Most human deprivation indicators show a correlation with the level of consumption expenditure, although the inter-quintile differences are not always large, as can be seen in Figure 2.12 and in greater detail in Annex Table B.1. The PMS survey found that chronic under-nutrition in children under 5 rises from 37% in the fifth quintile to 51% in the first quintile, but even in the fifth quintile this is well above the WHO stunting threshold of 30% for a ‘high level of public health significance’.

There are twice as many children aged 7-12 in the poorest quintile who are not in primary school (22%) as there are in the richest quintile (11%), and twice as many 1st quintile women deliver outside a health facility (26%) as 5th quintile women (13%). There is no clear relationship, however, between quintiles and use of health facilities by children when they are ill, possibly due to the success of the policy of free health care for children under 5 and its funding through the performance-based financing mechanism (see Section 5.6).

DHS 2010 PMS 2012/13

Mortality

Under-5 mortality rate (per 1,000 live births) 96 …

Infant mortality rate (per 1,000 live births) 59 …

Maternal mortality ratio (per 100,000 live births) 500 …

Malnutrition (% des enfants de moins de 5 ans)

Chronic under-nutrition (global) 57,7 46,3

Chronic under-nutrition (severe) 27,1 22,8

Acute under-nutrition (global) 5,8 5,8

Underweight (global) 28,8 23,6

Education

Primary NAR (% of children aged 7-12) 73,3 84,5

Secondary NAR (% of children aged 13-18) 11,9 21,0

Health

% of deliveries in health facilities 59,5 78,8

% of children aged 12-23 months fully immunized 83,0 65,4

% of households with an insecticide-treated bed-net 52,6 66,2

% of children under 5 with fever taken to health provider 62,1 67,2

% of women aged 15-49 who took an HIV test and received results 18,7 55,3

Water and sanitation (% de population)

Use of improved drinking water sources 75,2 83,5

Use of improved sanitation facilities (unshared) 31,4 26,2

Child registration

% of children under 5 with birth registered 75,2 83,3


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Levels of deprivation are much higher in rural areas and also vary by regions, with the North worst off for many indicators, as can be seen in Annex Table B.2. For example, the PMS data show chronic under-nutrition rising from 29% in urban areas (and 24% in Bujumbura Mairie) to 48% in rural areas and a high of 50% in the North. The North also has the highest proportion of children aged 7-12 not attending primary school (20%), while the overall rural and urban figures are 16% and 8% respectively. Almost a quarter of births take place outside a health facility in the rural areas (23%), compared with 6% in urban areas, with the highest regional figure again in the North (26%).

Figure 2-12: Selected human deprivation indicators by consumption expenditure quintiles, 2012/2013 (%)


While considerable progress has been made towards gender parity in primary education, some categories of children are especially vulnerable to the risk of being deprived of education. According to the 2010 DHS, the primary net attendance ratio for girls (73.8%) is marginally higher than for boys (72.8%), giving a gender parity index of 1.01. By secondary level, however, there is a wider gender disparity to the advantage of boys (with a GPI of 0.88), although the dominant problem at this level of education is the very low access for both girls and boys (with net attendance ratios of only 11.2% and 12.7% respectively). Some disaggregated education data are available for two specific groups with heightened vulnerability: orphans and Batwa children. It is also highly likely that children with disabilities have reduced access to education, due to discrimination and inadequate measures to address special educational needs.

The DHS 2010 found that only 74.7% of double orphans (orphans who have lost both their parents) aged 10-14 attended school, compared with 91.0% of non-orphan children who lived with at least one of their parents. 2.0% of children under the age of 18 have lost both their parents, a proportion that rises progressively with age, from 1.1% in the age group 5-9 to 3.1% of 10-14 year olds and 6.5% of 15-17 year olds.

The 2006-2008 survey on the Batwa found that 25.5% of Batwa children aged 0-18 were in primary school and 1.3% were in secondary school (UNIPROBA & IWGIA, 2008). The survey report provided no further breakdown of enrolment by age groups, but the figures suggest much lower levels of enrolment of Batwa children, compared with other children, especially at secondary level.

51

22

13

26

18

77

50

1815

25

18

76

49

12 13

19 17

72

43

11 11

21

15

77

37

11 13 13 14

67

0

10

20

30

40

50

60

70

80

90

Chronic under-nutrition (children

under 5)

Children aged 7-12aged not in school

Children under 5not consulting ahealth provider

when ill

Births outside ahealth facility

Non-utilization ofimproved water

sources

Non-utilization ofimproved

sanitation facilities

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5


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2.6 Conclusion

The situation of massive deprivation, with weak differentiation across the bottom deciles of the population, makes it intrinsically difficult to target social safety nets well, but very limited fiscal space makes the efficient use of resources essential.

As this chapter has shown, there is only a small inter-decile difference in consumption expenditure across the bottom six deciles, and only in the tenth decile are households substantially better off. Likewise, although there is a correlation between consumption expenditure and many indicators of human deprivation (or conversely human development), this also appears to be quite weak, with high levels of deprivation (in particular chronic under-nutrition) and child mortality across all quintiles, again with a larger improvement only in the richest quintile.

This structure of widespread raises challenges in terms of program coverage even though prioritization is unavoidable and critical in a country that has extremely limited resources for public expenditure, is heavily dependent on external aid and has many competing priorities for development.

Burundi’s public expenditure on social protection is the subject of the next chapter. At this stage of the analysis, however, we can conclude that priority must be given to improving the resilience of the poorest and weakest, difficult though the challenges of accurate targeting will be.

Given the fiscal space constraints and the livelihoods and human development challenges facing the most deprived and vulnerable, the analysis in this chapter suggests that the targeting of safety net programmes will probably needs to rely on a combination of methods, including geographical and categorical targeting as well as a set household-level variables linked to poverty such as demographic structure and ownership of key productive assets. The population in the first quintile is more concentrated in the North and Centre-East regions (the North also performing worse for several human development indicators).

The analysis has shown that, relative to better-off households, households in the poorest quintile have smaller land-holdings (with many more households owning less than 0.2 ha), are less likely to have livestock (and especially cows or other large livestock), and tend to have more household members and a higher dependency ratio.

Further analysis, including multivariate regression analysis, will be needed at the stage of developing the social protection strategic plan to identify more precisely the criteria that would best identify the poorest and most vulnerable households.


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3 PUBLIC EXPENDITURE ON NON-CONTRIBUTORY SOCIAL PROTECTION

Burundi’s public finances are dependent on high levels of external aid. The country has one of the lowest levels of domestic government revenue relative to gross domestic product (GDP) in Sub-Saharan Africa, reflecting the low level of development of the formal sector of the economy. However, it has been able to sustain quite high levels of public expenditure relative to GDP, due to large inflows of external aid, much of which has been for humanitarian assistance. Indeed, Burundi is one of the most aid-dependent countries in the world.

Figure 3.1 shows Burundi’s public finance performance in 2009-2013 in comparison with averages for the Sub-Saharan African countries that, like Burundi, depend on oil imports. To make the comparisons meaningful, South Africa has been excluded. As can be seen, Burundi has much lower levels of domestic revenue, averaging 14% of GDP in this period, compared to the comparator countries (19%).

On the other hand, it has much higher levels of expenditure, at 37% of GDP in this period, resulting in a very large overall fiscal deficit (excluding grants) that has been equivalent to almost one quarter of GDP (23%), compared with 6.8% in oil-importing Sub-Saharan Africa (minus South Africa). This has been made possible by the high level of official grants, which amounted on average to 13% of GDP over this period (3.6 times more than in the comparator group of countries), although this ratio has been declining, reaching 8.0% in 2012.

Figure 3-1: Public finance indicators for Burundi and oil-importing Sub-Sahran Africa excluding South Africa, average for 2009-2013

Source: IMF, Regional Economic Outlook, Sub-Sahran Africa, April 2014.

The fiscal space for financing expenditure on social protection is very limited, but can be expanded by efforts to boost domestic revenue and by the reconfiguration of humanitarian assistance to finance long-term safety nets. In assessing the scope for financing social protection, it is important to be aware of the constraints arising from the low level of domestic revenue mobilization and the risks of a high level of aid dependence.

Nonetheless, the fiscal space for long-term social protection programmes can be expanded in three main ways: first, by improving the tax yield through improved tax administration; second, by engaging with donors

22.8

14.4

37.1

13.1

6.8

18.8

25.6

3.6

0

5

10

15

20

25

30

35

40

Overall fiscaldeficit

excludinggrants

Domesticgovernment

revenue

Governmentexpenditure

Official grants

Burundi

Oil-importing Sub-SaharanAfrica (excluding South Africa)


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in a joint initiative to reorient resource flows away from short-term humanitarian assistance towards longer-term safety nets that address structural vulnerability; and third, by achieving improved efficiency in the use of resources for social protection. Each of these opportunities will be discussed further at the end of this chapter.

This chapter analyses the scale, composition and trends in public expenditure on non-contributory social protection in Burundi during the period 2010-2012. For this purpose the study has applied a broad inclusive approach to the concept of non-contributory social protection by including some types of programmes and projects that might be regarded as falling outside the scope of ‘safety nets’ in a narrow sense. This makes it possible to analyse the spending on different types of safety net programmes within a broader perspective. In addition to the analysis in this chapter, more detailed data may be found in Tables B.3-B.6 in Annexe B.

3.1 Data sources

Analysis of this nature is particularly difficult in Burundi due to the lack of integrated and comprehensive public finance data presented on a programme basis. Besides the fact that Burundi does not yet have a programme-based budget classification system, the main reason for this is that a large part of public expenditure is financed by foreign donors through project aid and is not recorded in the government accounts through the Integrated Public Finance Management System (SIGEFI). Project aid is particularly important in the sectors most directly related to poverty reduction and social/humanitarian programmes, and very little of this is recorded in the government accounts.

For the purposes of this study it was necessary to construct an integrated database on public expenditure on non-contributory social protection by making use of several different data sources. First, the SIGEFI data on allocated and executed on-budget expenditures were used. Second, for foreign financed programme/project expenditures, some data were obtained from the database of the National Aid Coordination Committee (CNCA). However, this data is not classified in a way that makes it easy to identify the nature of the projects financed, and is not disaggregated for projects that cover interventions in several fields. Third, to complement the CNCA data, expenditure data were collected directly from the agencies that finance or manage the main non-contributory social protection programmes. In all, data on about 80 programmes and projects were collected from government ministries, donors, UN agencies and NGOs.

The data analysed in this chapter are not totally comprehensive or reliable but do make it possible to draw a broad picture of the pattern of public expenditure on non-contributory social protection. Some smaller projects may have been missed and some inaccuracies may have arisen from the different nature of the expenditure data provided by the different sources (donor disbursements, expenditure commitments, actual payments, etc.). There may also be some double counting, although this has to a large extent been avoided by triangulating the data from the different sources. Given the weaknesses in the public financial management system, especially regarding the integration of data on foreign financed project expenditures, a completely accurate set of accounts on expenditures on non-contributory social protection is almost impossible to construct. Nonetheless, this analysis does provide a reasonably accurate picture of the overall scale, composition and trends in expenditure over the period 2010-2012.

3.2 Government expenditures

Non-contributory social protection receives a very small share of government expenditure. Analysis of the SIGEFI data shows that executed expenditure on non-contributory social protection rose from BIF 21.8 billion in 2010 to BIF 24.6 billion in 2011 and BIF 31.0 billion in 2012 at current prices. However, this did not represent an increase when expressed as a percentage of gross domestic product (GDP). Non-contributory social protection expenditure is well under 1% of GDP and there was actually a decline in 2011 followed by a slight recovery to 0.87% in 2012. Non-contributory social protection accounts for only about 4.5% of total government expenditure recorded in SIGEFI (see Table 3.1).


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If higher education scholarships are excluded, expenditure is much lower. One of the most striking findings of the analysis is that scholarships for higher education students account for almost two fifths of this expenditure (36.5% in 2012). Although these scholarships are a form of social transfer, they arguably do not constitute a core safety net programme and they generally don’t reach the poorest students (who tend to drop out before they can reach higher education). If the expenditure on these scholarships is excluded, the remaining government expenditure on non-contributory social protection declines to only 2.5% of total recorded government expenditure and 0.5% of GDP in 2012.

Table 3-1: Government expenditures on non-contributory social protection, 2010 – 2012

Allocated Actuael (paid)

2010 2011 2012 2010 2011 2012

Non-contributory social protection (BIF million) 31,8 27,2 31,4 21,8 24,6 31,0

As % of total government expenditure 4,70 3,68 4,02 3,66 4,30 4,51

As % of GDP 1,27 0,92 0,88 0,88 0,83 0,87

Execution rate (% of allocation) 68,7 90,6 98,9

Non-contributory social protection excluding scholarships (BIF million)

19,9 18,3 20,1 11,8 16,3 19,7

As % of total government expenditure 2,94 2,47 2,58 1,98 2,84 2,87

As % of GDP 0,80 0,61 0,56 0,47 0,55 0,55

Execution rate (% of allocation) 59,3 81,8 99,2

GDP (BIF billion) 2 495 2 971 3 566

Total government expenditure (BIF million) 675,7 739,0 779,9 595,8 572,8 688,1

Overall execution rate (%) 88,2 77,5 88,2

Source: Government accoutns (SIGEFI).

Further analysis shows that, after scholarships, the largest expenditure components are humanitarian assistance, medical assistance, services for persons with disabilities and school feeding (see Table 3.2). Humanitarian assistance (14.9% of the total in 2012) is mainly for the repatriation and reinstallation of returning refugees and relief items for communities affected by natural disasters.

Medical assistance (12.0% of the total in 2012) consists of two items: subsidies for the medical assistance card (CAM), through the health ministry, and the medical assistance provided by the national solidarity ministry to settle the hospital and pharmacy bills of destitute patients. Government funding of school feeding (9.7% of the total) started in 2011 but provides quite a small part of overall expenditure on school feeding (about 17% in 2012).

Government expenditure on services for persons with disabilities (7.0% of the total) includes transfers to several institutions that provide specialized services, such as the CNAR and the CNRSP. These different types of programmes will be reviewed in Chapter 5.

Other expenditure areas receive very little funds. These include labour-intensive public works (only 0.7% of the total in 2012), services for vulnerable children (2.2%), assistance to persons affected by HIV/AIDS (1.4%), gender programmes (2.0%), and the protection and promotion of human rights (3.1%). Expenditure on central administration, which consists almost entirely of salaries, is very low (2.2%), but additional recurrent costs are financed through transfers to autonomous institutions and projects. The Family and Community Development Centres (CDFCs), which are responsible for social assistance at provincial level, received only 0.2% of government expenditure on non-contributory social protection in 2012, which indicates that they


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are not yet receiving resources that are anything like commensurate with their critical mandate as front-line service delivery units for social action at community level.

Table 3-2: Composition of executed government expenditure on non-contributroy social protection, 2010 – 2012

Million BIF % of total

2010 2011 2012 2010 2011 2012

Central Administration 669 509 675 3,1 2,1 2,2

CDFC 258 9 64 1,2 0,0 0,2

Humanitarian assistance, including aid for repatriation

3 188 4 130 4 640 14,6 16,8 14,9

Aid to persons affected by HIV/AIDS 833 603 445 3,8 2,4 1,4

Aid to vulnerable children 447 523 691 2,0 2,1 2,2

Air to persons with disabilities 2 500 2 061 2 187 11,5 8,4 7,0

School feeding 0 3 000 3 000 0,0 12,2 9,7

Scholarships for higher education 10 039 8 385 11 315 46,0 34,0 36,5

Medical assistance 1 297 2 427 3 732 5,9 9,9 12,0

Labour-intensive PWPs 140 266 232 0,6 1,1 0,7

Distribution of livestock & agricultural inputs 129 131 130 0,6 0,5 0,4

Promotion of women & gender equality 88 375 622 0,4 1,5 2,0

Human rights 116 171 953 0,5 0,7 3,1

Other 2 127 2 052 2 351 9,7 8,3 7,6

Total 21 832 24 642 31 036 100,0 100,0 100,0

Source : Government accounts (SIGEFI).

Unfunded mandates limit the financing of social assistance at decentralized level. Although the communes have a mandate for social assistance, and are the bodies responsible for issuing the indigence certificates (attestations d’indigence) for fee waivers in health care and secondary education, they have no specific budget lines to finance these programmes. This limits implementation in practice although the national solidarity ministry does have some budget resources for its medical assistance scheme, which is used to settle the hospital and pharmacy bills of a few indigents (see Section 5.6). The communes have financial autonomy, but the low level of retained local taxes and the lack of fiscal transfers from the central government (apart from transfers for certain investments) mean that in practice the communes have almost no resources to finance current expenditures on social assistance.

3.3 Donor funded expenditure

Donor funded expenditure on non-contributory social protection (including humanitarian assistance) is about four to five times higher than expenditure by the government with its own internal resources. Externally funded expenditure rose from BIF 107 billion in 2010 to BIF 126 billion in 2011 and BIF 135 billion in 2012. As a proportion of GDP, however, there has been a decline from 4.3% in 2010 and 2011 to 3.8% in 2012, due to the reduction in humanitarian and post-conflict assistance, which has provided a large part of these aid flows (see Table 3.3).

The composition of donor-financed expenditure is heavily tilted to labour intensive public works (PWPs). A large and growing share of donor-financed expenditure, rising to 38% in 2012, is for PWPs. This includes several projects financed by the World Bank, the African Development Bank, the International Fund for Agricultural Development (IFAD), the World Food Programme (WFP), the United Nations Development Programme (UNDP) and the Belgian aid agency, which will be discussed in Section 5.2.


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Humanitarian assistance, in particular for the return and resettlement of refugees, is another large component, although its share has declined from 32% in 2010 to 25% in 2012.

Other major expenditure areas for donors have included demand-side education measures (mainly school feeding and the distribution of school kits, supported respectively by WFP and UNICEF and accounting for 12% of the total spending in 2012), the provision of food supplements for the prevention and treatment of acute malnutrition (9%), the distribution of livestock (through the livestock solidarity chain approach discussed in Section 5.3) and agricultural inputs (7%) and support for vulnerable children (5%).

Table 3-3: Donor expenditure on non-contributory social protection, 2010 – 2012

2010 2011 2012

BIF

million % of total

BIF million

% of total

BIF million

% of total

Humanitarian assistance, including aid for repatriation and resettlement

34 385 32 29 279 23 34 186 25

Aid to persons affected by HIV/AIDS 3 805 4 788 1 1 369 1

Aid to vulnerable children 6 124 6 7 233 6 7 032 5

School feeding and school kits 21 825 20 12 712 10 16 283 12

Labour intensive PWPs 23 139 22 41 483 33 51 132 38

Distribution of livestock and agricultural inputs 3 766 4 5 137 4 9 243 7

Food supplements (for malnutrition) 12 694 12 24 705 19 12 382 9

Others 1 519 1 5 733 5 3 120 2

Total 107256 100 127070 100 134750 100

As % of GDP 4,3 4,3 3,8

Sources: CNCA, SIGEFI, donors, government agencies and NGOs.

3.4 Overall expenditures

Taking both internally and externally funded expenditure together, overall expenditure on non-contributory social protection is about 5% of GDP, but this reflects the inclusion of post-conflict humanitarian aid, which is likely to decline in the coming years. Including humanitarian aid, total non-contributory social protection expenditure has already fallen relative to GDP, from 5.2% in 2010 to 5.1% in 2011 and 4.7% in 2012 (see Table 3.4).

As the post-conflict situation comes to an end, with almost all Burundian refugees now back in the country and resettled, the decline in humanitarian assistance can be expected to continue, creating challenges to mobilize adequate resources for a long-term safety net system to address structural vulnerability.

Due to the predominance of aid financing, the composition of expenditure largely reflects the breakdown of aid-financed expenditure, discussed above. Expenditure on labour-intensive public works is the largest component and has grown steadily as a share of the overall total, from 18% in 2010 to 31% in 2012. This is followed by humanitarian assistance, which is on a declining trend, from 29% in 2010 to 23% in 2012. The other main expenditure categories are the demand-side education interventions (school feeding and others), food supplements for prevention and treatment of acute malnutrition and higher education scholarships. Due to their large share of the internally financed expenditure, scholarships accounted for almost 7% of total expenditure in 2012 (see Table 3.4 and Figure 3.2).


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Table 3-4: Overall expenditure on non-contributory social protection, 2010 – 2012

2010 2011 2012

Total internally and externally financed expenditure (BIF billion) 129 087 150 985 165 786

Total as % of GDP 5,17 5,08 4,65

Composition of expenditure (% of total)

Humanitarian assistance, including aid for repatriation and resettlement

29,1 22,1 23,4

Aid to persons affected by HIV/AIDS 3,6 0,9 1,1

Aid to vulnerable children 5,1 5,1 4,7

Aid to persons with disabilities 1,9 2,7 1,3

School feeding & other assistance to school attendance 16,9 9,9 11,6

Labour intensive PWPs 18,0 27,7 31,0

Distribution of livestock and agricultural inputs 3,0 3,5 5,7

Food supplements (malnutrition) 9,8 16,4 7,5

Medical assistance 1,9 2,6 3,2

Scholarships for higher education 7,8 5,6 6,8

Other 2,8 3,6 3,7

Total 100,0 100,0 100,0


Figure 3-2: Composition of non-contributory social protection expenditure, 2010 – 2012


Humanitarian assistance25%

Aid to persons affected by HIV/AIDS

2%Aid to vulnerable

children5%

Aid to persons with disabilities

2%

School feeding & school kits12%

Labour intensive PWPs26%

Distribution of livestock and

agricultural inputs4%

Food supplements (malnutrition)

11%

Medical assistance3%

Scholarships for higher education

7%

Other3%


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Burundi

3.5 Conclusion

A major challenge will be to mobilize adequate resources for long-term safety nets despite the decline in humanitarian assistance. Fiscal space for expanding public expenditure will remain quite limited in the coming years, given the large overall deficit in government finances before grants, equivalent to 18.7% of GDP in 2012 (IMF, 2014). The three main opportunities for improved financing of safety nets would be an increase in domestic revenue, the reorientation of humanitarian aid to support for longer-term social protection and the phasing out of fuel subsidies.

One potential source of fiscal space would be an increase in internal revenue mobilization, as revenue (13.0% of GDP in 2012) is still low by regional standards (19.5% in oil-importing countries in Sub-Saharan Africa excluding South Africa and 19.3% in the East African Community in 2012). Measures are being taken to widen the tax base, but the IMF expects net borrowing to remain around 2.9% of GDP in 2015-2016 (IMF, 2013b).

Humanitarian aid should be reconfigured to assist the strengthening of the long-term resilience of the most vulnerable households. This would adapt aid flows from short-term humanitarian needs to address the structural challenge of reducing the vulnerability of households. As in Ethiopia, where several donors have come together to provide coordinated and predictable long-term assistance through the Productive Safety Nets Programme as an alternative to short-term humanitarian assistance, the Government should work with donors to plan this shift.

It will be critical to finance safety nets increasingly through budget support, which would provide a more stable framework for long term financing of programmes than continued heavy reliance on time-bound project financing. This could be done within the framework of general budget support, or alternatively through a basket fund such as the Social Protection Support Fund (FAPS) envisaged in the National Social Protection Policy and the Strategic Framework for Growth and the Fight against Poverty (CSLP). In either case, multi-donor programme aid would require multi-year strategic planning with targets for the coverage of core programmes within a performance assessment framework, monitored either at the macro level of the CSLP and public finances (for general budget support) or at the level of a social protection strategic plan (for a social protection fund).

On the expenditure side, the rationalization of social protection spending could free up resources for high-priority safety net programmes. This could include a shift in donor funding from short-term humanitarian assistance to longer-term safety nets, as indicated above.

As far as internal expenditure is concerned, resources could be freed up for safety net programmes by reducing the substantial spending on fuel subsidies (approximately 0.75% of GDP), which, although presented as a temporary measure to mitigate the impact of the high cost of living on the poor, mainly benefit the better-off.


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4 THE POLICY AND INSTITUTIONAL FRAMEWORK

The policy and institutional foundations for a strengthened social protection system are being put in place. This process began with the adoption of the National Social Protection Policy by the Council of Ministers in April 2011, and led on to the inauguration of its inter-ministerial coordinating body, the National Social Protection Commission, in April 2013, and the establishment of a secretariat to support the implementation of the Policy (operational from early 2014). The main challenges now are, first, to develop further the programmatic content of the Policy, especially with respect to the non-contributory branch of social protection, and second, to build the institutional capacity needed to design social protection programmes and manage their implementation at central and local level. The crucial next step is to prepare a costed strategic plan for implementing priority programmes in the next few years.

4.1 The policy framework

The National Social Protection Policy sets out an overall framework for strengthening social protection, which was subsequently incorporated into the second-generation poverty reduction strategy paper, the Strategic Framework for Growth and the Fight against Poverty (CSLP II) for 2012-2015. Pillar 3 of the CSLP II focuses on improving the accessibility and quality of basic social services and strengthening the ‘social protection floor’. Strengthening the social protection system is therefore prominent in the national development discourse, and the fact that the Head of State chairs the National Social Protection Commission, reflects this prominence (see Section 4.2).

Other official documents orient policies and programmes related to social protection in specific thematic areas. For example, the National Strategy for the Socioeconomic Reintegration of Populations Affected by the Conflict, adopted in May 2010, provides the overall framework for programmes assisting the reintegration of returning refugees, displaced persons and ex-combatants (MSNRRRS, 2010). The National Policy for Orphans and Vulnerable Children, adopted by the Council of Ministers in September 2008, provides an integrated framework for supporting vulnerable children (MSNDPHG, 2008).

The National Social Protection Policy aims to extend social protection as a human right, in accordance with the international conventions ratified by Burundi and the rights enshrined in the national Constitution. It has five specific objectives, which are to strengthen the contributory capacity of the population, extend coverage progressively to the whole population, improve the governance of social protection schemes, strengthen mechanisms for the prevention of social risks and strengthen the institutional capacity for programme implementation.

The policy is more concrete regarding the contributory branch of social protection (social insurance), and health insurance in particular, than on non-contributory social protection, including safety nets. It sets quantified targets for expanding health insurance coverage, but does not provide similar targets in other areas. However, given the weak contributory capacity of the poor, contributory social protection will need to be complemented by non-contributory social assistance to widen the coverage of social protection and reduce the vulnerability of the poorest. Despite the intrinsic administrative difficulties involved, there is also need for more work to adopt and implement realistic measures that seek to extend social insurance to the population in the informal sector that can realistically afford to contribute. The Policy is vaguer about the development of non-contributory part of social protection, despite its potential role in supplementing the income of poor and vulnerable households, improving access to basic social services (including education as well as health), building human capital and improving the productivity of the poor.

4.2 The institutional framework

The establishment of the National Social Protection Commission (CNPS) augurs well for the development of a stronger and more coherent social protection system. The CNPS was set up by presidential decree no


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100/237 of 22 August 2012 and was formally inaugurated in April 2013. Chaired by the President of the Republic and including eleven ministers, the Commission has political-level responsibility for promoting and overseeing the implementation of the National Social Protection Policy. As such, it could give social protection much greater visibility than in the past while also improving the overall coherence of social protection programmes.

To realize this potential, the Commission needs to be supported by a technically strong secretariat and effective mechanisms for coordination among the different public, non-governmental and external agencies involved in managing and financing social protection programmes.

The decree establishing the CNPS accordingly provides for a permanent executive secretariat and for a technical committee that is chaired by the Minister of the Civil Service, Labour and Social Security and includes senior civil servants from the member ministries and the donors most active in supporting social protection. The Technical Committee has four thematic groups, responsible for social and mutual insurance, social assistance, access to incomes and financing of social protection.

Decree no 100/237 provides also for the establishment of provincial commissions chaired by the provincial governors and communal commissions chaired by the communal administrators, including in both cases nominated representatives of decentralized and de-concentrated public institutions and civil society organizations. As has been noted in Chapter 3, the decree envisages in addition the creation of a Social Protection Support Fund (FAPS) to finance programmes set up under the Policy.

The permanent executive secretariat of the CNPS has also taken over the role previously played by the Directorate-General of Social Protection (DGPS) in the Ministry of the Civil Service, Labour and Social Security. DGPS had traditionally focused mainly on overseeing the contributory social insurance schemes for formal sector workers managed by the National Social Security Institute (INSS), the National Office for Pensions and Professional Risks (ONPR) and the Mutuelle de la Fonction Publique (MFP), which provides health insurance for civil servants. DGPS also became increasingly involved in accrediting organizations engaged in mutual health insurance, in accordance with procedures adopted in May 2011 (MFPTSS, 2011), but it had little experience of the non-contributory branch of social protection.

The permanent executive secretariat will require technical strengthening to perform effectively its role. Its staff will need training in the broader theory and practice of social protection. This is particularly needed outside the field of contributory social security, in which its staff already have some longstanding expertise. The secretariat is receiving some capacity-building support from the AfDB, UNICEF and UNDP.

The Ministry of National Solidarity, Human Rights and Gender, which has the core responsibility for social assistance programmes for the most vulnerable, also needs strengthening. This ministry was set up in 2006 as a result of the fusion of several smaller ministries. In addition to overseeing programmes for traditional vulnerable groups such as orphans, street children, disabled persons and the vulnerable elderly, it coordinates humanitarian programmes, including programmes for the return, resettlement and reintegration of returning refugees, IDPs and ex-combatants, and relief for the victims of natural disasters. It also has responsibilities for the promotion and protection of human rights, and for the promotion of women and gender equality. As of April 2013, this ministry had 672 employees, of which about 30% were at central level, 25% in the Family and Community Development Centres (CDFCs), its de-concentrated units at provincial level, and 45% in specialized centres and project units. The overall educational level of staff is quite low. Only 20% of staff members have any level of tertiary education (Category 1 staff), while 48% have secondary education and 31% have primary education (see Table B.5 in Annex B).

Like the staff of DGPS, the personnel of the national solidarity ministry needs retraining to acquire broader social protection (and social work) knowledge and skills, after years in which the Ministry’s main focus has been on providing humanitarian assistance, engaging in community awareness raising (through the CFDCs) and providing a limited range of services through specialized centres and projects, notably to persons with


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disabilities, children in institutional care and victims of gender based violence. In addition to providing in-service training to broaden and upgrade skills, consideration should be given to reviewing and improving the initial training provided by the two main schools in this field in Burundi: the Ecole Sociale (ECOSO) and the Ecole Normale de l’Economie Familiale (ENEFA).

Several other ministries have social protection mandates within their sectors, underscoring the need for effective inter-ministerial coordination. The fact that the CNPS has eleven member ministries reflects the fact that social protection is not only a sector in its own right, with two ministries sharing a core mandate for contributory and non-contributory social protection respectively, but is also a crosscutting function that concerns many other ministries within their own particular domains. For example, the education ministry is responsible for the school feeding programme and other demand-side education initiatives like the distribution of free school kits. The Ministry of Public Health and the Fight against HIV/AIDS implements the policy of free health care for children under 5 and pregnant women, as well as the CAM, while the National Council for the Fight against AIDS (CNLS) coordinates programmes to support families affected by HIV/AIDS, including OVCs. Project management units that report to the ministries responsible for public works, agriculture and livestock, and development planning implement most of the labour-intensive public works programmes. Effective coordination among these different ministries would help to ensure the coherence and complementarity of programmes, in particular by establishing shared systems (for example for the targeting of beneficiaries) and mechanisms for referral of beneficiaries between complementary services in different sectors.

The division of responsibilities for social assistance between the vertical structures of national ministries and horizontal decentralized institutions is unclear. The administrative responsibilities for delivering social assistance at the local level are not well delineated. There seems to be an overlap between the mandates of the local governments, in particular the communal administrations, and the de-concentrated bodies of national ministries. On the one hand, the communal administrations play a role in social assistance by issuing the indigent certificates (attestations d’indigence) for the waiver of secondary school fees and for health care, but this mandate is not financed in practice (see Chapter 3). It is left to the schools and health facilities (managed by the vertical systems of the education and health ministries) to absorb the costs or, as if often the case, simply to ignore the certificates issued by the communes, unless (in the case of health) the bills are paid by the medical assistance of a third ministry: the national solidarity ministry (see Section 5.6). The main public bodies for social work at community level, the CDFCs, are local structures of the national solidarity ministry, rather than the communes, although they liaise in an ad hoc way with the latter, referring indigents to the communes to obtain attestations. The social aid provided by the national solidarity ministry itself, including through its medical assistance scheme, remains centralized, with all requests for aid sent to the capital for approval and disbursement of funds. The CDFCs themselves receive no funds for social aid of any sort.

Local-level capacity for the delivery of social assistance is especially weak. The Ministry of the Civil Service, Labour and Social Security has no presence at sub-national level apart from its regional civil service offices (antennes régionales de la fonction publique), which are currently located in seven provincial capitals but do not have a specific social protection function. As of April 2013, only 50 of the 354 staff of this ministry were at provincial level and none at communal level (see Table B.6 in Annex B). The ministry plans to establish secretariats for the provincial and communal social protection commissions, as envisaged in decree no 100/237.

The CDFCs exist in each province, but their capacity to deliver services to the most vulnerable appears to be limited. Originally set up by the ministry responsible for the promotion of women and gender equality,


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their mandate has expanded as a result of their absorption into the wider Ministry of National Solidarity, Human Rights and Gender.8

The CDFCs are expected to work in all fields addressed by the ministry. Specific responsibilities include assistance to vulnerable groups, support for the community-based Child Protection Committees (CPEs) set up at provincial, communal and colline levels9, the monitoring of residential centres and organizations providing services for vulnerable groups, participation in provincial and communal coordination mechanisms, facilitation of access by vulnerable persons to the medical assistance provided by the Ministry, support for the reintegration of returning refugees and other war victims, the promotion and protection of human rights, improvement of the well-being of rural women, the prevention of and response to violence against women and children, and the promotion of gender equality. They are also involved in promoting and coordinating the community-based Women’s Forums recently established along lines similar to the CPEs.

To carry out their wide-ranging mandate, the CDFCs still have only a very small core staff in the provincial capitals (a coordinator, a deputy coordinator and a secretary-accountant), with usually one vehicle, and small sub-offices in the communes, staffed normally by just one employee (an assistant social) per commune equipped with a moped for fieldwork in the communities.10 These are clearly very light structures, and this is reflected in their low level of funding, which amounted to only 0.2% of government spending on non-contributory social protection in 2010-2012, as highlighted in Chapter 3.

For community level activities, the CDFCs depend heavily on the self-motivation of unpaid volunteers (imboneza), while also linking up with NGOs implementing donor-funded projects. They concentrate their limited resources on community awareness raising (see Chapter 5), while also backstopping the community-based Child Protection Committees and the newer community-based Women’s Forums. A strategic plan to strengthen the CDFCs over the period 2013-2015 has been developed by the ministry with assistance from GIZ (MSNDPHG, 2013).

Much of the community-level work is carried out by NGOs, creating a high degree of fragmentation, donor dependence and risks of non-sustainability. A large number of NGOs, international and national, secular and confessional, are involved in the delivery of social assistance programmes at community level. This is both a strength and a weakness: a strength because in practice these are the main service-providers reaching the most vulnerable populations, but a weakness because their sheer profusion and their dependence on short-term project funding from donors make it especially challenging to build a coherent and sustainable system of social protection. There is some coordination among the NGOs themselves, mainly for information exchange. The international NGOs are members of a network known as RESO (Coming Together, Exchange and Solutions among NGOs), while the national NGOs are organized in various thematic networks, such as the Burundian Network of Associations of Persons with Disabilities (RAPHB). The community-based mutual health organizations and their promoters (often specialized NGOs) have set up a coordinating structure, the National Platform for Dialogue among Mutual Health Organizations in Burundi.

8 See decree no 100/325 of 17 December 2012 on the creation, structure, mission and functioning of the CDFCs (Cabinet du Président, 2012b).

9 The CPEs at colline level have seven members, of which five are adults (including the chef de colline/quartier and two women) and two children aged between 15 and 18. At communal and provincial levels, the committees include representatives of the respective administrations, as well as the CDFC, education, health, the police and other services, and representatives of civil society and children.

10 Decree no 100/325 of 17 December 2012 increases the number of social assistants per commune from 1 to 2, but these have not yet been recruited.


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4.3 Conclusion

A budgeted strategic plan should be drafted and adopted, setting out concrete and realistic results to be achieved in the next few years. This is already planned as a follow-up task to the adoption of the PNPS and the establishment of the National Social Protection Commission. This plan should give priority to strengthening non-contributory programmes. It should focus in particular on transforming the current patchwork of fragmented short-term safety net projects into a core of long-term sustainable programmes reaching a critical mass of the poorest and most vulnerable households with the aim of improving their consumption, their access to social services and their human and productive capital as a strategy for building resilience and reducing long-term vulnerability.

The plan needs to include a strong focus on institutional capacity building. This needs to encompass both the capacity to plan, coordinate and manage social protection programmes at national level and the capacity to deliver programmes at local level. At national level, it is crucial to deepen staff knowledge on social protection concepts and practice in the Permanent Executive Secretariat of the PNPS and in the directorates of the ministry responsible for national solidarity. At local level, the main priority is to strengthen the CDFCs, as these are at present under-staffed and under-funded.

Without a stronger system of government bodies responsible for the delivery of social assistance at local level, it will be difficult in practice to build a stronger and sustainable system of non-contributory social protection.

The high level of donor dependence and the fragmentation of donor-funded social protection programmes and projects make it urgent to improve donor alignment and harmonization in accordance with the principles of the 2005 Paris Declaration on Aid Effectiveness. The adoption of the PNPS, the creation of a donor social protection group (following a joint government-donor meeting, convened by the Minister of the Civil Service, Labour and Social Security, in May 2013) and the preparation of a strategic plan for social protection should facilitate moving in this direction.


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5 EXISTING SAFETY NET PROGRAMMES

Safety nets in Burundi have been designed primarily to respond to short-term humanitarian and post-conflict needs, but more promotional, longer-term approaches have started to emerge in the post-conflict transitional period. Humanitarian assistance still takes the largest share of non-contributory social protection expenditure, although, as Chapter 3 showed, this share has been declining (from 29% in 2010 to 23% in 2012), reflecting the progress made in addressing immediate humanitarian needs, including the return and resettlement of refugees, during the post-conflict transition period.

Increasing attention has been given to promotional approaches that strengthen the capacity and resilience of vulnerable populations. Labour-intensive public works, whose share of non-contributory social protection spending has risen from 18% in 2010 to 31% in 2012, have emerged as a favoured strategy for raising the incomes and consumption of vulnerable households, including in particular returning refugees and ex-combatants, and some of these programmes have also included components for training, savings and access to micro-finance with the aim of promoting greater autonomy and eventual ‘graduation’ from extreme vulnerability.

Transfers of agricultural inputs and livestock have emerged as another type of intervention to strengthen the productive capacity of rural households, usually as components of broader agricultural or rural development programmes. However, cash transfers, aimed at increasing the consumption of the poorest and facilitating/promoting their investment in human capital, have not yet emerged as a social protection mechanism in Burundi, apart from one small NGO pilot, which will be discussed later in this chapter.

Interventions to promote access to basic social services and human capital development have focused up to now on fee abolition in primary education and some health services (for children under 5, pregnant women and some priority illnesses such as malaria, HIV/AIDS and tuberculosis, as well as to a very limited extent for ‘indigents’), along with the distribution of school kits to primary pupils, school feeding and the extension of health insurance through the medical assistance card (CAM) and mutual health organizations. School feeding and school kits have together comprised about a tenth of non-contributory social protection expenditure.

To facilitate the analysis in this chapter, the existing types of safety net programmes and projects have been grouped in six broad clusters: 1) assistance for returning refugees, IDPs and ex-combatants and other forms of short-term, in-kind assistance, such as food supplementation for malnourished children and women; 2) labour-intensive public works; 3) input and asset transfers within agricultural development programmes; 4) programmes for specific vulnerable population groups such as children, women, the elderly, persons with disabilities, persons living with or affected by HIV/AIDS and the Batwa; 5) school feeding and other measures to improve the demand for education; and 6) measures to improve financial access to health care.

The following sections will describe the main policy measures, programmes and projects, assess their population coverage and targeting methods, and, within the limits of available data, discuss issues concerning their efficiency and effectiveness. The analysis of effectiveness is limited by the almost total absence of rigorous impact evaluations of the programmes and projects under review, which means that very little is known about the outcome or impact level effects that can be attributed to these programmes and projects rather than to other contextual changes that have taken place in Burundi since the end of the war.

5.1 Social transfers – from humanitarian response to long-term poverty reduction

Les transferts ont été surtout des aides en nature et à court terme, suscitées par les besoins humanitaires et post-conflit. Pendant la dernière décennie, il y a eu des secours énormes à court terme en faveur des Burundais affectés par le conflit et ses séquelles, en particulier pour appuyer le retour et la réinstallation des réfugiés rapatriés et des ex-combattants. La plupart de cette assistance a été en nature, incluant en


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particulier la distribution de rations alimentaires, de kits agricoles, de kits scolaires et de matériaux de construction (tels que les tôles) pour permettre aux bénéficiaires de satisfaire leurs besoins de consommation les plus élémentaires à titre provisoire, de se réinstaller (dans leurs communautés d’origine ou dans de nouveaux villages établis à cette fin par le Gouvernement), d’envoyer leurs enfants à l’école et de démarrer des activités productives.

Compte tenu du fait que le processus de réintégration post-conflit est bien avancé, le volume d’aide alimentaire se réduit. Cette tendance se voit dans la Figure 5.1, qui montre le volume de vivres distribués par le Programme Alimentaire Mondial (PAM), qui a le plus contribué à l’assistance alimentaire aux populations vulnérables au Burundi. Incluant les vivres pour d’autres types de programmes, tels que les travaux publics à HIMO (discutés ci-dessous dans la Section 5.2) et les cantines scolaires (discutées dans la Section 5.5), ainsi que l’assistance humanitaire « pure », le volume de vivres distribués a diminué de plus de la moitié et le nombre de bénéficiaires de 36 % entre 2008 et 2012. Le défi du développement de programmes de transferts sociaux à plus long terme, avec des modalités plus flexibles de paiement en espèces, pour faire face aux problèmes structurels de la pauvreté monétaire et des privations multiples, reste entier au Burundi, bien que l’évolution dans ce sens soit abordée dans la Politique Nationale de Protection Sociale.

Figure 5-1: WFP food transfers, 2008-2012: volume distributed and number of beneficiaries

Source:WFP standard project reports.

0

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35,000

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45,000

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400,000

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2008 2009 2010 2011 2012

Total volume of fooddistributed (tons)

42,550 42,422 25,977 21,396 19,209

Total number of WFPbeneficiaries

1,157,794 1,103,818 963,589 784,166 743,377

Ton

s o

f fo

od

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arie

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Main programmes

Four main types of in-kind programmes will be reviewed here: assistance for refugees, returnees, IDPs and ex-combatants; seasonal targeted food distribution; food assistance for highly vulnerable residents of social institutions; and nutritional supplementation for children under 5, pregnant and lactating women and AIDS patients. As noted above, other types of assistance, such as the provision of employment in public works, the distribution of livestock and productive inputs through agricultural development programmes, school feeding and the distribution of school materials to facilitate and incentivize school enrolment and attendance, will be discussed in subsequent sections of this chapter.

Assistance for refugees, returnees, IDPs, ex-combatants and host communities. The UN High Commission for Refugees (UNHCR), WFP and other UN agencies, along with the national solidarity ministry, the National Office for the Protection of Refugees and Stateless Persons (ONPRA) and other Government bodies, have been the main actors providing support for these vulnerable groups. While the Congolese and other foreign refugees in camps on Burundian territory receive permanent food rations and other support, assistance is temporary for returning Burundian refugees (usually lasting six months) to avoid creating dependency or arousing jealousy from host communities. This has been coordinated by the support programme for the repatriation and reintegration of victims of the conflict (PARESI), which is overseen by the national solidarity ministry and supported by UNHCR and other partners. Assistance has gradually been downsized as the process of return has progressed, although this process has not yet completely ended. At the end of 2012, the Government and aid agencies had to cope with the sudden repatriation of 34,000 refugees after the closure of the Mtabila camp in Tanzania. In contrast to refugees and returnees, IDPs have received almost no structured assistance for many years.

Seasonal targeted food distribution. WFP has continued to provide some temporary food assistance to households in areas of high food insecurity during the two lean seasons (February-March and October-November), especially in response to climatic shocks.

Food assistance for highly vulnerable residents of social institutions. WFP has provided food for a number of social institutions run by the Government and private organizations that provide accommodation, training and other support for orphans, street children, old people and persons with disabilities.

Nutritional supplementation programmes. These are programmes for children under 5 with acute malnutrition (wasting) and malnourished pregnant and lactating women (PLW), as well as AIDS patients needing nutritional support to ensure the success of anti-retroviral therapy (ART). UNICEF is supporting the Ministry of Health to extend the coverage of community-based management of acute malnutrition (CMAM), using ready to use therapeutic food (PlumpyNut) for children with severe acute malnutrition. WFP provides blended foods (CSB, oil and sugar) for children with moderate acute malnutrition and malnourished PLW, while also providing blanket feeding for children under 2 as a preventive measure during the lean season in areas with high rates of child malnutrition. WFP food aid for ART patients is provided for 6 months, but was reduced in scope from full family rations to individual rations from 2011 due to resource constraints. There has been a geographical division of labour between WFP and two large USAID-funded nutrition programmes implemented by a consortium of NGOs led by Catholic Relief Services (CRS). The Tubaramure (‘Let’s help them to grow’) programme for preventing malnutrition in children under 2 (PM2A) is being implemented in 2009-2014 in the provinces of Cankuzo and Ruyigi, in eastern Burundi, while a Multi-Year Assistance Programme (MYAP), integrating agricultural and nutrition interventions, was


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implemented in the three northern provinces of Kayanza, Kirundo and Muyinga in 2008-2012. Both programmes have included preventive and therapeutic components for moderate acute malnutrition in young children, and for malnourished PLW, as well as capacity-building support for health centres and awareness raising for mothers on critical health and nutrition behaviours (exclusive breastfeeding, complementary feeding, hygiene, etc.), while MYAP also provided rations for AIDS patients.

Targeting and coverage

All these programmes are intended to benefit particular categories of vulnerable persons requiring special assistance, such as refugees, returnees, malnourished PLW, children suffering from or at risk of acute malnutrition, ART patients and residents of social institutions. Some of the programmes are geographically limited in scope, because needs are spatially concentrated (for example in areas receiving large influxes of returning refugees, affected by climatic shocks or with high levels of food insecurity and child malnutrition) or because resources are scarce.

While on a declining trend overall, the numbers of beneficiaries of different programmes have oscillated in response to shifting needs and resource availability. For example, the number of repatriated refugees receiving assistance from UNHCR declined from 95,000 in 2008 to 32,000 in 2009 and less than 5,000 a year in 2010-2011, but rose again to over 35,000 in 2012 following the closure of the Mtabila camp. The number of Congolese and other refugees receiving UNHCR assistance has continued to rise, from about 42,000 in 2010 to over 48,000 in 2012.

The spike in WFP’s general food distribution in 2011, shown in Table 5.1, resulted from an unplanned need to provide seed protection rations to vulnerable people in the drought-affected north of the country, as well as to provide food assistance to landless returnees settled in the integrated rural villages. The sharp decline in food provided to AIDS patients (and the number of beneficiaries) in 2011-2012 followed the decision to provide individual rather than family rations.

Table 5-1: WFP food distribution (excluding food for assets and school feeding)

Food delivered (tons) Number of beneficiaries

2010 2011 2012 2010 2011 2012

General food distribution 1 571 5 630 1 907 99 593 343 800 92 904

Food for social institutions 371 559 633 7 000 … …

Food for refugees 3 042 4 166 4 730 20 349 21 667 25 723

Food for returnees 963 746 712 20 327 6 790 35 000

Nutritional supplements: children under 5 2 262 556 1 511

9 699 19 500 67 940

Nutritional supplements: pregnant & lactating women 45 089 2 530 31 047

Food rations for HIV/AIDS patients 1 378 300 208 25 000 3 110 3 010

Source: WFP standard project reports; data provided by WFP.

Efficiency and efectiveness

More than 550,000 Burundian refugees have been assisted to return since 2002, but socioeconomic reintegration is still partial and fragile. Reintegration has presented serious challenges because of the historical cleavages within communities, fear of reprisals, disputes over land and limited opportunities for the development of sustainable livelihoods, particularly for those with little or no land. More far-reaching interventions have been devised, including the establishment of ‘peace villages’ or ‘integrated rural villages’ for the returnees with no ties to existing communities, such as most of those who fled Burundi (or whose parents fled Burundi) during the crisis of 1972. Section 5.2 will discuss projects that provide returnees and vulnerable households in host communities with opportunities for employment in public works and access to start-up capital for the launching of income-generating activities.


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Nutritional supplementation programmes have shown positive results, although the challenge of child and maternal malnutrition remains immense. The CMAM approach has been scaled up nationwide by the Ministry of Health, with implementation in 82 provinces by 2011, compared with 71% in 2010. Services for severe acute malnutrition in outpatient centres meet the national CMAM protocol norms, with an average cure rate of 78%, a mortality rate of 3% and a dropout rate of 9% (UNICEF, 2011a).

WFP has reported a supplementary feeding recovery rate for moderate acute malnutrition that has risen over the past few years from 75% to 84% (WFP, 2012a). These interventions have focused on the prevention and treatment of acute under-nutrition. However, little has been done to address the issue of chronic under-nutrition, of which Burundi has one of the highest rates in the world (see Chapter 2), and which requires a more comprehensive multisectoral approach. A programme of regular cash transfers, targeted to households with very young children, might help improve nutrition indirectly through their income effects on the quantity and quality of food consumption. The nutrition and child development impacts could also be reinforced with complementary community and parental awareness-raising on child nutrition and development, parenting, hygiene, and basic illness care. This is the approach taken in Niger, Mali, and Burkina Faso.

Transfers are not yet in place to address the long-term challenge of poverty reduction. While humanitarian and post-conflict assistance is scaling down, little has yet been done to set up transfer programmes that would help to reduce the high levels of poverty and promote human development in a long-term sustainable way. There are no statutory social assistance entitlements such as non-contributory old-age pensions, disability grants or child grants and no programmes provide regular transfers to extreme poor households with the aim of raising and stabilizing their consumption levels, developing the human capital of their children (within an inter-generational perspective of long-term poverty reduction) and enabling families to start saving and investing to build better futures. However, one NGO, Concern Worldwide Burundi (CWB), has begun a potentially path-breaking experiment of this type, the Terintambwe programme in the provinces of Cibitoke and Kirundo, which is discussed in Box 5.1.


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Box 5-1: Cash transfers in the Terintambwe programme

An international NGO, Concern Worldwide Burundi (CWB), has launched a project that provides regular cash transfers to extremely poor households. Financed by Irish Aid, this pilot project has an operational research component, which will enable CWB and the Burundian authorities to measure the impacts and learn practical lessons from the experience of implementing this type of intervention.

The Terintambwe (‘Take a Sep Forward’) programme began in mid-2012 in three communes of Cibitoke and two communes of Kirundo, selected because of their high levels of vulnerability. Cibitoke has the highest level of landlessness in Burundi, affecting 49% of households in 2008 (compared to 26% nationally), and Kirundo has one of the highest population densities (351 per square kilometre) resulting likewise in a severe shortage of land. The programme targets very poor households (in the first decile) who own no land but have labour capacity and normally depend on non-regular income from casual labour (Ntahonikora). These households are trapped in a cycle of low income, lack of productive assets and low human capital (low knowledge and skills), compounded by social exclusion and discrimination in the case of some sub-categories of returnees, Batwa, widows and people living with HIV and AIDS.

The overall goal of Terintambwe is to ensure that extremely poor and marginalized households are more resilient and have a sustainable source of livelihood. The project aims to lift the Ntahonikora out of extreme poverty with a two-stage ‘graduation’ strategy. First, starting in March 2013, the beneficiary households have been receiving consumption support through cash transfers. Amounting to BIF 25,000 (USD 16) a month per household, these transfers are paid over a period of 11 months, to help the participants stabilize their consumption and begin saving. Payments are made through ECONET, a mobile telecommunications company, and can be redeemed in cash at local post offices.

Second, the project helps the beneficiaries to plan for the future, take advantage of economic opportunities and reduce their exposure to risk. This includes the formation of small informal savings and credit groups, literacy and skills training, and the provision of asset transfers (about BIF 130,000 to 150,000 per household) to set up income generating activities. CWB has conducted market studies to identify the most promising economic opportunities.

Alongside the core graduation strategy, complementary components address other risks and needs. The project facilitates access to birth certificates, needed for children’s enrolment in school, and to the CAM health insurance scheme by paying participants’ premiums. Children of participant households are provided with a kit of school materials at the start of the school year and are required to attend school regularly, with attendance monitored through school records at the end of each term. All adults are expected to attend literacy classes, which also include modules on hygiene, children’s education, family planning and HIV/AIDS. This is a ‘soft’ rather than “hard” form of conditionality.

The project has selected the most deprived collines within the selected communes, through a social and wealth ranking, and then used community-based targeting methods to identify the eligible households within those areas. The elected selection committees produced lists of the most vulnerable households on the basis of the eligibility criteria, and the proposed beneficiaries were then verified through household visits by CSW staff and committee representatives. 2,000 beneficiary households were selected (1,000 in each province) and another 600 were allocated to a control group for the operational research.

Terintambwe has a complex set of inter-related interventions, requiring a high level of support to the participants from a cadre of ‘case managers’ (24 per province) who act as mentors. Provided with bicycles, they visit the households once a week to monitor progress and give advice, while also helping to develop the savings and credit groups, facilitating access to birth registration and the CAM, providing skills training and guiding the participants to develop micro-business activities. This may mean that the full Terintambwe design would be difficult to scale up nationally, as it would require a very large investment social workers capacity but some of the core elements may be more easily scaled-up.

Sources: CWB documents and field visit.


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5.2 Labour-intensive public works

Labour intensive public works programmes (PWPs) play a social protection role since they boost the incomes of the poorest through the large-scale provision of employment. In addition they have a potential to contribute to the creation and maintenance of community assets and the protection of the environment. In Burundi, PWPs have been a prominent component of a wide range of programmes, including programmes focused on post-conflict social reintegration, agricultural development, improvement of food security and the construction and rehabilitation of infrastructure. Basic data on these programmes is provided in Table 5.2.

Main programmes

PWPs have been a key ingredient in post-conflict initiatives to reintegrate returning refugees and ex-combatants. In accordance with the National Strategy for the Socioeconomic Reintegration of Persons Affected by the Conflict (MSNRRRS, 2010), public works feature prominently in the Programme of Support for the Socioeconomic Reintegration of Persons Affected by the Conflict in Burundi, managed by the United Nations Development Programme (UNDP). This is an umbrella programme for several different projects financed by different donors (including in particular the UN Peace-Building Fund for Burundi, the EU, Japan and the Netherlands), which follow a common methodology called the ‘3x6’ approach.11

This is based on the three principles of inclusion, appropriation and sustainability and has six steps (enrolment, rapid income generation, savings, joint ventures, investments and market access). The approach was designed to take into account the precarious situation of the returnees and the poorest, in particular the fact that they often had no access to land and so required alternative means of building sustainable livelihoods.12

11 The most recent is a project launched in 2013 to assist the socioeconomic reintegration of the Burundian refugees forced to leave the Mtabila camp in Tanzania at the end of 2012 (UNDP, 2013c).

12 In one project financed by the EU, focusing on the development of the economic and social viability of the ‘integrated rural villages’ set up by the Government to resettle some returnees without land, the returnees have been given plots of land.


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Table 5-2: Programmes with labour-intensive public work: basic data

Programme or project Period Donor Management Provinces

Projet d’Appui au Programme de Création d’Emplois (PAPCE)

2009-2012 AfDB ST-PTPCE/ ABUTIP

Ngozi, Gitega, Kayanza

Projet Multisectoriel de Réinsertion Socio-Economique (PMRSE)

2006-2012 AfDB ST-PTPCE/ ABUTIP

Bujumbura R, Bujumbura M, Gitega, Kayanza, Bururi, Rutana

Projet de Travaux Publics et de Gestion

Urbaine (PTPGU) 2009-2014 World Bank

ST-PTPCE/ ABUTIP

National (urban)

Programme Transitoire de

Reconstruction Post Conflit (PTRPC) 2006-2013

IFAD, OPEC, FBSA

IFAD/MFPD Bujumbura R, Bururi, Ruyigi

Projet d'Appui à l'intensification et à la Valorisation Agricoles du Burundi (PAIVA-B)

2010-2018 IFAD, EU, WFP IFAD/MAE Gitega, Karusi, Kayanza, Cibitoke

Programme de Développement des

Filières (PRODEFI) 2011-2019

IFAD, OPEC, WFP

IFAD/ MAE Bubanza, Muramvya, Ngozi

Programme d'appui à la réintégration socio-économique des personnes affectées par le conflit au Burundi (PARSPAC-B)

Since 2009 PBF, Japan, UE, Netherlands

UNDP Cibitoke, Bubanza, Bururi, Bujumbura M, Bujumbura R, Makamba, Rutana, Ruyigi

WFP Country Programme (through PAIVA-B and PRODEFI)

2011-2014 Multiple WFP/IFAD PAIVA-B & PRODEFI provinces

WFP Protracted Relief and Recovery Operations (PRRO 105281 & 200164)

2009-2012 Multiple WFP National

Social and economic development through labour-intensive road paving

2009-2014 Belgium (CTB) Ministry of Interior/CTB

Bujumbura M

Sources: Questionnaires and programme documents.

PWPs have been the vehicle of choice for the ‘rapid income generation’ step, while helping to build social cohesion by bringing together local residents and returnees to work together to build and rehabilitate community assets. Participants are employed in reconstruction projects for three months, receiving two-thirds of wages in cash, which in turn helps to stimulate the local economy, and one-third in compulsory savings. The projects, drawn from commune development plans, have included the rehabilitation of rural feeder roads, the construction of markets and social infrastructure, and reforestation, among others. The participants are then organized in groups or associations to prepare longer-term income-generating activities. For the start-up capital, these activities can draw on the accumulated savings of the members during the PWP phase plus an amount three times as large provided by the UNDP projects. A feasibility study is undertaken to assess whether the proposed activities have a potential market and will be economically viable. In short, there is a continuum of steps designed to facilitate the transition from short-term reintegration and income support (through PWPs) to savings, investments and long-term sustainable income-generation.

All these projects include also an important component of civic education, aimed at facilitating the social reintegration of returning refugees and ex-combatants into host communities and avoiding future conflicts (in particular over land).


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Some PWPs have been an integral part of broader rural/agricultural development programmes. This is the case, for example, of three large projects managed by the International Fund for Agricultural Development (IFAD): the Transitional Post-Conflict Reconstruction Programme (PTRPC), the Agricultural Intensification and Value-Enhancing Support Project of Burundi (PAIVA-B) and the Value-Chain Development Programme (PRODEFI). FAO has employed a similar approach. These projects have all used remunerated community labour, mainly for environmental protection works on the hillsides bordering valley marshlands that have been converted into irrigated rice fields.13

The Multi-Year Assistance Programme (MYAP), financed by USAID, used food-for-work for both the marshland irrigation works and the hillside anti-erosion works. In the IFAD projects, labour is also hired by the companies contracted to develop the rice irrigation perimeters and to build and rehabilitate access roads. A large part of WFP’s assistance for ‘food-for-assets’ (FFA) has been channelled through these IFAD projects, particularly for the community labour employed in watershed anti-erosion works.

WFP has also provided stand-alone support for FFAs through the Provincial Directorates of Agriculture and Livestock (DPAE) and NGOs. These FFAs provide short-term livelihood support by providing food rations in return for employment, while also strengthening long-term resilience by combating environmental degradation and promoting the construction and rehabilitation of assets to improve agricultural productivity and access to markets. WFP’s food-for-assets projects have focused on the production of tree seedlings, reforestation, land clearance, watershed management and the rehabilitation of rural feeder roads.

Other programmes have focused more narrowly on infrastructure development. One of the main agencies managing PWPs in Burundi is the Burundian Agency for the Implementation of Public Works (ABUTIP), which has executed the PWP components of the World Bank-financed Public Works and Urban Management Project (PTPGU)14 and two AfDB projects: the Employment Creation Programme Support Project (PAPCE) and the Multi-sector Socioeconomic Reintegration Project (PMRSE). Although these projects all aim to increase employment, their main focus has been on infrastructure.

The ABUTIP projects have financed the construction, rehabilitation and extension of primary schools, craft training centres, health centres and markets, and the paving of roads. Some of these projects have also had other non-infrastructural components, such as the strengthening of urban management (PTPGU) and the promotion of income generating activities, training and communication to communities about HIV/AIDS, sanitation and environmental protection (PMRSE).

One small project financed by Belgian Technical Cooperation (CTB) since 2009, for the paving of roads in poor suburbs of Bujumbura and in Kirundo, has a more explicit focus on maximizing labour intensity in infrastructure project design.


Targeting has had various degrees of sophistication, ranging from complex community-based methods to self-selection, rationing and in some cases a complete absence of socioeconomic criteria. All the PWPs reviewed as part of this study are geographically targeted in the sense that they (and the wider programmes

13 IFAD has also incorporated into PRODEFI a new component on the employment of rural youth, which was due to begin in March 2013 with ILO technical support. Similar components have been included in a new $120 million IFAD project, the National Programme for Food Security and Rural Development of the Imbo and Moso plains (PNSDR–IM), which is expected to begin in 2014.

14 The PTPGU (2009-2014) is the successor project to the World Bank’s earlier Public Works and Employment Creation Project (PTPCE), which began in 2001.


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and projects of which they often form part) are focused on specific provinces and communes, as shown in Table 5.2.

The rationale for selection of these geographical areas varies according to the nature, priorities and financial resources of the different programmes and projects. For example, in the case of the UNDP projects for socioeconomic reintegration of persons affected by the conflict, these have been areas of high concentration of repatriated refugees and ex-combatants. The IFAD programmes (PTRPC, PAIVA-B and PRODEFI) have selected geographical areas largely on the basis of the availability of marshlands suitable for conversion into irrigated rice-fields. WFP targets food-insecure areas, using data from its Food Security Monitoring System, and has prioritized areas with large numbers of returnees. Within project areas, the Communal Committees for Community Development (CCDC) are generally involved in organizing the selection process where this involves community-based targeting methods, which are characteristic of the UNDP, IFAD and WFP supported projects in particular.

WFP uses community-based selection methods and criteria such as household assets, food production and trading activities, while also prioritizing returnees and female-headed households.

Given its focus on post-conflict reintegration, the UNDP programme has focused on repatriated refugees, IDPs and ex-combatants, but has also sought to mix returnees with highly vulnerable local residents in PWP activities in order to avoid appearing discriminatory and to promote social cohesion. Whereas all returnees are in principle eligible, the UNDP programme has used simple categorical criteria to select vulnerable local residents: landless households headed by orphans, indigents, the disabled and chronically sick, Batwa, widows and widowers.

IFAD has used a more complex process by which all households in the areas targeted by its programmes classify themselves, in community assemblies, into different socioeconomic categories.15 The first two categories, comprising households without land or livestock (category 1) and households with less than half a hectare of land and no livestock (category 2a), are eligible for food-for-work or cash-for-work, while better-off categories of households (2b, 3, 4 and 5) receive other types of support to improve agricultural productivity and incomes. In Ngozi, the research team was told that this process of self-classification works because every category ‘wins’.

In most programmes, demand to participate in the projects outstrips the number of jobs on offer. In other words, self-selection based on the nature of the work and the level of remuneration is insufficient as a targeting mechanism, even when complemented by categorical criteria or household classification, and despite (in most cases) restricting the number of participants to one per household. Many of the programmes have to resort to rationing, using community methods to make the final selection.

Some programmes leave the selection process entirely to the companies contracted to execute construction projects. Recruitment is then on a purely market-driven basis, based on the principle of ‘first come, first serve’, with no use of social criteria apart from a requirement (in the ABUTIP contracts) that companies hire women as part of the workforce.

PWPs are providing temporary employment to less than 2% of the working-age population. Table 5.3 provides data on the number of participants in PWPs, the number of person-days of direct employment created and the average length of employment. The data are not always reliable, being in some cases estimates based on partial information. In the case of the World Bank and AfDB programmes, the data

15 This is somewhat reminiscent of the ubudehe categories in Rwanda’s Vision 2020 Umurenge Programme (VUP), although unlike in the VUP there is no category for labour-constrained households.


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reported by ABUTIP includes also the estimated indirect employment created by the multiplier effects of PWPs, without providing any information on the actual number of participants.16

The estimated total number of participants in 2012 (excluding the ABUTIP projects) was about 63,500 (or 1.2% of the population aged 15-49), while the number of person-days of direct employment created was approximately 5 million. It would be reasonable to conclude that less than 2% of the working-age population is obtaining employment through public works, and this only for short periods of time. PWP employment ranges generally between 3-4 months for the IFAD, UNDP and WFP projects and 5-8 months for the ABUTIP programmes, while the longest employment is provided by the urban CTB road-paving project (9 months).

Some programmes have been successful in promoting female participation, although several are unable to provide gender-disaggregated data. The female proportion of employment has been in the range of 30 to 44% in the UNDP programme in 2010-2012 (lowest in the case of a project focused on ex-combatants), rising to 48-49% in the case of WFP in 2010-2012 and 65% or higher in the CTB road-paving project in 2009-2012.

Table 5-3: Labour-intesive public work: employment created and wage rates

Participants (number) Direct employent created (person-days) Average period

employed

Average unskilled

wage, 2012 (BIF/day)

2010 2011 2012 2010 2011 2012

PAPCE a 0 … … 0 221,020 420,970 5-8 months 2,500

PMRSE a … … 0 30,776 40,965 0 5-8 months 2,500

PTPGU a … … … 262,500 737,054 290,646 5-8 months 2,500

PTRPC 1,801 3,323 2,733 125,460 267,170 155,205 3-4 months 2,500

PAIVA-B 9,243 12,365 3,560 447,251 574,673 178,000 3-4 months 2,500

PRODEFI 0 11,582 16,257 0 764,412 1,072,962 3-4 months 2,500

PARSPAC-B a 8,471 7,128 8,018 660,764 556,010 625,430 78 days 3,000 (incl.

1,000 savings)

WFP excluding through IFAD

61,251 32,536 32,405 4,042,566 2,147,376 2,138,730 66 days Food ration (1,525 gr)

Labour-intensive road paving (CTB)

80 345 544 1,900 82,000 204,000 9 months 3,000 (incl.

1,200 savings)

Total 80,846 67,279 63,517 5,571,217 5,390,681 5,085,943

Note: a Estimates based on partial data. Sources: Programmes annual reports, questionnaires and interviews.

Efficiency and effectiveness

Most of the programmes and projects pay participants in cash. The only exception is WFP, which still provides wages in the form of food rations, including through the IFAD programmes (PAIVA-B and PRODEFI). However, WFP began experimenting with the use of vouchers (redeemable at local shops) as a payment mechanism in Kirundo in 2012 and intends to introduce cash payments as well, based on feasibility and market studies and the fact that it provides recipients with more flexibility than food rations.

Wage rates appear to be somewhat higher than market rates. As Table 5.3 shows, most of the programmes pay unskilled manual workers about BIF 2,500-3,000 a day. Both the UNDP and CTB projects pay BIF 3,000 a day, but require the workers to deposit one third of this in savings accounts. In comparison, market wage

16 Direct employment (in person-days) has been calculated on the basis of ABUTIP’s reported ratios of indirect to direct employment created: 65/35 in 2010 and 57/43 in 2011-2012 (ABUTIP, 2011b, 2012b).


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rates for unskilled manual labour vary spatially and seasonally, but appear to average about BIF 2,000 a day in rural areas, sometimes falling to as low as BIF 1,000-1,500. This is likely to be one reason why demand exceeds the supply of short-term PWP jobs. In the case of WFP, workers receive a food ration of 1,525 grams, which is based on the consumption requirements of an average household of five members while taking into account market wage rates. WFP vouchers have a value derived from the market cost of this standard food ration, although market prices can oscillate substantially between pre and post-harvest seasons.

The paucity of data makes it impossible to calculate the labour intensity of most PWP programmes. On average, PWPs in Sub-Saharan Africa have a labour intensity (share of wages in overall programme expenditure) of about 45% (McCord and Slater, 2009), while in the ‘best’ cases this can be much higher, reaching 87% in the case of the largest such programme, the Productive Safety Nets Programme in Ethiopia (World Bank, 2009). It is very difficult, if not impossible, to calculate the labour intensity of most PWPs in Burundi, since these are often part of much wider programmes and expenditure data are not adequately disaggregated. Very few of the programmes appear to be monitoring labour intensity as a performance indicator. However, CTB has reported that its road-paving project has achieved labour intensity of 40% (see Box 3.2). Wages made up 46% of project costs in the PWP component of the socioeconomic reintegration programme in 2010-2012, according to data provided by UNDP for this study. The anti-erosion works of IFAD/WFP projects, which require very little capital equipment, may have higher wage/cost ratios than this. However, these ratios are almost certainly far lower in the ABUTIP projects that contract companies for the construction of schools, health centres and roads and use more capital-intensive construction methods.

The timing of PWP employment in rural areas has to take into account the seasonality of agricultural activities, food security and climate. Since most of the rural PWPs provide short-term employment, an important practical issue is their timing during the agricultural year. Due to the rains, it is difficult to schedule projects during the lean period in March-April, when food prices rise and food insecurity is highest before the main ‘B season’ harvest in May-June (see Section 2.2). This limits their role as an income smoothing mechanism. It is also important to avoid scheduling PWPs in rural areas during peak periods of farm-work, to avoid diverting labour from agriculture and reducing agricultural productivity. Most rural PWP activity therefore takes place after the B season harvest during the dry C season (July-September), when agricultural work is limited mainly to small areas of irrigated land. This comes shortly before the second lean period in October-November.

Both the UNDP-managed projects and the CTB road-paving project include compulsory savings and training to help beneficiaries ‘graduate’ from short-term public works employment to income generating activities. This is particularly important for populations that are landless, such as many of the returnees and other highly vulnerable rural households, as well as the urban poor, although not everyone has an aptitude for micro-business activities and it may be too optimistic to expect the beneficiaries of these projects to make the transition from a situation of destitution to successful micro-entrepreneurship in a short period of project support. Prospects for successful graduation are improved in the CTB project by the longer period of employment (9 months) and the intensive nature of the worksite training provided, which absorbs 22% of the workdays. In the UNDP projects, a grant equivalent to three times the amount saved is provided to invest in micro-projects. Data from one of the UNDP projects, in Bujumbura Rural and Bururi provinces in 2011-2012, indicates that 62% of the 7,474 persons employed in PWPs went on to form groups to develop income-generating activities (UNDP, 2013a), although no information is available on the eventual outcome of these endeavours. The other programmes have simply provided short episodes of employment in public works without giving attention to the challenge of helping their beneficiaries to move towards sustainable long-term sources of employment and income.


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Box 5-2: Maximization of labour intensity for social impacts and economic efficiency: Lessons from the road paving project in Bujumbura

5.3 Agricultural input transfers and the livestock solidarity chain

Input or asset transfers can help raise income-generation capacity and subsequently consumption. They are a form of redistribution to the poorest but focus on raising their productive capacity (Ellis et al, 2009may contribute more directly to the promotional dimension of social protection.

Main programmes

The distribution of agricultural inputs and livestock is a feature of several large agricultural development projects. In the immediate post-conflict period, agricultural inputs (seeds, tools, fertilizer and livestock) were distributed as a means of recapitalizing small farmers, including returning refugees, and jump-starting the recovery of agricultural production. Since then, the nature of the programmes has shifted to broader agricultural or rural development approaches, including the production and distribution of improved seed varieties, the provision of agricultural extension services and expansion of irrigated cultivation (mainly of rice), the development of value chains for livestock and specific crops (including storage and marketing) and in some cases legal services to resolve land disputes and register land-holdings, the construction and rehabilitation of rural feeder roads to improve access and marketing, support for microfinance, nutrition interventions and social infrastructure.

A road paving project in poor neighbourhoods of Bujumbura, using labour-intensive construction methods, shows that in the right conditions the PWP approach is both economically efficient and a highly effective means of achieving social objectives. Begun in 2009 with assistance from the Belgian development agency CTB, the project for ‘social and economic development through labour-intensive road paving’ aims to reduce unemployment, both in the short term through jobs in road construction and in the long term by providing training to these worker-apprentices and helping them to develop their own income generating activities. The project also creates substantial indirect employment in the quarries that produce the paving stones and stimulates the local economy by improving access to the beneficiary communities.

Paving is more appropriate than tarmac or cement for neighbourhood roads, since it is conducive to labour-intensive rather than capital intensive approaches, while also being cheaper, durable and easy to maintain and repair. The project tested two alternative approaches, which were implemented in different parts of the capital: first, construction companies were contracted to build the roads in Bwiza and Nyakabiga communes; and, second, the project managed directly the road construction in Kamenge, Kinama and Cibitoke using labour-intensive methods. The second approach proved to be more economically efficient (costing €180,000 per kilometre compared to €290,000 in the first), while also creating far more employment (29,000 compared to 17,100 person-days of work per kilometre). Labour intensity was 40% in the second approach but only 10-12% in the first.

In 2012, the project created directly 204,000 person-days of employment. However, including the indirect jobs created in the quarries, it is estimated that 766,985 person-days of total employment (equivalent to about 3,000 year-long jobs) were created by the labour-intensive methods used in Kamenge, Kinama and Cibitoke. Special measures were taken to facilitate the participation of women (pauses for breastfeeding and maternity leave after the 7th month of pregnancy), and overall women comprised more than 65% of the workforce on all sites. The economic efficiency of the labour-intensive approach is all the more impressive in so far as the costs include the training components incorporated into the project, which have taken up 22% of the workers’ time and are intended to help prepare them to launch their own income generating activities when they graduate from their nine-month ‘apprenticeships’. This graduation is facilitated also by a compulsory savings scheme, whereby BIF 1,200 out of total wages of BIF 3,000 a day is placed in a savings account in a microfinance institution.

Sources: Chanoine, 2012; CTB, 2013; questionnaire.


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Among the main programmes have been the World Bank’s Agricultural Productivity and Market Development Project (PRODEMA), the EU’s Post-Conflict Rural Development Programme (PPCDR), various FAO projects, the USAID-financed Multi-Year Assistance Programmes (MYAP) and four large IFAD projects: the Support Project for the Reconstruction of the Livestock Sector (PARSE) and the PTRPC, PAIVA-B and PRODEFI projects that were discussed in the previous section with respect to their public works components. A fifth IFAD project, for food security and rural development in the Imbo and Moso plains (PNSDR-IM), started in 2013.

Several of these programmes include a livestock distribution component using an approach known as the ‘community livestock solidarity chain’. Under the National Agricultural Investment Plan for 2012-2017, adopted in November 2011, the Government, with the support of external partners, seeks to to distribute 200,000 cows to rural households, with the aim of increasing production of milk and manure, raising farmers’ incomes and improving nutrition. In the programmes distributing milking cows, households receive a high-value imported cow, along with veterinary support, and have to repay the programmes with the first calf, which is then distributed to additional beneficiary households (the next link in the solidarity chain).

Some programmes focus more on the distribution of small livestock (goats, pigs, rabbits, poultry). PARSE, for example, distributes kits consisting of two goats or pigs, and beneficiaries have to reimburse the programme with two animals once they have reproduced. The MYAP included a ‘goat solidarity chain’ among its interventions.


Some programmes include ‘social’ components that focus explicitly on the most disadvantaged households with very little or no land, although most have broader objectives and provide benefits for a wide spectrum of rural households with different levels of assets and income. They also have an element of geographical targeting, in so far as they are all implemented in selected provinces, communes and communities, although the selection of these has often been driven as much by technical factors (the availability of watershed systems available for irrigation) as much as by social considerations.

For example, the World Bank financed PRODEMA includes a facility to provide annually about 60 grants of $5,000 or less to groups of repatriated refugees (resettled in ‘peace villages’ set up for landless returnees) and groups of Batwa. Many of these are for the purchase of goats and other small livestock (with no reimbursement requirement). Assistance for returnees in the peace villages started only in 2013 due to delays in providing them with land. By contrast, PRODEMA finances annually over 800 much larger grants, each of $30,000 or more, for farmers’ groups or associations with more sophisticated projects to increase agricultural production or invest in the collection, storage and processing of agricultural produce.

In the case of the IFAD programmes, the type of assistance provided is linked to the targeting system described in Section 5.2, by which the households in project areas classify themselves into different socioeconomic categories based on their access to land and ownership of livestock. Category 2b households (with 0.5 to 1 hectare of land and no livestock) and category 3 households (with 1-2 hectares of land and no livestock) are the target group for the distribution of cows. Households with smaller holdings (the vast majority as shown in Chapter 2) or with no land at all are excluded since space is required to establish a cattle-shed. While the households themselves do the initial classification, eligibility for the receipt of a milking cow requires follow-up verification that the household has the technical prerequisites to receive and raise the cow. Data for the four IFAD projects (PRODEFI, PAIVA-B, PTRPC and PARSE) show that they distributed imported Frisian cows to about 1,100 beneficiaries a year between 2010 and 2012, plus another 1,000 or so calves over the three-year period through the community solidarity chain (CSC). Some IFAD programmes, in particular PARSE, have prioritized the distribution of kits of smaller animals with the aim of reaching the poorest households (in categories 1 and 2a) who do not have the land and skills to raise high-value milking cows. Overall, about 25,000 highly vulnerable rural households have received goats, pigs, poultry or rabbits through the IFAD programmes, mainly through PARSE and PTRPC, in the past


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few years, including through the CSC redistribution mechanism. The beneficiaries of the investments in irrigated rice production are mainly better-off households with landholdings in the plains and marshlands apt for the development of irrigation, although some landless households have been allocated newly developed irrigated fields.


The programmes have recorded substantial achievements at the output level as measured by hectares of irrigated land created, tons of seeds produced and distributed, agricultural yields and numbers of livestock distributed. For example, the PTRPC has distributed seeds, cassava cuttings, fertilizers, tools and other agricultural inputs to over 33,000 households. Together, the PTRPC, PAIVA-B and PROFEDI projects have created or rehabilitated about 3,000 hectares of irrigated land for rice cultivation. Along with the introduction of improved rice seeds, production in these irrigated areas has risen more than 100%. MYAP also recorded significant increases across a range of agricultural output indicators and an outcome level impact in terms of improved dietary diversity (CRS, 2012).

The IFAD data also show substantial outcome-level impacts regarding household income, child nutrition and household perceptions of wellbeing, among others. However, none of these programmes has used rigorous impact evaluation methodologies, with control groups, making it difficult to draw firm conclusions about the attribution of socioeconomic impacts to the programmes or their relative cost-effectiveness.

5.4 Programmes for specific vulnerable groups

The national solidarity ministry has overall responsibility for assistance to population groups with especially high levels of vulnerability, including repatriated refugees and ex-combatants, and certain categories of children, women, the elderly and persons with disabilities, although most of the programmes are managed by NGOs. The National Council for the Fight against AIDS (CNLS) coordinates socioeconomic support for people living with HIV/AIDS (PLHIV) and for orphans and vulnerable children. This section will briefly review these programmes, although those for returnees and other victims of the conflict will not be considered further here, having already been discussed in previous sections of this chapter.

Main programmes

The national solidarity ministry has a general directorate for the promotion of women and gender equality, and this has historically been the main thematic focus of the CDFCs – the Family and Community Development Centres that are the ministry’s units at provincial level. Although seriously under-resourced, with very few staff in the communes (see Chapter 4), the CDFCs engage in social mobilization activities to raise community awareness on themes such as gender-based violence, family planning, reproductive health, nutrition and childcare practices, and women’s and children’s rights. These types of activities are also integrated into other programmes, such as the USAID-funded Multi-Year Assistance Programme for food security and nutrition and the UNDP-supported projects for the reintegration of victims of the conflict.

To strengthen the efforts being made to empower women and promote gender equality, the CDFCs have recently begun to establish community-based ‘women’s forums’, groups of 15 local women elected at colline level. The CDFCs also manage literacy campaigns and promote savings and credit groups, mainly oriented to women, with the support of agencies such as IFAD (through its integrated rural development projects), the United Nations Population Fund (UNFPA) and UN Women. UNFPA and the German GIZ have been supporting the CDFCs’ work to combat gender-based violence. Victims are referred to two specialized public institutions, the Humura Centre in Gitega and the Seruka Centre in Bujumbura, which provide an integrated package of residential, psychosocial, medical and legal support, co-financed by the Government and donors.

The nawe nuze (‘you are also welcome’) movement has been the main vehicle for promoting the economic empowerment of women. Based on the group solidarity approach, informal savings and credit clubs have


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been set up all over Burundi by different NGOs, with the support of different donors and UN agencies. Well known in other parts of the developing world, the approach was pioneered in Burundi by Care International, which set up several hundred of these groups in Bujumbura and Gitega through the Ishaka project, funded by the Nike Foundation, in 2009-2011. This aimed to strengthen the economic autonomy of young women and adolescent girls (aged 14-22) and thereby reduce their vulnerability to transactional sex, early pregnancy and school dropout. The groups included both a savings and credit fund and a social fund (drawing on about 10% of members’ savings) to meet emergency needs such as members’ illness.17

The nawe nuze approach has been adapted to mobilize funds also for orphans and vulnerable children (OVCs). With UNICEF support, a national NGO, FVS-AMADE, has set up similar groups with an additional (third) fund for supporting the school enrolment of OVCs.18 In Gitega alone, FVS-AMADE has set up over 230 such groups, with 30-45 members each, and the money set aside for OVCs was used to provide notebooks and pens for 7,765 pupils in the province at the start of the 2012/2013 school year.

A major initiative to promote community-based protection of vulnerable children has led to the establishment of 743 child protection committees (CPEs) at commune and colline levels. The national solidarity ministry, with the support of UNICEF and several NGOs (FVS-AMADE, Fondation Terre des Hommes, AVSI and others), has led the drive to set up these committees, which, according to recently adopted terms of reference, are tasked with preventing abuse, exploitation, violence and negligence of children, providing assistance to children whose rights have been violated, raising community-awareness of children’s rights and supporting the reintegration of children who are living outside a family framework. At colline level, these committees, which have seven voluntary, non-remunerated members, of whom two must be children aged 15 to 18, are supposed to be aware of the situation of all children in their communities, in particular those at high risk, and to find practical solutions, notably through mediation and counselling, to resolve problems. To facilitate the referral of cases for higher-level solutions, similar committees have been established at commune and provincial levels. The committees have been set up mainly in the five focus provinces of UNICEF’s Country Programme (Ngozi, Kayanza, Kirundo, Muyinga and Gitega) but are now being extended nationwide by the national solidarity ministry, with the CDFCs playing a key role. This community-based approach goes hand-in-hand with an integrated package of services, as defined in the national policy for OVCs. This is a package of educational, training, health, nutrition, psychosocial and legal services, including assistance to protect the inheritance rights of orphans, which has been one of the main challenges facing the CPEs. It should be noted that Burundi has adopted a broad approach to the concept of ‘OVC’, which is not restricted to HIV/AIDS-related vulnerability but recognises the multiple sources of vulnerability, including poverty and the consequences of the conflict (MSNDPHG & UNICEF, 2008).

The National Action Plan for the Struggle against HIV/AIDS devotes one of its four pillars to the reduction of the socioeconomic impact of HIV and AIDS. The Plan’s pillar 3 includes a number of measures to support the income of people living with or affected by HIV and AIDS, mainly through savings and credit groups (nawe nuze), as well as educational, health, nutritional, psychosocial and legal assistance, in particular for OVCs. These interventions have received support from large projects of the World Bank (PMLSAO), the Global Fund to Fight AIDS, Tuberculosis and Malaria (APRODIS and PRIDE) and the United States (PEPFAR). As has been mentioned in Section 5.1, food rations are also provided to some ART patients to ensure the effectiveness of

17 About 12,000 young women and adolescent girls were enrolled in the groups supported by CARE. Each had about 20-30 members, who contributed savings of BIF 200 to 500 a week to a common pot managed by each group. About 10% was reserved for a social fund to meet members’ medical costs, while the rest went into a credit fund. The latter provided microcredit, ranging from BIF 10,000 to BIF 300,000, at a very high interest rate of 10% a month, indicating that in practice it was used mainly for micro-commercial activities with a rapid turnover.

18 Each week, members contribute BIF 100-300 to the fund for OVCs, which is used for buying school materials, plus BIF 100-200 to the mutual assistance fund (mainly used for paying hospital bills) and BIF 500-2,500 to the fund for microcredit. Members can borrow up to three times the level of their savings (in the range of BIF 10,000 to BIF 400,000) for three months at a maximum interest rate of 5% a month. The interest received is recycled at the end of each year to savers. Members who are in a position to borrow more are referred to formal microfinance institutions (MFIs), in particular the Dukuze MFI set up by FVS-AMADE.


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the treatment regime. Most of these socioeconomic support activities are implemented by NGOs such as FVS-AMADE, the Society for Women and AIDS in Africa (SWAA), ActionAid and the Burundian Network of Persons Living with HIV (RBP+).

There is no specific policy to guide support for the vulnerable elderly and no publicly funded old age pension. Retirement pensions are limited to the small minority of former contributors to the social security systems in the formal sector managed by the National Social Security Institute (INSS) and the National Office for Pensions and Professional Risks (ONPR).19 The national solidarity ministry provides some assistance to associations and centres for old people, and there is a high proportion of old people among the ‘indigents’ who receive medical assistance from this ministry (see Section 5.6). WFP also provides some food assistance to centres for the elderly.

Some limited assistance is provided to persons with disabilities. As in the case of the elderly, there is no statutorily established, publicly funded income support for persons with disabilities, such as a social invalidity pension, except for a few demobilised ex-combatants with disabilities (for which BIF 300 million or USD 208,000 was provided in 2012). The national solidarity ministry has a small budget line for physical rehabilitation and socio-professional reintegration of persons with disabilities (BIF 1.2 billion or approximately USD 830,000 in 2012), which is used to provide financial support for associations of disabled persons for revenue generating activities and to provide some in-kind individual assistance on a one-off basis for mobility aids (prostheses, wheelchairs, crutches, etc.). Some persons with disabilities also obtain free drugs through the medical assistance facility for indigents.

At the local level, the CDFCs play a role in referring persons with disabilities to sources of assistance (the central ministry, NGOs and specialized centres). The national solidarity ministry is responsible for overseeing the limited number of centres that provide specialized services for certain types of disabilities, including two in the public sector: the National Centre for Equipment and Re-education (CNAR) at Gitega and the National Centre for Socio-Professional Rehabilitation (CNRSP) in Bujumbura, which also has a branch in Ngozi. Other centres, such as the Medico-Pedagogical Institute (IMP) of Mutwenzi, at Gitega, which provides specialized rehabilitation and special education services for children with mental disabilities and multiple disabilities, are managed by religious orders but receive very small government subsidies. WFP provides some of the food for these different centres. Burundi is currently in the process of ratifying the International Convention on the Rights of Persons with Disabilities.

Several projects aim to improve the social and economic situation of the Batwa, or include the Batwa within a wider target population. The Batwa cause is promoted by a national NGO, UNIPROBA (‘Unissons-Nous pour la Promotion des Batwa’ – ‘Let’s Unite for the Promotion of the Batwa’), and many of the projects targeting Batwa are implemented by NGOs, with support from international agencies and donors, sometimes in partnership with the national solidarity ministry. The World Bank’s agriculture project, PRODEMA, includes a facility for providing small grants to Batwa who set up groups to develop productive activities. Most receive goats. Batwa communities have also benefited from the distribution of goats through IFAD’s PTRPC (FIDA & MFPDE, 2013a). Projects run by the NGO Bureau d’Etudes au Développement et Entraide Communautaires (BADEC) and the Catholic NGO Action Batwa have promoted access to education and health care. BADEC, with WFP support, has implemented a food-for-work project for a Batwa cooperative producing soap, bread and bricks in Mumba, Ngozi province. The NGO ActionAid has been providing multi-faceted support to promote the social inclusion and resilience of the Batwa community in Karusi province since 1984, and USAID has provided funds in 2013 to assist Batwa to obtain identity cards.

19 ONPR, which manages the pension regime for civil servants and magistrates, had 65,535 contributors and 3,470 beneficiaries (including 1,216 beneficiaries of retirement pensions) in 2011. INSS had 155,090 contributors in 2010 and 35,978 beneficiaries of pensions in 2008 (ILO, 2011).


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Coverage of the intended target groups appears generally to be small, although consolidated data are often lacking due to the fragmented nature of interventions. Targeting in these projects is categorical in nature, defined by the specific population groups that the projects are intended to assist. Many of them are geographically circumscribed because of the ‘project’ nature of the interventions and their limited funding.

The data on socioeconomic support for people living with HIV/AIDS (in Table 5.4) show that only 13% of ART patients received nutritional support in 2012 (equivalent to about 7% of all persons requiring ART). Data of the National Council to Fight AIDS (CNLS) indicate that there was a large fall in the coverage of educational, health, nutritional and legal assistance in 2012 due to resource constraints. The coverage of the associations and specialized centres providing services for the severely disabled appears to be extremely small: The last consolidated data on coverage indicates that there were 5,553 beneficiaries in 2007 (ILO, 2011).

Table 5-4: Socioeconomic support for people living with HIV/AIDS (PLHIV) and for orphans and vulnerable children (OVCs)

2010 2011 2012

ART patients receiving food rations

Number of ART patients 18 674 26 402 29 121

% of persons requiring ART … 39,0 56,5

Number of ART patients receiving nutritional support 3 801 11 054 3 782

% of ART patients receiving nutritional support 20 42 13

Support to Income generating activities (IGA) and professional training

Number of PLH receiving support for IGA 4 130 5 744 4 443

Number of PLH employed In professional activities after training 223 586 …

Support for OVCs

Number of OVCs receiving support for education (school kits) … 91 572 42 259

Number of OVCs receiving medical assistance 65 160 24 878 1 983

Psychosocial assistance 38 571 14 343 …

Nutritional assistance 12 671 6 496 2 480

Number of OVCs receiving support for protection of their property 4 181 3 200 533

Source: CNLS (annual reports)

Efficiency and efectiveness

Donor dependence leaves many projects difficult to sustain or exposed to sudden falls in resources. For example, the execution rate for pillar 3 of the National Action Plan for the Struggle against HIV/AIDS, on socioeconomic support, was only 11% in 2012, the lowest (by far) of all four pillars of the Plan (CNLS, 2013), explaining why support provided to PLHIV and OVCs fell sharply that year. All the programmes and centres for persons with disabilities appear to be financially precarious.

Total government funding for its own centres (CNAR and CNRSP) as well as subsidies for private centres amounted to BIF 663 million (about USD 460,000) in 2012, while these centres depended on WFP to feed their residents and on specialized NGOs such as Handicap International for technical assistance. The construction of two new government centres for sensory handicaps and persons with mental disabilities is planned but this investment not yet been funded. A coherent strategy, with a medium term financing plan, is needed to build and sustain the safety net needed for this highly vulnerable category of the population.

The nawe nuze groups have both strengths and weaknesses. The nawe nuze savings and credit clubs can best be seen as an informal community-based mechanism for encouraging savings and providing access to microcredit for the poor, in particular women, who would not normally have access to more formal microfinance institutions (MFIs), let alone banks, due to their lack of collateral. The repayment rates are


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reportedly very high. In addition to this elementary form of microfinance, the groups’ mutual aid funds have played a proto-insurance role, and the OVC funds included in the groups supported by UNICEF and FVS-AMADE have an added social value, assisting school enrolment. However, their informality also carries a fiduciary risk in so far as these groups, unlike formal MFIs, are generally not accredited by the central bank or subject to any formal supervision.

Second, even though the savings requirements are quite low, it is questionable whether participation is affordable for the very poor, for whom non-contributory social transfers are likely to be a prerequisite for any savings at all. Third, these groups are sometimes heavily dependent on technical assistance from donor-funded NGOs. Many of the groups set up by CARE dissolved after the Nike-funded project ended in 2011.20

The absence of an integrated national programme to address the social exclusion and extreme vulnerability of the Batwa is a major weakness of the social protection system. The existing projects targeting the Batwa are managed mainly by NGOs, fragmented, dependent on donor assistance and therefore difficult to sustain. Although the national poverty reduction strategy, CSLP II, identifies the Batwa as an especially vulnerable group (paragraph 184), it includes no specific measures for the Batwa, and there is no other national policy, strategy or plan that aims in an integrated, cross-cutting way to overcome the social, economic and institutional factors that have put this minority group in a situation of structural disadvantage and marginalization. Burundi could follow the example of some other countries with marginalized minorities, such as the Republic of Congo (Brazzaville), which has adopted a National Action Plan for the Improvement of the Quality of Life of Indigenous Populations (2009-2013) and in 2011 enacted a law on the promotion and protection of the rights of indigenous populations (OPM, 2011).

The crucial issue of gender equality in inheritance needs to be addressed head-on. One of the main limitations of the current efforts to empower women and protect orphans is the legal discrimination against women and girls regarding inheritance rights. This is one of the main constraints on what the CPEs can do to protect widows and their children, as well as girl orphans. Proposals to reform the legal framework (the Code des successions, des régimes patrimoniaux et des libéralités) have been awaiting decisions for several years, but no action has yet been taken.

5.5 Demand-side education measures

‘Demand-side’ education measures aim to reduce the costs of education borne by households and to incentivize right-age enrolment and retention. As such, these interventions complement supply-side measures such as the investment in new schools and classrooms, the training and hiring of teachers and the supply of textbooks, which concern the provision and quality of education services.

Main programmes

There have been four main demand-side education initiatives in Burundi: the abolition of official primary school fees, fee waivers for some very poor secondary students, school feeding in selected primary schools and early childhood development (ECD) centres, and the distribution of school kits to primary school children in certain provinces as part of a ‘back-to-school’ campaign at the start of each school year.

School fee abolition

The main demand-side policy measure taken to date was the abolition of official primary school fees from the start of the 2005/06 school year. To compensate schools for the loss of revenue, a capitation grant,

20 Information provided by the Association des ex-employés de CARE (Association of Former CARE Employees), which hired two of the 26 former project staff to try to keep the groups going.


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known as the frais de compensation, was instituted. At present this amounts to about BIF 2,800 per pupil per year, of which BIF 2,000 is financed from domestic resources and BIF 800 by donors through the Education Common Fund set up in 2011. The funds are transferred to schools once a quarter and are managed by the school directors and the school management committees, which include representatives of teachers, parents and pupils.

Secondary school fees have not been abolished. However, some communal administrations provide fee waivers for children of indigents.

Fee abolition is not being extended to grades 7-9 despite their integration (as a fourth cycle) into the new 9-year programme of basic education. This reform, which is being implemented progressively over a three year period (beginning with grade 7 in 2013/2014), is intended to increase transition to the first grades of what has been lower secondary education up to now.21 This measure is increasing the burden on households, since households are required to contribute BIF 8,000 per pupil to the cost of constructing the new classrooms being added to primary schools to accommodate the new grades.

School feeding

School feeding aims to incentivize attendance in primary schools in the provinces with the worst food security and primary education indicators. The World Food Programme (WFP) is the main agency supporting school feeding, with counterpart funding provided by the Government since 2011. This is the largest item in WFP’s current Country Programme for 2011-2014, continuing assistance that was previously part of WFP’s protracted relief and recovery operations (PRRO) in 2009-2010.

The programme focuses on primary schools and to a very limited extent early childhood development (ECD) centres in food-insecure rural areas in the provinces of Kirundo, Muyinga and Ngozi, in the northeast. Children in the selected primary schools and ECD centres receive a hot meal at lunch, consisting of maize meal, beans, oil and iodized salt provided by WFP, supplemented sometimes with green vegetables produced in school gardens. Meals are supposed to be provided all days of the school year: about 180 days per year. In the past, when gender disparity in school enrolment was higher than it is now, the school feeding programme in Burundi also included a component of take-home rations for girls, as an incentive to encourage girls’ participation, but this was discontinued in 2009 since there was by then almost complete gender parity in primary school attendance.22

School kits

The distribution of school materials by the education ministry with UNICEF support helps to reduce the direct costs of education for parents and incentivize enrolment at the start of the school year. This is part of a ‘back to school’ campaign that has taken place at the start of every school year since 2007. In addition to the distribution of kits, the campaign has a strong communication component to arouse communities’ awareness of the importance of education. The kits are very basic, consisting only of exercise books and pens. The Education Common Fund, which includes funds from the Global Partnership for Education, Belgium, Norway, France and UNICEF, contributes to the financing of the distribution of textbooks, which had previously also been supported by the World Bank through the PARSEB Project (completed in June 2012).

Related policy measures

Uniforms are compulsory, adding to the direct costs borne by households, but the authorities hold the view that abolition of this requirement might have perverse effects. Information obtained in the course of

21 Basic education will have 4 cycles, with automatic promotion between grades within each cycle: 1st cycle (grades 1 and 2), 2nd cycle (grades 3 and 4), 3rd cycle (5th and 6th grades) and 4th cycle (7th to 9th grades). There will be a final examination at the end of the 9 years.

22 The gender parity index for net primary enrolment was 1.01 in 2010, according to the DHS in that year.


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this study in different provinces indicates that uniforms cost in the range of BIF 8,000 to 10,000 ($5.20-6.50) in rural areas, constituting a significant burden for poor households. Although school directors have some discretion not to require pupils to wear them at primary level, the implications are ambiguous and it has been argued that children feel ashamed to attend school without uniforms.23 The subsidization or free distribution of school uniforms for children in the most vulnerable families or in geographical areas with the highest poverty rates and the lowest educational enrolment and attendance might be one way to reduce the direct costs of school for these families. The requirement for children to have birth certificates is an additional barrier to access. Without birth certificates, children are refused entry to school. This is a more rigid stance than that applied in most countries with low rates of civil registration and is particularly disadvantageous for children of the poorest households. Although there are no data available for school-age children, 16.7% of children under 5 do not have birth certificates, according to the PMS survey in 2012/2013. Possession of birth certificates is inversely correlated with household wealth.24


The abolition of official primary school fees in 2005 led to a surge in enrolment. This policy applied to all pupils in the public school system, which accounts for 99% of pupils at primary level. According to administrative data, the primary net enrolment ratio soared from 59.8% in 2004/05 to 95.4% in 2012/13 and the primary gross enrolment ratio from 81.6% to 136.9%, with a particularly sharp increase in the period immediately after fee abolition (UNICEF, 2013b). PMS survey data for 2012/2013 show a slightly lower net attendance ratio (NAR) of 84.5%, while the secondary NAR was much lower at 21.0%. There is now almost complete gender parity at primary level, albeit with some provincial exceptions (notably in Muyinga), whereas large gender disparities remain in secondary education. Pre-school education remains fee-paying and has very low enrolment rates (6.5%), although these have also been increasing rapidly in the post-war period.

There are no data on the number of fee waivers provided for vulnerable children at secondary level, but this is probably very small due to lack of funding. This is a decentralized process, managed by the colline and communal administrations. According to information received from the Communal Administration of Gitega, the chefs de collines identify candidates for fee waivers based on one nationally established criterion (children who are orphans of both parents) and sometimes additional criteria adopted at the local level, which in Gitega includes children who have lost a single parent and live in highly vulnerable households. The lists are sent to the communal administration for consolidation and the issuance of attestations (certificates). In Gitega, about 800 of these certificates were issued in 2012. However, there is no budget line at either national or communal level to compensate secondary schools for waiving the fees of these students, requiring the schools to absorb the costs. According to this same source, the only funding ever provided for this measure was a one-off allocation in 2011 from the World Bank’s Community and Social Development Support Programme (PRADECS).

The WFP school-feeding programme targets beneficiaries geographically and reaches about one tenth of all primary pupils nationally. The programme focuses on rural areas of Kirundo, Muyinga and Ngozi provinces. The targeting criteria use food security and education indicators, as well as a requirement for

23 In the words of one study (Somers, 2013): ‘The requirement that all students must wear uniforms appears to vary from school to school: some schools reportedly ‘chase’ students who don’t wear them, others do not. But even if schools “accept” students who cannot afford to wear a uniform, many adolescents reported that students without uniforms are routinely teased by those who wear them. The most common primary school uniform policy appeared to be a mix of the two: students without uniforms can remain in school for a limited period of time. Then they are chased.’

24 Birth registration in children under 5 declines from 87.9% in the richest (5th) quintile to 78.2% in the poorest (1st) quintile, according to the PMS survey in 2012/2013. The DHS in 2010 found lower rates of birth registration (75.2% overall in children under 5).


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adequate hygiene conditions for the provision of meals on school premises. UNICEF has provided appropriate water sources for schools where these are lacking. Within the selected schools and ECD centres, all pupils are eligible, with no individual selection, in accordance with international practice. The programme aims to benefit 200,000 children each year, somewhat less than under the previous PRRO. As Table 5.5 shows, the actual number of beneficiaries was 189,912 in 2011 and 186,869 in 2012 (97% in primary schools). This means that about 9-10% of primary pupils nationally are benefiting from the programme. Take-up in ECD centres has been much lower than expected and coverage is marginal compared to the population of the corresponding age group, mainly because of the low level of pre-school enrolment in the country. The coverage of school days in beneficiary schools is sometimes less than 100% due to teacher strikes (in 2010) or breaks in the WFP food pipeline (2012). A second school-feeding project for 95,000 children in areas affected by the influx of returning refugees from the closed Mtabila camp in Tanzania started in March/April 2013.

Table 5-5: Coverage of demand-side education interventions, 2010-2012

2010 2011 2012

Distribution of school kits (Back to School Campaign)

No of primary school beneficiaries 777 172 455 832 476 034

% of total primary school pupils 40 23 24

Total cost per beneficiary pupil (US$) 6,0 7,3 7,7

No of primary schools 507 556 599

School feeding

Total no of beneficiaries 400 000 189 912 186 869

No of pre-school beneficiaries 0 5 175 5 523

No of primary school beneficiaries 400 000 183 340 181 346

% of total primary school pupils 10 9

Total cost per beneficiary pupil (US$) 30 23 27

No of pre-schools 0 31 32

No of primary schools 451 201 202

% of school days covered 70 100 90

Source: WFP.

The UNICEF-supported Back to School Campaign provides a basic kit of school materials to approximately one quarter of primary school pupils. When this programme began, in 2007, it was targeted to OVCs in all 17 provinces. However, the definition of OVC was ambiguous, generating concern that many children vulnerable due to poverty were being excluded.

Given the risk of exclusion, the very high poverty incidence and the administrative challenges of targeting individual pupils, from 2008 onwards the programme was geographically focused on three provinces with particularly poor education indicators (Kirundo, Muyinga and Kayanza). Within these provinces, the programme became universal, with all pupils in all grades of primary school benefiting. The programme expanded to five provinces with the addition of Ngozi and Gitega in 2010, reaching peak coverage of 777,172 pupils.

As of 2012, the programme was focusing on these same five ‘convergence’ provinces of UNICEF’s country programme, plus four provinces affected by the return of refugees from Tanzania (Makamba, Rutana, Bururi and Ruyigi). A total of 476,034 pupils in 599 schools, or 24% of all primary school pupils nationally, received these kits at the start of the 2012/13 school year.


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Official primary school fee abolition has improved access to education, but the surge in enrolment has put further strains on the quality and efficiency of primary education. Classroom sizes have swelled, with teachers sometimes managing classes of more than 100 pupils. Almost half of primary school classes operate on a double shift, reducing the contact time between teachers and pupils. Nationally, the primary repetition rate was 38% and the primary completion rate 49% in 2011, with worse performance in some north-eastern provinces (UNICEF, 2013b).

Families still incur significant costs to send their children to school. The communal administrations require parents to contribute (in time and money) for the construction of classrooms, most of which are built using community labour (travaux communautaires).25 In addition, parents incur other direct costs, notably for uniforms and school materials, while indirect/opportunity costs (the trade-off between children’s labour and time in school) become increasingly important in the higher grades of primary school, where many children are well into their teens due to late enrolment and repetition. Even after the abolition of primary school fees, the QUIBB survey in 2006 found that financial factors were the main reason cited for children aged 10-12 not attending school (27.5%) and the second main reason for children aged 7-9 (the first reason being the view of parents that children are too young, which is likely to reflect the reluctance to send young children unfed to school in the morning and so ultimately the underlying problems of poverty and food insecurity). The need to engage children in work activities (the opportunity cost factor) becomes more important as children grow older, being cited as the main reason for non-attendance of 13-16 year olds (25.6%), compared with 23.3% in the 10-12 age group and 8.5% among 7-9 year olds.

School kits may help to boost enrolment at the start of the school year at very low cost, but as a one-off intervention their impact on subsequent attendance and children’s progression through the primary school cycles is likely to be less, although there is no empirical evidence on this subject. The programme’s total cost per pupil has risen from $6.04 in 2010 to $7.71 in 2012, although the kits themselves cost only $2.12 per pupil in 2012.

School feeding costs more but may be more effective in sustaining higher attendance rates and reducing dropout. The cost per pupil was USD 27 in 2012. WFP monitoring data indicate that the attendance rate in WFP-assisted primary schools rose from a baseline of 84.9% to 96.2% in 2011, and that the dropout rate fell from 8.4% to 6.3%. These are not ‘difference-in-difference’ estimates from a controlled trial, so do not ‘prove’ the effectiveness of school feeding.

However, it would be reasonable to presume that the positive impacts on attendance and retention found in other countries (see Bundy et al, 2009) apply also in the Burundian context. These impacts were highlighted in focus group discussions during this study with teachers, who affirmed that school feeding has improved school attendance and also improved concentration in class by pupils attending the afternoon shift.26

School feeding faces the challenges of scale-up and moving towards local procurement. As noted above, school feeding currently only reaches about 10% of primary school children and is highly concentrated geographically. Many vulnerable children in non-targeted provinces are not benefiting from this programme,

25 As one informant stated, ‘il n’y a pas de système de prélèvement uniforme, mais il y a beaucoup de pression sur les communautés’ (‘There is no uniform system of levies, but there is a lot of pressure on the communities’). In Bujumbura Rural, the communal authorities reportedly tax parents BIF 8,000 per child per year for education, mainly for school construction, although the children of parents with an indigent certificate are apparently exempted. If this is correct, the local education levies being charged by communes dwarf the national fees that were abolished (BIF 1,500 per pupil per year).

26 Most schools in Burundi operate on a double-shift basis, with some pupils attending in the morning and the others during the afternoon.


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due to financing constraints, although the increasing share of Government financing is a positive development (see Chapter 3). In the areas where children are benefiting, it might be appropriate to consider adding high-energy biscuits at the start of the morning shift as a cost-efficient measure to strengthen the incentive for school attendance, while also improving concentration in class and learning achievement, since many children have not eaten breakfast before going to school.

Another challenge is to increase local procurement of food, as a way of reducing costs and stimulating local markets. The programme currently relies on centralized procurement, generally from abroad, on the grounds that there are inadequate food supplies in local markets, especially during the lean period, to permit local procurement. However, WFP is expecting to launch shortly a new project for ‘home-grown school feeding’, linked to the development of smallholder agriculture, which could help to inform the development of a new model for food procurement.

To promote ownership and sustainability, responsibility for management of the school-feeding programme needs to pass to national institutions. At present, the preparation and serving of the meals at school level is the responsibility of school meals committees, which work in liaison with the school management committees. However, WFP handles all central procurement, storage and distribution, while NGOs under contract to WFP are responsible at provincial level for coordination, management of food stocks and monitoring. It is WFP policy to transfer progressively the central-level responsibilities to the School Feeding Unit set up in the education ministry in 2008, and provincial level responsibilities to the provincial education directorates. WFP is also assisting the education ministry to prepare a strategy for a national school meals programme.

5.6 Programmes to improve financial access to health care

Much of the policy discourse about social protection in Burundi has put a strong emphasis on social protection in health. The government has been especially concerned about the financial barriers of access to health services, given the extent and depth of poverty. The National Social Protection Policy has therefore given prominence to initiatives to facilitate financial access to health care. The most important measure has been the abolition of fees for specific vulnerable groups (children under 5 and pregnant women) and for certain critical services. In addition, a small number of indigents receive fee exemptions for medical services.

Meanwhile, there have been efforts to extend contributory health insurance beyond the small minority of the population benefiting from employment-linked health insurance in the formal sector.27 These have included an embryonic national health insurance system, through the Carte d’Assistance Médicale (CAM – Medical Assistance Card), and community-based mutual health organizations (MHOs). The MHOs and the CAM strictly speaking lie outside the scope of this study on non-contributory safety net mechanisms. However, they will be discussed here due to their importance in the national policy dialogue on social protection, particularly with respect to their role in facilitating access to health care by the poorest and most vulnerable.

Main programmes

Fee abolition for children under 5, pregnant women and priority health services

The main demand-side measure to facilitate financial access to health services has been the abolition of fees for children under 5 and pregnant women and for some high-priority services. Fees for children under 5 and deliveries were abolished in 2006.28 Other free services include vaccinations and the testing and treatment of HIV/AIDS, tuberculosis and (since 2010) malaria. These reforms were among a series of bold

27 Public sector employees are insured through the Mutuelle de la Fonction Publique (MFP), established in 1980, while some private sector employees are covered either by company health services or commercial health insurance.

28 Decree no 100/136 of 16 June 2006.


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measures taken by the Government to improve access to health services and reduce mortality following a national health conference (états généraux de la santé) in 2004. There has also been a substantial increase in investment in health infrastructure to improve physical access. Implementation of selective fee abolition, in particular regarding the mechanisms for reimbursement of health facilities, has been integrated with performance-based financing (PBF) in the health sector, which started as a pilot in 2006 and became a national programme in 2010.29

Fee waivers for indigents

The Ministry of Solidarity, Human Rights and Gender provides medical assistance for indigents, loosely linked to the issuance of indigence certificates by the communes. The national solidarity ministry has had a budget line for medical assistance since 1995. Originally intended for IDPs and repatriated refugees, its scope has been widened to provide fee waivers for extremely poor patients (including the 20% co-payment required under the CAM scheme). It currently has the ministry’s single largest budget line, amounting to BIF 1,390 million or 17% of the ministry’s total expenditure in 2012. However, this is still very small (equivalent to USD 963,050) relative to the medical needs of millions of poor Burundians. The beneficiaries are mainly hospital patients who might otherwise be detained in the hospitals if their bills were not paid. Vouchers are also provided to enable patients to purchase drugs when these are only available in private pharmacies, although this is limited to a few pharmacies in the capital with which the ministry has signed agreements.

Due to funding constraints, the scheme does not cover medical costs incurred in health centres. It also does not pay CAM premiums for indigents. Some NGOs pay CAM membership and co-payments for very poor households, as for example in Concern Worldwide’s Terintambwe cash-transfer project in Cibitoke and Kirundo (see Box 5.1) and in a project of the Belgian NGO Memisa to promote access to health care in Muyinga and Muramvya.

CAM

The CAM was first set up as a health insurance mechanism for the informal sector in 1984, but was re-launched in 2012 in an attempt to revive acceptance by health facilities and increase membership.30 In its earlier format, the CAM had fallen into abeyance, being widely rejected by health facilities due to substantial reimbursement arrears. The reorganized CAM is seen as a transitional mechanism towards a national health insurance system. Households pay a minimal amount for the card (a flat rate of BIF 3,000 or about USD 2 a year per household31), and make a co-payment of 20% for consultations, hospitalization (on referral to district hospitals only) and generic drugs.32

29 PBF is operating at two levels: a minimum health package provided by health centres and a complementary package in district hospitals. Nutrition programmes have recently been integrated into the PBF mechanism.

30 The scheme was reorganized by arrêté no 01/VP2/2012 of 25 January 2012 and the new CAM became operational in May 2012.

31 This replaced a progressive structure of premiums under the old scheme whereby those engaged in farming, livestock and fishing paid BIF 500, artisans and petty traders paid BIF 1,000 and registered traders and other self-employed persons paid BIF 3,000.

32 The package of health care covered in health centres includes preventive services, curative consultations, laboratory tests, generic drugs available in health centres, deliveries and minor surgery, health promotion (including family planning), and in-patient admittance. In district hospitals (the first referral level), the CAM covers outpatient consultations, emergency services, hospitalization, diagnostic services (laboratory, echography and radiography) and specialized technical services (maternity, nutrition, emergency surgery, etc.).


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Mutual health organizations (MHO)

NGOs have been promoting the development of community-based mutual health insurance, but this remains small-scale and sits uneasily with the development of the CAM. A recent study described community-based MHOs as being ‘still at the stage of a few private initiatives’ and ‘limited for the moment by the weak contributory capacity of households’ (ILO, 2011, pages 30, 34). Belgian NGOs with donor financing have been the main promoters, working together with local institutions such as farmers’ organizations and the Catholic Church. Most of the MHOs have a limited geographical area of operations, in which they engage in outreach activities to communities to attract members and set up local sections. The sections, which have elected management committees of volunteers, are generally responsible for enrolling members, collecting premiums and sending health facilities’ reimbursement claims to the MHO office, usually situated in a provincial capital.

Most schemes cover the core services (consultations and drugs) provided by health centres plus (in some though not all MHOs) the costs of hospitalization (on referral from health centres). In most cases, drugs from private pharmacies are excluded. Premiums tend to be in the range of BIF 10,000-20,000 per year per household, with quite high co-payments, usually in the range of 20% to 40% (for details see Table 5.6). As will be discussed below, population coverage remains extremely small, except to a limited extent among coffee farmers,.


In principle all children under 5 and pregnant women are eligible for free health care, although that this is not always the case in practice if patients do not have IDs or birth certificates. Patients have to produce an ID card and, in the case of children, a birth certificate and a vaccination card. This excludes part of the vulnerable population, given the high proportion of children without birth certificates (see above).

The medical assistance for indigents has low coverage and rudimentary procedures for determining eligibility. According to data provided by the national solidarity ministry, there were 11,056 beneficiaries in 2012. This is 0.1% of the population, indicating that the scheme is reaching only a tiny proportion of the extreme poor. The PMS survey in 2012/2013 found that indigence cards were used in 0.7% of consultations in health facilities. The selection process begins with the identification of potential recipients of indigence cards at colline level, with subsequent verification by the communal administrations. However, there are no clear criteria, resulting in a high risk of abuse. The low credibility of the indigence cards has led the national solidarity ministry not to rely on these cards alone for approving support for patients from its medical assistance fund. The ministry sometimes uses health sector social workers in the hospitals, as well as its own staff in the CDFCs, to verify that potential beneficiaries are unable to pay their hospital bills. Again, however, there are no clear criteria for eligibility.

Health insurance schemes still cover only a very small minority of the population. Data on the population coverage of health insurance are available in both the DHS 2010 and the PMS 2012/2013. There was an increase in overall coverage (by all schemes) to 17.9% of the population in 2012/2013 (see Figure 5.2). However, this still left four-fifths of the population uninsured. Almost all the growth in this period came from the development of the CAM, which covered 11.5% of the population by the time of the PMS survey (December 2012 to January 2013), compared with 4.4% of women and 5.5% of men recorded by the DHS in 2010. The PMS survey was conducted shortly after the restructuring of the CAM and there has been further growth in coverage since then, according to administrative data (see below). The Mutuelle de la Fonction Publique (MPF), which provides health insurance to public sector employees, covers only a very small proportion of the population (3.4% according to the PMS). The MHOs are clearly marginal, covering only 1-2% of the population according to the two surveys.


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Figure 5-2: Population coverage of health insurance schemes, 2010 and 2012/2013


Coverage of health insurance is regressive, benefiting mainly the better off. According to the PMS data, coverage rises from 15.8% in the poorest quintile to 24.8% in the richest quintile, mainly due to the concentration of MPF beneficiaries in the 4th and 5th quintiles (see Table 5.6). The MFP membership is also almost entirely urban, and this is offset only partially by the higher coverage of the CAM and MHOs in the rural areas. The DHS data also show slightly higher insurance coverage of men than women, including by the CAM and MHOs.

Table 5-6: Population coverage of health insurance schemes by quintiles, 2012/2013 (%)

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5 Rural areas

Urban areas

CAM 12,4 12,2 10,2 10,9 12,1 12,1 5,8

MFP 1,4 2,0 2,0 3,5 8,2 2,8 10,6

MHOs 1,1 1,5 1,1 1,5 1,4 1,4 0,7

Unclassified 0,9 1,0 1,7 1,3 3,1 1,6 2,0

Total insured 15,8 16,6 15,0 17,2 24,8 17,8 19,0

Not insured 84,2 83,4 85,0 82,8 75,2 82,2 81,0


At present the CAM covers about 23% of the population, according to information provided by the health ministry. The CAM scheme has been strongly promoted by local government authorities and by government owned health centres, in line with official policy. Further growth of membership (and renewal of membership by those who have already joined) may be thwarted, however, by the reluctance of many health facilities, particularly accredited non-government health facilities, to accept the CAM due to long reimbursement delays, despite the reorganization of the scheme in 2012. Enrolment in the CAM may also be held back by low awareness, documentation requirements (in particular the need to show an ID card to register) and, in the case of the poorest, inability to pay even a modest premium.33

Population coverage by community-level MHOs is very low. This is confirmed by data from both the DHS and the PMS survey, the latter estimating total MHO coverage at 1.3% of the population.

33 One study on the experience of the CAM (Butoyi, 2012, page 33) noted that, even before the reform of the CAM in 2012, the premium of BIF 500 ‘was already regarded as being too expensive for indigents’.

10.4

4.8 4.4

1.2

12.1

4.7 5.5

1.8

17.9

3.4

11.5

1.3 1.6

0

5

10

15

20

Population insured MFP CAM MHOs Indigence cards

DHS 2010( women)

DHS 2010 (men)

PMS 2012/13


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The largest MHO has developed in the coffee sector. The Mutuelles de Santé des Caféiculteurs du Burundi (MUSCABU) appear to have benefited from the administrative advantage of establishing the scheme within an existing organization, the local unions of coffee farmers, and from the higher contributory capacity of coffee farmers, although their incomes are subject to cyclical instability. MUSCABU had 14,830 affiliated households (31% of the members of coffee farmers’ unions) and a total of 79,896 beneficiaries as of August 2012. The Catholic MHOs in the archdiocese of Gitega (MUNASA Twitwararikane) are the second largest structure, with 3,700 affiliated households and 19,240 beneficiaries in 2012.

Overall, there were about 24,000 households affiliated to MHOs, with nearly 131,500 individual beneficiaries, in 2012. However, this is only 1.3% of the national population, concurring with the survey data provided above. Even in their geographical operating zones, the ‘penetration rate’ is low: about 4% in the case of Gitega after 15 years of operations by MUNASA Twitwararikane. This is similar to the experience of other African countries, where ‘pure’ community-based health insurance (without state subsidies and public management, as in Rwanda) has rarely achieved coverage exceeding 1-4% of the national population (Ouattara & Soors, 2007). The national health accounts in 2007 estimated that MHOs accounted for only 0.1% of total health expenditure (ILO, 2011).

Low household contributory capacity has held back the development of MHOs, which are likely to be benefiting mainly the better-off households. Most MHOs were set up and developed since the restoration of peace. However, the widespread and multi-dimensional deprivation, particularly in rural areas, which forces households to focus on day-to-day survival, is not conducive to an insurance culture in which households divert some current resources to risk-smoothing for future health shocks. The PMS data suggest that population coverage is very low in all quintiles (average 1.3 percent), although rising slightly with income. The DHS found a larger bias in favour of richer households, with coverage of men at 3.4% in the fifth quintile, compared with 2.1% or less in all other quintiles, and coverage of women at 2.5% in the fifth quintile, compared with 1.0% or less in the other quintiles. In interviews during this research, MHO managers concurred that members of the schemes tend to come from better-off households that own land and engage in revenue-generating activities.

As a way of increasing contributory capacity, some MHOs provide their own support for revenue-generating activities – for example, using the livestock solidarity chain approach to distribute goats in the case of MUNASA Twitwararikane in Gitega or the Nawe Nuze microfinance schemes in the case of FVS-AMADE in Bujumbura Mairie and Makamba. In the absence of substantial subsidies, except to finance administrative costs (see below), MHOs are torn between the conflicting needs to keep premiums low enough to attract members and to raise enough revenue to cover the cost of an adequate package of essential health services. In fact, their premiums would have to be even higher if they also had to cover the services for children under 5, pregnant women and the treatment of malaria that are currently free.

In this sense, the MHOs provide a complementary mechanism for financing the remaining non-free services, as an alternative to the CAM, but at a cost that is considerably higher than the CAM and is affordable or attractive only to a small minority of the rural population.


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Table 5-7: Mutual health organizations operational in 2012

MHO Province No of

affiliated HH No of bene-

ficiaries

Premium per HH of 6

members (BIF/year)

Services covered

Co-payment (%) Ceiling (BIF)

MUSCABU National 14,830 79,896

13,500 (+ 2,500 per 7th

to 10th person)

All services in health centres,

lab tests, hospitalization, drugs in health

facilities

Public health facilities: 20 Accredited

private health providers: 40

None

Mutuelle Nationale de Santé (MUNASA) Twitwararikane

Gitega, Kwaro, Karuzi

3,700 19,240 10,000

Curative & preventive services in

health centres

40 None

Muyinga 1,620 8,642

Mutuelle Tuzokira Twese (FVS-AMADE)

Bujumbura 98 535 37,200 Consultations, glasses, minor surgery, dental

extraction hospitalization

Health centres: 20

Hospitals, pharmacies &

ophthalmology: 50

20,000 (glasses)

Makamba 1,600 10,200

20,000 Bururi 570 3,477

Mutuelle Tugarukire amagara y'imiryano (UCODE)

Ngozi 1,070 5,312 1 person 5,000; 2-3

persons 10,000; 4-6

persons 12,000; 7-10

persons 14,000

Consultations, minor surgery

(health centres),

hospitalization

Public health facilities: 20 Accredited

private health providers: 40

Health centres:

3,000 Hospitals:

8,000

Kirundo 550 3,313

Kayanza 156 874

Total 24,194 131,489

Beneficiaries as % of total population

1.3

Sources: Questionnaires and interviews; Ministry of the Civil Service, Labour and Social Security.


The removal of health service fees for children under 5 and for deliveries in 2006 was enormously appreciated by the population and led to a dramatic increase in utilization of health services. According to one study (OAG, 2009), consultations of children under 5 rose by 146% between 2006 and 2007 in Makamba province and by 198% in Cankuzo province. Hospital admissions for children under 5 rose between 152% and 235% in four of the main hospitals: the Centre Hospitalo-Universitaire de Kamenge, Hôpital Prince Régent Charles and the hospitals in Ngozi and Cankuzo. Deliveries in these four hospitals and a fifth hospital in Makamba rose between 120% and 178%, and the number of caesarean sections between 118% and 222%. The proportion of deliveries assisted by health staff rose from 23% in 2005 to 41% in 2007 and 67% in 2012, according to administrative data.34 This continued improvement reflects also the large investments made to

34 This rate was 60.3% in the 2010 DHS and 78.8% in the PMS survey in 2012/2013.


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improve the supply and quality of services (offsetting the negative repercussions of the surge in utilization35), notably as a result of a large increase in government and donor financing of the health system and the introduction of incentives through the PBF mechanism.

The mechanism for fee waivers for indigents performs poorly and its future is uncertain in the context of the CAM. The issuance of indigence certificates theoretically gives the right to free health services. However, these certificates are not backed up by any budget allocation at commune level or through the health ministry, so health facilities are not automatically reimbursed for honouring them. As noted above, hospitals sometimes send requests to the national solidarity ministry for medical assistance on behalf of those unable to pay their bills. This is a highly centralized process, in which a letter supported by the required documentation (indigence certificate, CAM, confirmation of hospitalization, prescriptions and invoices, etc.) is sent to Bujumbura, addressed to the minister.

The Ministry states that approval is rapid (within a few days) to avoid patients being detained in hospitals for non-payment of debts. However, the budget for medical assistance, which is financed entirely from domestic revenue (with no donor support), has been inadequate to cope with the volume of requests. This resulted in an accumulation of arrears to hospitals and pharmacies, which further reduced the resources available for meeting new requests for assistance. At the end of 2012, the Ministry’s medical assistance arrears amounted to BIF 2.7 billion (USD 1.87 million). These arrears were to be settled by a specific allocation for this purpose in the 2013 budget. In the longer term, the locally-issued indigence cards or the medical assistance scheme should integrate into a unified health insurance scheme, such as the ones of the Rwanda’s community-based health insurance system or Ghana’s National Health Insurance Scheme.

The CAM system has a noble objective but suffers from serious design and implementation weaknesses. The CAM scheme is a bold initiative to extend health insurance coverage beyond the formal sector to the population dependent on family agriculture and other branches of the informal economy. However, when it was reorganized in 2012, the lack of prior technical studies resulted in weaknesses that threaten the scheme’s efficiency, effectiveness and sustainability.

The annual premium of BIF 3,000 per household was not decided on the basis of any parametric calculations of long-term viability, taking into account the cost of services covered, household contributory capacity and the potential level of government subsidy.

The CAM is thus severely under-funded, resulting in delays in reimbursement and the build-up of debts by health facilities. According to conservative cost projections by the World Bank (2012), the minimum government subsidy needed to finance the scheme if there was full take-up (as officially intended) would have amounted to BIF 28.9 billion in 2013. This was eleven and a half times more than the BIF 2.3 billion actually spent by the Ministry of Health on the CAM in 2012. Information obtained from a health centre in Gitega in the course of this study indicated that reimbursement was nine months in arrears as of May 2013. As a result, many non-public health centres and hospitals no longer accept the CAM and require payment in cash, recalling the situation that existed with the old CAM before the 2012 reorganization.

A number of technical design and implementation weaknesses limit the CAM effectiveness: the limitation on coverage of hospitalization to the district hospital level, excluding referral to the higher tier hospitals (where costs for patients are higher); the voluntary nature of the scheme, which creates a risk of adverse selection; weak controls and perverse incentives that lead to over-prescribing and over-billing; and supply-side problems in health facilities, in particular drug shortages, that limit the

35 These included drug stock-outs, overcrowding in hospitals, long waiting times for consultations, a large increase in the workload of health staff and delays in reimbursing health facilities’ invoices (OAG, 2009). The free health services for children and pregnant women were integrated into the PBF mechanism in 2010, greatly improving the reimbursement of health facilities’ invoices.


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availability of the CAM package of services in practice, obliging patients to buy drugs in private pharmacies without reimbursement.

Lastly, unlike most health insurance schemes, the CAM has no autonomy vis-à-vis the main institution responsible for health care provision and for overseeing the sector as a whole: the health ministry. In fact, it is a programme run by the ministry itself. The absence of a provider-purchaser split creates inefficiencies and conflicts of interest. As mentioned above, the question of the relationship between the CAM and the private mutual health initiatives, run by NGOs and regulated by the ministry responsible for social security, remains to be addressed.

MHO membership has stalled since the re-launching of the CAM in 2012. This is true for both of the largest MHOs. The number of households affiliated to MUSCABU declined from 16,557 in August 2011 to 14,830 in August 2012. In Gitega, MUNASA Twitwararikane saw membership slip from 3,853 households in 2011/12 to 3,700 in 2012/13, reversing a previous period of uninterrupted growth. All the MHO managers interviewed see the CAM as a threat to the further development of their schemes. The MHO premiums are between 3 and 7 times higher than those of the CAM, co-payment rates are often twice as high (40% instead of 20%) and the services covered are sometimes less than those provided by the CAM.

Furthermore, the CAM scheme has strong official support. MHO managers claim that Government health centres are giving priority to patients enrolled in the CAM for political reasons36, while the accredited health centres, which are mainly church-run, tend to prefer the MHOs. While the MHOs cannot compete with the CAM on price, they benefit from the weaknesses of the CAM system, their own good track record in promptly reimbursing health facilities and their wider role as community-based solidarity mechanisms, often linked to group-based microfinance and support for the development of livestock, agriculture and other revenue generating activities.

The viability of MHOs is precarious. Most of the MHOs appear to be financially viable only in the limited sense that their expenditure on reimbursing the health services provided to their members is offset by their revenue from membership fees and premiums. Some have also been able to build up a small reserve fund. However, if donors were not financing their administrative costs (mainly through Belgian NGOs), many MHOs would have operating deficits. Furthermore, given the diseconomies of scale in these small schemes and the intensive nature of the back-up provided to the local sections, administrative costs are a high proportion of total expenditure (in the range of 25-50% according to information received from MHOs), raising questions about the cost-efficiency and sustainability of the mutualist movement.

As voluntary movements, they also face the risk of adverse selection, which they try to limit by a moratorium of two months on the activation of insurance cover after membership, while it is also sometimes difficult to prevent fraud in the use of membership cards (by uninsured relatives and friends). Table 5.8 provides data on the largest scheme, MUSCABU, which accounts for approximately half of all MHO members and beneficiaries, showing that this scheme moved from a position of surplus to deficit (excluding grants) between 2011 and 2012, with its premium recovery rate declining from 62% to 54% and administrative costs rising from 34% to 37% of total costs.

Les adhésions aux mutuelles ont stagné depuis la réforme de la CAM en 2012. Ceci peut se voir dans les cas des deux mutuelles les plus grandes. Le nombre de ménages membres des MUSCABU s’est réduit de 16 557 en août 2011 à 14 830 en août 2012. A Gitega, la MUNASA Twitwararikane a vu le nombre d’adhérents diminuer de 3 853 ménages en 2011/12 à 3 700 en 2012/13, mettant fin à une période précédente de croissance non interrompue. Tous les gestionnaires de mutuelles rencontrés ont mentionné la CAM comme

36 In Ngozi, the research team was told that members of MHOs are sometimes refused services if they do not have the CAM as well.


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menace au développement futur de leurs structures. Leurs cotisations sont de 3 à 7 fois plus élevées que celles de la CAM, leurs tickets modérateurs sont souvent deux fois plus élevés (40 % au lieu de 20 %) et les services couverts sont quelquefois plus limités que ceux de la CAM.

En outre, la CAM a un fort appui officiel. Les gestionnaires des mutuelles affirment que les centres de santé du Gouvernement donnent priorité aux patients inscrits à la CAM pour des raisons politiques37, tandis que les centres de santé agréés, qui sont principalement gérés par des ordres religieux, tendent à préférer les mutuelles.

Malgré le fait que les mutuelles ne peuvent pas concurrencer la CAM en termes de prix, elles bénéficient des faiblesses du système de la CAM, de leur propre mécanisme de remboursement rapide des formations sanitaires et de leur rôle plus large comme mécanismes de solidarité à base communautaire, souvent liés au groupes d’épargne et de crédit et à l’appui au développement de l’élevage, de l’agriculture et d’autres activités génératrices de revenus.

La viabilité des mutuelles est précaire. La plupart des mutuelles semblent être viables seulement dans le sens limité que leurs dépenses de remboursement des factures des services sanitaires consommés par leurs membres sont compensées par leurs recettes des frais d’adhésion et des cotisations. Quelques-unes ont aussi réussi à cumuler des petits fonds de réserve. Cependant, si des PTF ne finançaient pas leurs dépenses administratives (principalement à travers des ONG belges), beaucoup de mutuelles auraient des soldes déficitaires.

D’autre part, compte tenu du manque d’économies d’échelle dans ces petites structures et de la nature intensive des appuis donnés aux sections locales, les dépenses administratives sont élevées par rapport aux dépenses totales (de 25 à 50 % selon des informations reçues de certaines mutuelles), ce qui donne à s’interroger sur le coût-efficience et la pérennité du mouvement mutualiste.

Comme structures d’adhésion volontaire, les mutuelles font face aussi au risque de la sélection adverse, qu’elles essaient de limiter par un délai de 2 mois dans la mise en vigueur de l’assurance après l’adhésion, et au risque d’utilisation frauduleuse des cartes des assurés (par des parents et amis non assurés).

Le Tableau 5.8 présente des données sur le plus grand système mutuel, celui des MUSCABU, avec environ la moitié des membres et des bénéficiaires de l’ensemble des mutuelles, qui ont évolué d’un solde excédentaire en 2011 à une situation de déficit (excluant dons) en 2012, liée à une diminution du taux de recouvrement des cotisations de 62% à 54% et à une hausse de la part des coûts administratifs dans les coûts totaux de 34% à 37%.

37 A Ngozi, l’équipe de recherche a été informée que l’accès aux services est quelquefois refusé aux membres des mutuelles qui n’ont pas acheté aussi la CAM.


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Table 5-8: MUSCABU performance data (year to 31 August), 2011-2012

2011 2012

Population coverage

Members of coffee farmers unions 48 564 48 564

MUSCABU members 16 557 14 830

Penetration rate (%) 34 31

Beneficiaries 87 370 79 896

Utilization of services

Utilization rate: local consultations (%) 0,90 0,98

Utilization rate: hospitalization (%) 0,03 0,04

Finances (BIF)

Total revenue 173 098 385 133 237 591

Membership fees 16 702 000 14 444 000

Premiums due 223 926 000 198 477 000

Premiums received 138 832 569 107 839 232

Premium recovery rate (%) 62 54

Grants 17 561 495 9 794 924

Total expenditure 115 778 974 142 795 256

Reimbursement of medical expenses 76 016 699 89 642 570

Hospitalization 18 623 604 22 411 272

Administrative expenditure 39 762 275 53 152 686

Administrative costs as % of total costs 34 37

Total expenditure as % of total revenue (minus grants) 74 116

Medical expenditure as % of total revenue (minus grants) 49 73

Average cost of local consultations 1 263 1 456

Average cost of hospitalization 11 000 12 584

Source : ADISCO.

5.7 Conclusion

Although humanitarian assistance remains important, the Government and development partners are increasingly turning to longer-term safety net approaches that strengthen the productive capacity, incomes and consumption of the poor. Pure short-term humanitarian assistance continues, but on a declining trend, reflecting the progress made in addressing humanitarian and resettlement needs. New approaches are developing, that address the long-term structural vulnerability of communities, especially in the rural areas, by strengthening their resilience. However, apart from universal fee abolition measures in the social sectors, most safety net programmes and projects have quite low coverage.

Labour-intensive public works and various types transfers have emerged as favoured interventions for raising the incomes and consumption of vulnerable households, but these are still small-scale and do not yet constitute real long-term national programmes. There are several small uncoordinated, donor-funded public works programmes (or public works components of broader programmes), but overall these cover only 2% of the working age population. Input transfers, in particular of livestock, are prominent features of several agricultural development programmes, aiming to strengthen the productive capacity of rural


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households, but again these interventions reach only a small part of the vulnerable rural population. A key challenge is to scale up labour-intensive public works and input/asset transfers. This requires long-term nationally led programmes rather than scattered donor-funded interventions that are difficult to sustain.

Given tight resource constraints and the extensive nature of vulnerability, improved prioritization and more efficient targeting (possibly based on combination of poverty-related characteristics) will be essential. The review of programmes in this chapter has highlighted the diversity of approaches to targeting, ranging from the absence of clear criteria and procedures in some cases (indigence certificates and some public works programmes) to simple categorical approaches (for example the targeting of returning refugees and ex-combatants) to elaborate and sophisticated targeting mechanisms such as the community-based categorization of households according to ownership of land and livestock (in the IFAD/WFP programmes).

Going forward, a more systematized approach to beneficiary selection, that gives priority to the most vulnerable, will be required. Targeting efficiency is not easy to achieve in a country with mass poverty and weak differentiation of consumption levels and human development across the bottom six or seven deciles of the population. However, as Chapter 2 discussed, an appropriate approach in the Burundian context would be a combination of geographical targeting and a combination of methods to target households including potentially multi-variate proxy-means tests, categorical criteria and community involvement.

Consideration should also be given to the option of establishing a complementary programme that addresses the extreme vulnerability of households with a high dependency ratio. These are households that either have no labour capacity at all (for example households headed by old persons or persons with disabilities and with no able-bodied working-age adults), or have a very high dependency ratio, for example households (often female-headed) with a single working-age adult and a large number of children.

When female-headed, these households are likely also to have an acute land constraint. While these households may not be the most numerous, the analysis in Chapter 2 showed that they are among the most deprived and that they face multiple vulnerabilities. In several other African countries (for example, Burkina Faso, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Sénégal and Zambia), the answer has been to establish cash transfer programmes for these highly vulnerable households with complementary interventions to promote investments in human capital, with the promotion of nutrition, education and health.

Apart from the very recent and localized pilot experience of the Terintambwe programme discussed in Box 5.1, there is at present no national cash transfer programme. A programme of this type could be designed and launched, as one potential pillar of the operationalization of the National Social Protection Policy.

Programmes to promote demand-side access to basic social services are another key dimension of the emerging social protection framework, but likewise need strengthening. Given the seriousness of mortality and human deprivation risks, as well as the social benefits of an educated and healthy population, the Government has appropriately opted for universal approaches to the provision of some basic health and education services.

The main measures adopted have been the abolition of fees for primary education and for priority health services (for children under 5, pregnant women and the treatment of illnesses such as malaria, HIV/AIDS and tuberculosis). These are in effect indirect social transfers, financed by taxation and external aid (linked to the performance-based financing mechanism in the case of health care). In terms of coverage, they are at present by far the largest non-contributory social protection mechanisms in Burundi. However, social protection in the social sectors could be strengthened by some further measures:

In basic education, more attention needs to be given to reducing the remaining cost barriers to school entry, attendance and completion, as families still have to meet a range of direct and indirect costs to send their children to school (school materials, uniforms, informal school levies and opportunity costs). Cash transfers may provide one way to address these barriers. Other possible interventions include extending school fee abolition to the new 4th cycle of basic education (grades 7-9), and expending school feeding, which is still limited in scope (covering only about 10% of primary pupils)


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but could act as a strong incentive to get children into school at the correct age and to retain them in the school system.

In the health sector, additional measures are needed to ensure access to services by the most vulnerable and also to strengthen the long-term viability of complementary health insurance mechanisms. To ensure access in practice to the priority health services that are officially free, documentation requirements need to be eased, as anecdotal evidence indicates that the most vulnerable families sometimes cannot meet these requirements. The system for providing indigence certificates giving a right to free health care needs to be reformed, so as to establish more solid selection procedures and adequate mechanisms for its financing, possibly within the framework of a wider reform of the CAM. The CAM itself needs to evolve towards a national health insurance system that is financially viable and sustainable, providing a complementary pre-payment mechanism for risk-smoothing and thereby improving financial access to the health services that, given public finance constraints, the Government cannot provide free to the population.

Additional social protection measures should aim to combat social exclusion and discrimination. The absence of an integrated national programme to combat the social exclusion and extreme vulnerability of the Batwa is a striking weakness of the social protection system that needs to be corrected as the National Social Protection Policy moves forward to operationalization. Another key social protection measure is the guarantee of equal rights to inheritance and ownership of land by men and women.


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6 CHARTING THE WAY FORWARD

Following the post-conflict transition, Burundi is entering a new phase of its development, during which the social protection system should play a key role in reducing the structural vulnerability of the poorest layers of the population. This challenge is now coming to the fore, as short-term humanitarian/resettlement needs recede. Long-term non-contributory social protection programmes could help to reduce vulnerability and strengthen resilience by increasing the income and consumption of the poorest households, improving their access to basic social services and building their human and productive capital. This final chapter makes some general suggestions on how to move forward to build a stronger safety net system.

Very limited fiscal space makes the prioritization of programmes and efficient targeting essential. Despite the extensive nature of poverty and the weak differentiation (in consumption expenditure and human development) across the poorer deciles of the population, prioritization of programmes and targeting of the most vulnerable are unavoidable in a country that has extremely limited resources, is heavily dependent on external aid and has many competing priorities for development. Given the human development challenges, which threaten the foundations of the country’s development, social assistance interventions should concentrate on improving the resilience of the poorest and weakest. The most appropriate targeting criteria in the existing circumstances will need to be designed as part of the social protection strategic plan and safety nets programs design.

Given the fiscal space constraints and the livelihoods and human development challenges facing the poorest, the targeting of safety net programmes will probably need to rely on a combination of methods, including geographical and categorical targeting as well as a set household-level variables linked to poverty such as demographic structure and ownership of key productive assets. The population in the first (poorest) quintile is more concentrated in the North and Centre-East regions (the North also performing worse for several human development indicators). Relative to better-off households, households in the poorest quintile have smaller land-holdings (with many more households owning less than 0.2 ha), are less likely to have livestock (and especially cows or other large livestock), and tend to have more household members and a higher dependency ratio. Further analysis, including multivariate regression analysis, will be needed at the stage of developing the social protection strategic plan to identify more precisely the criteria that would best identify the poorest and most vulnerable households.

Although fiscal space for expanding public expenditure on safety nets will remain quite limited in the coming years, some resources could be freed through the reorientation of humanitarian aid, improvements in domestic revenue mobilization (from what is currently a very low base, relative to GDP, by regional standards), and the phasing out of poorly targeted fuel subsidies. Donors will need to reorient their assistance by moving away from fragmented short-term safety net projects and instead jointly supporting the building of a coherent and sustainable national social protection system. Such a shift is particularly important given the degree of aid dependency, for the financing of public expenditure in general and especially in the social sectors. In 2012, aid accounted for over 85% of non-contributory social protection expenditure, including humanitarian assistance. The current dominant practice by which donors fund a multiplicity of small disconnected short to medium term projects, usually outside government management systems, is not conducive to sustainability and risks leaving no national systems or resources to the country once project financing ends. The adoption of the PNPS has established a policy framework to guide the development of social protection, which should make it easier to move in the direction of programmatic joint support as is done in other countries in the region such as Ethiopia and Tanzania.

Given the challenges facing the country in terms of vulnerability to man-made and natural crisis and human, development, the social protection system will need to build on twin-track interventions that can help alleviate poverty in the short-run, mitigate risks, and build human capital and livelihoods in the medium- and long-terms. The core pillars of such a system would probably include some income-support measures complemented with investments in both the foundations of human capital of extremely poor households and the productive capacity of these households and their communities. Table 6.1.describes some social assistance interventions, which contribute to the twin tracks of poverty alleviation and


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investment in human capital and livelihoods and summarizes their strengths and challenges in the Burundian context.

Table 6-1: Options for strenghtening non-contributory social protection

Options Potential strenghts/opportunities Possible weaknesses or risks

Income support with investment effects

Labour-intensive public works programme

Extensive and diverse experience of PWPs in Burundi, providing an opportunity to apply best practices in an integrated national programme

Provision of short-term employment, increased household incomes and consumption (and sometimes worksite training and promotion of savings)

Income-smoothing mechanism in rural areas, counteracting seasonal food insecurity, recurrent safety net

Assets produced through public works, including improved environmental protection, water and soil fertility management, agricultural roads

Economic efficiency in fields suitable for labour-intensive approaches

Greater social and political acceptability, as social assistance is accompanied by a work requirement

Short-term nature of the employment and increase in earnings,

Need complementary employment measures to address low skills and sluggish labor market

Wage setting would need revision for self-targeting to work. Otherwise complementary targeting mechanisms are needed.

High administrative capacity requirements for design and implementation of sub-projects, selection of participants and procurement of equipment and materials

Cash transfers Increase in the income and consumption of beneficiaries, with indirect effects on human development, savings, etc.

Generally lead to greater use of education and health services, this effect can be increased with complementary measures ranging from awareness-raising, communication for behaviour change and soft conditions.

Can function as a complementary programme to support labor-constrained households

Opportunity to learn from the Terintambwe pilot project

Technical and practical challenges of efficient targeting

(Possibly) some social/political reluctance to support ‘hand-outs’, although maybe not if targeted to households or individuals without labour capacity

More suited to address structural long-term poverty (needs long-term commitment) although some effects in protection against crises.

School feeding Incentive to school attendance and in particular to correct-age enrolment and retention

Second-round effects on other children in the household depending on the delivery modality

Potential links to local production of PWP-supported community kitchens

Management requirements for procurement of food and delivery of meals (simplified if based on local procurement)

Fiscal constraints on the scale of implementation

Generally geographically and school targeted (some loss of efficiency)

Missing pre-school children


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Support to livelihoods and human capital

Transfers of agricultural inputs and livestock

Increase in the productive capacity and yields of small farmers and indirectly their incomes and consumption

Socially and politically acceptable, given these transfers’ direct contribution to agricultural/rural development and food security

Technical and practical challenges of efficient targeting

High administrative capacity requirements for procurement and distribution of inputs

Mixed impacts on poverty and extreme poverty

Need complementary rural extension and animal husbandry services

Fiscal constraints on the scale of implementation

Community-based nutrition interventions

Extensive and diverse experience in Burundi with both preventive and therapeutic components as well as behaviour change interventions around early childhood development and hygiene

Can complement income-support activities to maximize their impact in terms of building foundations of human development

High cost-effectiveness efficiency

Long-term impacts

Multi-sectoral coordination challenges

Fee waivers

Extension of school fee abolition to the new 4th cycle of basic education

Reduction of direct costs of school enrolment, improving transition to the 4th cycle and completion of basic education

Fiscal constraints

Reform of the attestations d’indigence

Improved access to secondary education (fee waivers) and health services by the extreme poor

In the case of health, would need to be integrated into a broader reform of the health insurance system

Technical and practical challenges of efficient targeting Vulnerable to political capture at the local level

To raise the incomes and consumption of the most vulnerable households, consideration could be given to scaling up labour-intensive public works programmes (PWPs). Burundi has gained considerable experience in implementing PWPs, which help to smooth the consumption of vulnerable households during lean seasons through temporary periods of employment and also help to build household and community assets of the poor, for example through water and land conservation works and soil productivity investments.

The current programmes are fragmented, implemented through donor projects that are time-bound and small-scale in coverage, providing short-term employment to only 2% of the working age population. The challenge would therefore be to scale up these types of interventions and to ensure their long-term sustainability through a nationally led program in a context of low implementation capacity. Managing the design of large numbers of investment projects, the targeting of works and selection of participants, the procurement of equipment and materials, and sub-project implementation at scale may stretch existing capacity. However, these programmes are conducive to donor and inter-sectoral coordination and may provide one of the pillars of a safety net system

Another complementary safety net would be the continuation of transfers of agricultural inputs to selected poor rural households, in coordination with rural extension services. These could be delivered as part of broader agricultural or rural development programmes, as has been the practice to date. Several of these programmes have included components that have a social protection or safety net character, although the programmes are aimed more generally at improving productivity and incomes in the agricultural sector. This type of intervention however faces the same challenge of efficient targeting and has high implementation


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capacity requirements for the procurement and distribution of inputs. They would have to fit in a systemic approach linking social protection and rural poverty reduction. .

Cash transfers for ultra-poor households could complement safety nets such as PWPs. Cash transfer programmes do not exist in Burundi, except in one small pilot project. Paid on a regular predictable basis, cash transfers would reduce the vulnerability of very poor households. This would be the case, for example, for households with high dependency ratio be it through elderly, disabled or children members. A cash transfer programme targeted at these types of households could be another pillar of the operationalization of the PNPS.

Given the challenges facing human capital accumulation among the poor, another pillar of a social protection system would probably consist of strengthening access to education and health services. This is another priority, given the importance of mortality and human deprivation risks, as well as the role of human capital in long-term poverty reduction and socioeconomic development. The seriousness of these social risks, and the high social returns to investments in nutrition, education, health, justify stimulating the use of these services. Targeted cash transfers can help resolve some of the demand-side barriers facing poor households.

On the supply-side, the country would need to consolidate the achievements already achieved through the abolition of fees for primary education and for priority health services (for children under 5, pregnant women and the treatment of illnesses such as malaria, HIV/AIDS and tuberculosis). These indirect social transfers, financed by taxation and external aid (linked to the performance-based financing mechanism in the case of health care) are at present by far the largest non-contributory public social assistance mechanisms. Fiscal space permitting, further interventions could include the extension of school fee abolition to the new 4th cycle of basic education (grades 7-9), to reduce direct costs and promote transition to this cycle, and the expansion of targeted school feeding or conditional cash transfers, which currently covers about 10% of primary school pupils, as an incentive to get children into school at the correct age and to discourage dropout.

In health, consideration should be given to easing documentation requirements in order to ensure access in practice by the most vulnerable to the priority health services that are officially free. Attention should also be given to improving the procedures for providing targeted fee waivers or cash transfers and to the financing of this mechanism. This could be integrated into the policy dialogue around the broader reform of the CAM, which at present covers 23% of the population but is financially unviable. Given the nutrition challenges facing the country, another set of interventions could be focused on fostering the foundations of human development through support to community-based nutrition interventions, focusing on pregnant women, and pre-school children and other nutrition-sensitive social protection interventions such as conditional cash transfers.

The social protection system should also include measures to address social exclusion and discrimination. This could include measures to combat the social exclusion and extreme vulnerability of the Batwa, covering access to land, employment, education and health care, among other dimensions of economic and social life, as well as measures to ensure women’s access to land ownership.

No matter the mix of interventions, the strategic plan for operationalizing the PNPS should include a strong component on institutional capacity building. This should include measures to strengthen the capacity to plan, coordinate and manage social protection programmes at national level and measures to strengthen the capacity to deliver programmes at local level. The only existing government structures for social assistance at local level, the CDFCs, are weak in terms of both human and financial resources.

The medium term priorities and objectives will be spelled out in a budgeted strategic plan for operationalizing the National Social Protection Policy (PNPS). Although it is expected that this plan, which is already envisaged, will also encompass contributory social security programmes, it is highly likely that contributory risk-pooling mechanisms will mainly benefit the better off, who can afford to contribute to


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them. The strategic plan should give priority to strengthening non-contributory programmes, which play a critical role for reducing the vulnerability of the poorest. It should focus in particular on transforming the current patchwork of fragmented short-term safety net projects into a core of long-term sustainable programmes reaching a critical mass of the poorest and most vulnerable households. Detailed decisions on the nature, scale, focus, targeting and financing of programmes should take place as part of the process of developing the strategic plan, based on a careful analysis of options and taking into account the fiscal space available for building a strong safety net system. This will be further facilitated by the development partners’ new working group on social protection, set up in 2013, which provides a framework for improved donor harmonization and coordination with the Government of Burundi.


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BIBLIOGRAPHY

ABUTIP (2010a) Projet Multisectoriel de Réinsertion Socio-Economique « PMRSE », Rapport d’activités du 4ème trimestre 2009, Octobre-Décembre 2009, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.


ABUTIP (2011b), Projet de Travaux Publics et de Gestion Urbaine « PTPGU », Rapport d’activités du quatrième trimestre 2010, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.

ABUTIP (2011c) Projet d’appui au programme de création d’emplois « PAPCE », Rapport d’activités du quatrième trimestre 2010, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.


ABUTIP (2012b) Projet de Travaux Publics et de Gestion Urbaine « PTPGU », Rapport d’activités du 4ème trimestre 2011, Octobre-Décembre 2011, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.

ABUTIP (2012c) Projet d’appui au programme de création d’emplois « PAPCE », Rapport d’activités du 4ème trimestre 2011, Octobre-Décembre 2011, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.

ABUTIP (2012d) Projet Multisectoriel de Réinsertion Socio-Economique « PMRSE », Rapport d’activités du 3ème trimestre 2012, Juin-Juillet-Août 2012, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.

ABUTIP (2013a) Projet de Travaux Publics et de Gestion Urbaine « PTPGU », Rapport d’activités du 4ème trimestre 2012, Octobre-Décembre 2012, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.

ABUTIP (2013b) Projet d’appui au programme de création d’emplois « PAPCE », Rapport d’activités du 4ème trimestre 2012, Octobre-Décembre 2012, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public.

Armstrong, M (2011) Analyse sur la situation des enfants dans les centres résidentiels au Burundi, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre, International Rescue Committee & UNICEF, May.

AVSI (2010) Rapport annuel des activités réalisées par AVSI Burundi au cours de l’année 2010, Association des Volontaires pour le Service International.

AVSI (2011) Rapport annuel des activités réalisées par AVSI Burundi au cours de l’année 2011, Association des Volontaires pour le Service International.

AVSI (2012a) Rapport annuel des activités réalisées par AVSI Burundi au cours de l’année 2012, Association des Volontaires pour le Service International.

AVSI (2012b) Rapport de la première annualité (01/12/2011–31/12/2012), Projet « Commune de Milan » : Intervention pour l’Amélioration de la Production et de la Sécurité Alimentaire grâce à l’Approche Agro-Zootechnique-Forestier dans la Commune Kayanza de la Province Kayanza, Association des Volontaires pour le Service International.

BAD (2013) République du Burundi : projet d’appui au renforcement des capacités institutionnelles dans les domaines de la promotion de l’emploi et de l’entreprenariat des jeunes, African Development Bank.

Béko, A (undated) Poverty Update – Burundi, World Bank.


74

Burundi

BIT (2011) Etude diagnostique sur les dispositifs de protection sociale existants et identification des espaces possibles en vue de la mise en place d’un socle de protection sociale au Burundi, provisional draft, International Labour Office, October.

Bundy D, Burbano C, Grosh M, Gelli A, Jukes M & Drake L (2009) Rethinking School Feeding: Social Safety Nets, Child Development and the Education Sector, World Bank, Washington, D.C., and World Food Programme, Rome.

Butoyi P (2012) Expérience de la CAM au Burundi, January.

Cabinet du Président (2008) Décret No 100/102 du 09 juin 2008 portant réorganisation du Ministère de la Fonction Publique, du Travail et de la Sécurité Sociale.

Cabinet du Président (2011) Décret No 100/216 du 4 août 2011 portant structure, fonctionnement et missions du Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

Cabinet du Président (2012a) Décret No 100/237 du 22 août 2012 portant création, organisation, composition, missions et fonctionnement de la Commission Nationale de Protection Sociale.

Cabinet du Président (2012b) Décret No 100/325 du 17 décembre 2012 portant création, structure, missions et fonctionnement des Centres de Développement Familial et Communautaire (CDFC) au Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

CNLS (2011) Bilan des Réalisations du Plan d’Action National de Lutte contre le SIDA 2010, Secrétariat Permanent Exécutif du Conseil National de Lutte contre le SIDA.

CNLS (2012) Bilan des Réalisations du Plan d’Action National de Lutte contre le SIDA 2011, Secrétariat Permanent Exécutif du Conseil National de Lutte contre le SIDA.

CNLS (2013) Bilan des Réalisations du Plan d’Action National de Lutte contre le SIDA année 2012, Secrétariat Permanent Exécutif du Conseil National de Lutte contre le SIDA.

Concern (2012) Concern Worldwide Burundi 2012 Programme Progress Report.

Concern (no date) Terintambwe Programme: Take a Step Forward, project proposal, Concern Worldwide.

Congrégation des Frères de Notre Dame de la Miséricorde (2013), Institut Médico-Pédagogique du Mutwenzi, information note.

Contribution des partenaires techniques et financiers du secteur de la santé pour la réussite de la réorganisation du système de carte d’assistance médicale (CAM) au Burundi, undated.

CRS Burundi (2012), Programme d'Assistance Pluriannuel 2008-2012, évaluation finale, Catholic Relief Services.

CTB (2012) Impacts du pavage HIMO et social dans les communes de Bujumbura, CTB-Agence de Développement Belge, May.

CTB (2013) Rapport des résultats 2012 développement économique et social par la mise en œuvre d’un programme de pavage à haute intensité de main d’œuvre, bdi 08049 11/bdi 09052 11, CTB-Agence de Développement Belge, January.

DGPFEG (2010) Rapport annuel 20010, Direction Générale de la Promotion de la Femme et de l’Egalité des Genres.

European Commission (2009), Mission d’étude des coûts et du financement du système de santé au Burundi, Cadre de dépenses à moyen terme et MBB, final report, April 20.

FAO (undated) Rapport final, OSRO/RAF/010/SWE, United Nations Food and Agriculture Organization.

FAO (undated) Document de projet, OSRO/RAF/010/SWE, United Nations Food and Agriculture Organization.

FAO (undated) Proposition de projet, Programme LRRD d’appui à la viabilisation des villages ruraux intégrés dans le cadre du rapatriement et de la réintégration au Burundi, United Nations Food and Agriculture Organization.

FAO (undated) OSRO/BDI/102/SWE : Rapport d’activités, United Nations Food and Agriculture Organization.


75

Burundi

FAO (sans date) Proposition de projet, Autonomisation agro-économique de ménages vulnérables dans les provinces de Bujumbura Rural, Bururi, Makamba, Rutana, Gitega et Mwaro, United Nations Food and Agriculture Organization.

FCP & PNUD (2009) Appui à la réintégration socio-économique des populations affectées par les crises et au relèvement communautaire dans les provinces de Bubanza, Bujumbura Rural et Cibitoke, proposition de projet soumise par le Programme des Nations Unies pour le Développement au Fonds de Consolidation de la Paix au Burundi

FCP & PNUD (2010) Rapport narratif final sur les progrès réalisés: Appui à la réintégration socio-économique des populations affectées par les crises et au relèvement communautaire dans les provinces de Bubanza, Bujumbura Rural et Cibitoke, 2009-2010, rapport du Programme des Nations Unies pour le Développement, Fonds de Consolidation de la Paix au Burundi.

FCP & PNUD (2012) Rapport narratif final sur les progrès réalisés: Consolidation de la paix à travers l’appui à la réintégration socio-économique durable en faveur des personnes affectées par le conflit, rapport du Programme des Nations Unies pour le Développement, Fonds de Consolidation de la Paix au Burundi.

FIDA (2012) République du Burundi, « Programme national pour la sécurité alimentaire et e développement rural de l’Imbo et du Moso » (PNSDR – IM), International Fund for Agricultural Development, concept note, January 2.

FIDA & MAE (2009) Projet d’appui à l’intensification et à la valorisation agricoles du Burundi, rapport des réalisations à fin décembre 2009, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2011) Rapport des réalisations annuelles du PAIVA-B, année 2011, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2012a) Rapport annuel des réalisations du PAIVA-B, exercice 2012, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2012b) Programme de Développement des Filières « PRODEFI », Rapport annuel 2012, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2012c) Projet d’appui à la reconstruction du secteur de l’élevage (PARSE), Rapport annuel 2012, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2012d) Projet d’appui à l’intensification et à la valorisation agricoles du Burundi, Programme de Travail et Budget Annuel 2013, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2012e) Programme de Développement des Filières (PRODEFI), Programme de travail et budget annuel 2013, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MAE (2012f) Projet d’appui à la reconstruction du secteur de l’élevage (PARSE), Programme de travail et budget annuel 2013, International Fund for Agricultural Development and Ministère de l’Agriculture et de l’Elevage.

FIDA & MFPDE (2013a) Programme Transitoire de Reconstruction Post Conflit (PTRPC), Rapport annuel 2012, International Fund for Agricultural Development and Ministère des Finances et de la Planification du Développement Economique.

FIDA & MFPDE (2013b) Programme Transitoire de Reconstruction Post Conflit (PTRPC), Programme de travail et budget annuel 2013, International Fund for Agricultural Development and Ministère des Finances et de la Planification du Développement Economique.

Grabot, S (2012) Analyse de la situation des droits de l’enfant, provinces de Bubanza, Bujumbura Rural et Cibitoke, War Child.


76

Burundi

Havyarimana, P (2012) Etat des lieux sur les initiatives d’éducation non-formelle visant la réalisation de la scolarisation universelle au Burundi, Ministère de l’Enseignement de Base et Secondaire, de l’Enseignement des Métiers, de la Formation Professionnelle et de l’Alphabétisation.

HI (undated) Vivre avec un handicap au Burundi, Handicap International.

IMF (2013a) Burundi: Second Review under the Extended Credit Facility – Staff Report, International Monetary Fund, Washington, D.C., January

IMF (2013b) Burundi: Letter of Intent, Memorandum of Economic and Financial Policies, and Technical Memorandum of Understanding, International Monetary Fund, Washington, D.C.

IMF (2014) Regional economic outlook: Sub-Saharan Africa, International Monetary Fund, Washington, D.C., April.

ISTEEBU (2013) Annuaire statistique du Burundi 2011, Institut de Statistiques et d’Etudes Economiques du Burundi & Ministère de l’Agriculture et de l’Elevage, October

ISTEEBU and MAE (2012a) Enquête Nationale Agricole du Burundi 2011-2012, Résultats de la saison

A (version définitive), Institut de Statistiques et d’Etudes Economiques du Burundi & Ministère de l’Agriculture et de l’Elevage, June

ISTEEBU and MAE (2012b) Enquête Nationale Agricole du Burundi 2011-2012, Résultats de la saison

B (rapport final), Institut de Statistiques et d’Etudes Economiques du Burundi, September

ISTEEBU and MAE (2013) Enquête Nationale Agricole du Burundi 2011-2012, Résultats de la saison

C (rapport provisoire), Institut de Statistiques et d’Etudes Economiques du Burundi & Ministère de l’Agriculture et de l’Elevage, February

ISTEEBU and MAE (2014) Enquête Nationale Agricole du Burundi 2011-2012, Aperçu, Institut de Statistiques et d’Etudes Economiques du Burundi & Ministère de l’Agriculture et de l’Elevage

ISTEEBU, INSP & ICF (2012) Enquête Démographique et de Santé Burundi 2010, rapport final, Institut de Statistiques et d’Etudes Economiques du Burundi et Institut National de Santé Publique, Bujumbura, & ICF International, Calverton, Maryland, USA, May.

IWGIA (2007) The Indigenous World 2007, International Work Group for Indigenous Affairs.

IWGIA (2011) The Indigenous World 2011, International Work Group for Indigenous Affairs.

Landell Mills (2012) Evaluation à mi-parcours des interventions dans le cadre du Programme LRRD d'appui à la viabilisation des Villages Ruraux Intégrés au Burundi, final report to the European Commission, May.

Lemarchand, R (1994) Burundi: Ethnocide as Discourse and Practice, Cambridge University Press, Cambridge, UK

MAE (2012) Evaluation des récoltes, des approvisionnements alimentaires et de la situation nutritionnelle, saison 2012B, Ministère de l’Agriculture et de l’Elevage, with FAO, WFP & UNICEF.

McCord A & Slater R (2009) Overview of Public Works Programmes in Sub-Saharan Africa, Overseas Development Institute, London.

MEBSEMFPA (2012) Rapport d’état du système éducatif burundais, Ministère de l’Enseignement de Base et Secondaire, de l’Enseignement des Métiers, de la Formation Professionnelle et de l’Alphabétisation.

MI/BCR (2011) Recensement General de la Population et de l’Habitat du Burundi 2008, volume 1, Tableaux Statistiques Burundi, Ministère de l’Intérieur, Bureau Central de Recensement.

MFPDE/PAPCE (2011) Rapport trimestriel PAPCE No 09, octobre-décembre 2011, Ministère des Finances et de la Planification du Développement Economique, Projet d’Appui au Programme de Création d’Emplois.

MFPDE/PAPCE (2012) Rapport trimestriel PAPCE No 13, octobre-décembre 2012, Ministère des Finances et de la Planification du Développement Economique, Projet d’Appui au Programme de Création d’Emplois.


77

Burundi

MFPDE/PMRSE (2011) Rapport trimestriel PMRSE No 24, octobre-décembre 2011, Ministère des Finances et de la Planification du Développement Economique, Projet Multisectoriel de Réinsertion Socio-Economique.

MFPDE/PMRSE (2012a) Rapport trimestriel PMRSE No 28, octobre-décembre 2012, Ministère des Finances et de la Planification du Développement Economique, Projet Multisectoriel de Réinsertion Socio-Economique.

MFPDE/PMRSE (2012b) Etude d’Evaluation des Impacts du Projet Multisectoriel de Réinsertion Socio-Economique (PMRSE), Ministère des Finances et de la Planification du Développement Economique, Projet Multisectoriel de Réinsertion Socio-Economique.

MFPDE/ISTEEBU & MAE/DGPAE/DSIA (2012) Enquête Nationale Agricole du Burundi 2011-2012, résultats de la saison A, version définitive, Ministère des Finances et de la Planification du Développement Economique/ Institut de Statistiques et d’Etudes Economiques du Burundi et Ministère de l’Agriculture et de l’Elevage/Direction Générale de la Planification Agricole et de l’Elevage (DGPAE)/Direction des Statistiques et Informations Agricoles, June.

MFPTSS (2009) Plan d’action national pour l’élimination des pires formes de travail des enfants 2010-2015, Ministère de la Fonction Publique, du Travail et de la Sécurité Sociale.

MFPTSS (2011) Ordonnance Ministérielle No 570/519 du 9 mai 2011 portant fixation des conditions requises pour l’agrément des mutuelles de sante au Burundi, Ministère de la Fonction Publique, du Travail et de la Sécurité Sociale.

MPDC & PNUD (2011) Burundi Vision 2025, Ministère du Plan et du Développement Communal & United Nations Development Programme.

MPDC/PAPCE (2010) Rapport trimestriel PAPCE No 05, octobre-décembre 2010, Ministère du Plan et du Développement Communal, Projet d’Appui au Programme de Création d’Emplois.

MPDC/PMRSE (2010) Rapport trimestriel octobre-décembre 2010, Ministère du Plan et du Développement Communal, Projet Multisectoriel de Réinsertion Socio-Economique.

MPDRN & CURDES (2006) Enquête QUIBB, rapport final, Ministère de la Planification du Développement et de la Reconstruction Nationale en collaboration avec le Centre Universitaire de Recherche pour le Développement Economique et Sociale, juin.

MSF (2004) Access to Health Care in Burundi, Results of Three Epidemiological Surveys, Médecins sans Frontières, Brussels.

MSNDPHG (2012a) Politique Nationale pour la Protection de l’Enfant au Burundi 2012 – 2016, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

MSNDPHG (2012b) Minima des standards pour les enfants en institution ou privés d’un environnement familial au Burundi, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

MSNDPHG (2012c) Etude de profilage des personnes déplacées internes vivant sur les sites au Burundi, rapport principal, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre, juin.

MSNDPHG (2013) Plan Stratégique de Renforcement des Centres de Développement Familial et Communautaire (CFDC) 2013-2015, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

MSNDPHG & UNICEF (2008) Politique Nationale en Faveur des Orphelins et Autres Enfants Vulnérables, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre & UNICEF.

MSNRRRS (2010) Stratégie Nationale de Réintégration Socioéconomique des Personnes Affectées par le Conflit (dans un Cadre de Relèvement Communautaire), Ministère de la Solidarité Nationale, du Rapatriement des Réfugiés et de la Réintégration Sociale, May.


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MSPLS (2010) Enquête ménages de base pour le suivi et l’évaluation de l’impact de l’appui au système de remboursement du Paquet Minimum des Services de santé (PMS 2009), study by ISTEEBU for the Ministry of Health and the Fight against AIDS.

MSPLS (2012) Plan National de Développement Sanitaire 2011-2015, Ministère de la Santé et de la Lutte contre le SIDA.

MTT Makamba (2012) Rapport annuel des activités M.T.T. Makamba : exercice 2012.

MTTPE/PTPGU (2010), Rapport trimestriel octobre-décembre 2010, Ministère des Transports, des Travaux Publics et de l’Equipement, Projet de Travaux Publics et de Gestion Urbaine.



Nduwayo, O (2009) Le travail des enfants au Burundi, Programme International pour l’abolition du travail des enfants, Organisation International du Travail.

Nkengne, C.T (2008) Diagnostic du secteur santé, Améliorer le taux d’utilisation des services de santé par les populations, Projet d’Appui à la Gestion Economique (PAGE).

Nkunzimana, A (2012) Plan d’Affaire 2012-2016, Mutuelle « Tugarukire Amagara Y’Imiryango », May.

Ndayisaba, J (2012) Etat des lieux des connaissances et des pratiques, des acteurs et des interventions dans le domaine du développement intégré du jeune enfant (DIJE) au Burundi, Ministère de l’Enseignement de Base et Secondaire, de l’Enseignement des Métiers, de la Formation professionnelle et de l’Alphabétisation, & UNICEF.

Niyonzima, C, & IBCR (2012) Evaluation rapide sur l’exploitation sexuelle commerciale des enfants, filles et garçons, au Burundi, International Bureau for Children’s Rights, UNICEF & Ministère de la Fonction Publique, du Travail et de la Sécurité Sociale.

OAG (2009) Evaluation des effets de la mesure de subvention des soins pour les enfants de moins de 5 ans et pour les accouchements sur les structures et la qualité des soins, Observatoire de l’Action Gouvernementale, April.

OPM (2011) Etat des lieux de l’action sociale au Congo, report for the Ministry of Social Affairs, Humanitarian Action and Solidarity, Brazzaville, Oxford Policy Management.

Ouattara, O, & W Soors (2007) ‘Social Health Insurance in French-speaking Sub-Saharan Africa: Situation and Current Reform’, in Huber G, J Hohmann & K Reingard (2003) Mutual Health Insurance (MHO), Five Years’ Experience in West Africa: Concerns, Controversies and Proposed Solutions, GTZ, Bonn.

Ramsay, K (2010) Uncounted: The Hidden Lives of Batwa Women, Minority Rights Group International, London.

République du Burundi (2011) Document de Politique Nationale de Protection Sociale au Burundi, April.

République du Burundi (2012a) Plan sectoriel de développement de l’éducation et de la formation 2012-2020, July.

République du Burundi (2012b) Cadre Stratégique de Croissance et de Lutte contre la Pauvreté, January.

Seberege, P-C (2010) Etude qualitative sur le phénomène des enfants en situation de rue au Burundi, Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

Sénat du Burundi (2009) « Rapport sur la situation des Batwa », www.senat. bi/spip.php?article1114.

Sommers (2013) Low Horizons: Adolescents and Violence in Burundi, report for UNICEF, 29 January.

Terre des Hommes et al (2010) Enquête quantitative sur les enfants en situation de rue au Burundi : Bujumbura, Gitega et Ngozi, Fondation Suisse Terre des Hommes and Giriyuja ASBL, January.

Terre des Hommes (2012) Burundi, Appui au système de protection des orphelins et autres enfants vulnérables (OEV), Rapport opérationnel 2012 pour la Fondation Christa.


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The Lancet (2013) Maternal and child nutrition, Executive summary of the Lancet Maternal and Child Nutrition series, www.thelancet.com

UCEDD & UNIPROBA (undated) Rapport d’enquête sur la discrimination des filles Batwa du Burundi dans l’éducation, cas des provinces Karusi et Muyinga.

UN (2012) Plan Cadre des Nations Unies pour l’Aide au Développement du Burundi 2012-2016, United Nations System in Burundi, December.

UNDP (2011a) Rapport narratif intermédiaire du projet d’appui à la viabilisation villages ruraux intégrés dans les provinces de Makamba, Rutana, Bururi (août 2010-août 2011), United Nations Development Programme.

UNDP (2011b) Service for Community Reconstruction and Social Reintegration of Associate Adults in Bujumbura-Rural and Bururi Provinces Project, project presentation note, United Nations Development Programme

UNDP (2013a) Projet de reconstruction communautaire et la réintégration sociale des adultes associés dans les provinces de Bujumbura Rural et Bururi, final narrative report to the Government of Japan, United Nations Development Programme, January.

UNDP (2013b) Rapport « projet d’appui à la réintégration durable des ex-combattants » dans les provinces: Cibitoke – Bubanza – Bujumbura Mairie & Rural et Bururi au Burundi, United Nations Development Programme, January.

UNDP (2013c) Réintégration socio-économique des rapatriés du camp de Mtabila, programme document, United Nations Development Programme.

UNDP (undated) L’Approche 3X6, United Nations Development Programme.

UNDP (undated) Projet d’appui à la réintégration des ex-combattants, United Nations Development Programme.

UNDP & EC (2010) Programme LRRD d’appui à la viabilisation des villages ruraux intégrés dans le cadre du rapatriement et de la réintégration au Burundi, United Nations Development Programme & European Commission.

UNDP & EC (2012) Programme LRRD d’appui à la viabilisation des villages ruraux intégrés dans le cadre du rapatriement et de la réintégration au Burundi, Composante appui à la coordination et appui à la relance économique et à la cohésion sociale, rapport intermédiaire (01 Janvier 2012 au 30 Septembre 2012), United Nations Development Programme & European Commission.

UNICEF (2009) Situation Analysis of Children and Women, Burundi, UNICEF, May.

UNICEF (2010a) Burundi Annual Report 2010, UNICEF.

UNICEF (2010b) Enhancing Equitable Access to Primary Education through Back-to-School Operation: Evolution from 2007 to 2010.

UNICEF (2011) Burundi Annual Report 2011, UNICEF.

UNICEF (2012a) Burundi Programme Protection de L’Enfant, note introductive, UNICEF, February.

UNICEF (2012b) Campagne nationale pour le retour, le maintien et la réussite des enfants à l’école au Burundi (Initiative BTS - 2012), note de stratégie, UNICEF, June.

UNICEF (2013a) Analyse de la malnutrition des enfants au Burundi 2013, UNICEF.

UNICEF (2013b) Basic Education and Gender Equality Progress Report, SC/2010/109910, Burundi, March.

UNICEF (2014) State of the World’s Children 2014, UNICEF, New York

UNICEF & GoB (2011) Sommaire des résultats de la cartographie et de l’évaluation du système de protection des enfants au Burundi, UNICEF and Government of Burundi, October.

UNIPROBA & IWGIA (2008) Rapport sur la situation foncière des Batwa au Burundi, UNIPROBA and International Work Group for Indigenous Affairs.


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Burundi

UNIPROBA & IPNC (2008) Atelier Régional d’Echanges d’Informations sur les Mécanismes de la Convention sur la Diversité Biologique et la Préparation de la Neuvième Conférence des Parties, Bujumbura, Burundi, 17-19 mars 2008, UNIPROBA & Indigenous Peoples Network for Change Project.

WFP (2008) Comprehensive Food Security and Vulnerability Analysis Burundi, World Food Programme, December.

WFP (2010a) Country Programme Burundi 200119 (2011-2014), Executive Board, Second Regular Session, World Food Programme, Rome, November 8-11, 2010.

WFP (2010b) Protracted Relief and Recovery Operation (PRRO) Burundi No 200164: Assistance to Refugees, Returnees and Vulnerable Food-Insecure Populations, World Food Programme, Rome.

WFP (2011a) Standard Project Report 2011, Country Programme Burundi (2011-2014), World Food Programme.

WFP (2011b) Standard Project Report 2011, Burundi, Assistance to Refugees, Returnees and Food-Insecure Vulnerable Populations, World Food Programme.

WFP (2012a) Standard Project Report 2012, Country Programme Burundi (2011-2014), World Food Programme.

WFP (2012b) Standard Project Report 2012, Burundi, Assistance to Refugees, Returnees and Food-Insecure Vulnerable Populations, World Food Programme.

WFP (2012c) Analyse des données secondaires de la sécurité alimentaire, vulnérabilité et nutrition au Burundi, World Food Programme, November.

WFP (2012d) Burundi Système de Suivi de la Sécurité Alimentaire, bulletin no 1, World Food Programme, November.

World Bank (2006) Repositioning nutrition as central to development: a strategy for large-scale action, Washington DC

World Bank (2009a), Projet de travaux publics et gestion urbaine, document d’évaluation du projet, draft, report No 47507-BI, April.

World Bank (2009b) Project appraisal document on a proposed grant in the amount of SDR 30.1 million (US$45 million equivalent) to the Government of Burundi for a public works and urban management project, Washington, D.C., May 12.

World Bank (2009c) Project appraisal document on a proposed grant [...] in support of the third phase of the Productive Safety Net Program, report no. 48633-ET, September 25, Washington, D.C.

World Bank (2012a) Simulation de la demande et du costing de la Carte d’Assistance Médicale du Burundi, March.

World Bank (2012b) Aide mémoire de la mission de revue à mi-parcours du projet du mois de juillet 2012, Projet de travaux publics et de gestion urbaine, don H 485-B, July 2012.

World Bank (2012c) Aide-mémoire, Projet d’Appui au Développement du Secteur de la Santé au Burundi (PADSS), evaluation mission, 26 November - 14 December 2012.

World Bank (2013a) Social Safety Nets in Africa, A Review of the Experience in 20 Countries, draft, February 2013.

World Bank (2013b), Aide Mémoire (AM), Mission de supervision du 03 au11 Décembre 2012 et celle du 07 au 11 Janvier 2013, Projet de Travaux Publics et de Gestion Urbaine (PTPGU, IDA-H485 & H 781-BI).


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ANNEX A PERSONS CONSULTED DURING THE REVIEW

A.1. List of persons met at national level

Ministry of the Civil Service, Labour and Social Security

Annonciate Sendazirasa, Minister

Joseph Ntakabanyura, Director General of Social Protection

Oswald Habonimana, former Director General of Social Protection

Domitien Minani, Advisor to the Directorate General of the Civil Service

Noémie Siniremera, Head of Section, Mutual Health Services

Audace Nkunzinana, Planning Officer, Human Resources, Budget and Project Monitoring

Hubert Hangimana, staff

Ministry of National Solidarity, Human Rights and Gender

Joseph Ndayisenga, Director General of National Solidarity

Estelle Cimpaye, Director General of Women’s Promotion and Gender Equality

Imelda Nzirorera, Director General of Human Rights

Etienne Gashamura, Advisor to the Directorate General of National Solidarity

Corneille Nkoripfa, Advisor to the Directorate General of Repatriation, Reinstallation and Reintegration of War Victims

Ministry of Finance and Economic Development Planning

Edonias Nyongabo, Director General of Programming and Budget

Isidore Sindayikengera, Head of Financial Programming and Planning Services, Directorate General of Programming and Budget

Ministry of Health and Struggle against AIDS

Sosthène Hicburundi, Director General of Resources

Ministry of Agriculture and Livestock

Gérard Ndabemeye, Director General of Agricultural and Livestock Planning

Ministry of Basic & Secondary Education, Technical & Professional Training and Literacy

Eric Nshimirimana, Director of Finance


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Other public agencies

Nicholas Ndayishimiye, Director General, Burundi Institute of Statistics and Economic Studies (ISTEEBU)

Alphonse Niyongere, Director, Technical Secretariat, Projet de Travaux Publics et de Gestion Urbaine (PTPGU)

Philibert Musafiri, Chief Accountant, Technical Secretariat, Projet de Travaux Publics et de Gestion Urbaine (PTPGU)

Nicodème Ntakiyika, Permanent Secretariat, National Committee for Aid Coordination (CNCA)

Emile Nimpaye, National Expert, Monitoring and Evaluation and Data Base, Permanent Secretariat, CNCA

Salvator Nimubona, National Coordinator, Projet de Productivité et de Développement des Marchés Agricoles (PRODEMA)

Scarie Nivyintizo, Technical Director, Agence Burundaise pour la Réalisation des Travaux d’Intérêt Public (ABUTIP)

Damien Nimpagaritse, Technical Director, National Council for the Struggle against AIDS

International agencies and donors

Rosine Sori-Coulibaly, Deputy Special Representative of the Secretary General, Resident Coordinator of the United Nations System and Resident Representative of UNDP

Rachidi Radji, Resident Representative, World Bank

Johannes Wedenig, Representative, UNICEF

Abou Amadou Ba, Resident Representative, African Development Bank

Hamed Haidara, Country Director and Representative, International Fund for Agricultural Development (IFAD)

Natascha Paddison, Deputy Representative, UNICEF

Nicole Jacquet, Deputy Director, WFP

Abdoulaye Barry, Deputy Representative, UNHCR

Aurélien Béko, Poverty Economist, World Bank

Patricia Bheeka, Chief, Education Section, UNICEF

Sophie Léonard, Health Specialist, UNICEF

Aissa Sow, Chief, Child Protection Section, UNICEF

Matteo Frontini, Community Recovery Programme Specialist, UNDP

Anne Bariyuntura, Gender Specialist, UNFPA

Hervé Corbel, Chargé de Programme, CTB – Belgian Development Agency

Audace Mpoziriniga, Food Aid Specialist, USAID

Apollinaire Masuguru, Assistant to the Representative, FAO

Tharcisse Nkanagu, Social Security Coordinator for Africa, Social Security Department, International Labour Office, Geneva

Andrés Acuña-Ulate, Social Security Actuary, Social Security Department, International Labour Office, Geneva


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Donatien Bigirimana, Focal Point for Reproductive Health Services and Patient Security, WHO

Hercule Yamuremye, Senior Social Development Specialist, African Development Bank

Jean Mahwane, Food Security, WFP

Rénovât Goragoza, Food for Assets – Cash and Vouchers, WFP

Christian Nzeyimana, Programme Coordinator, WFP

Driss Zine-Eddine El-Idrissi, Senior Health Economist, World Bank

Tomo Morimoto, Chargé des Operations, World Bank

Pascal Crépin, Health Programme Officer and Focal Point for Disability, Economic and Social Section, Delegation of the European Union

Daniel Gbetnkom, Economist, UNDP

Jean Kabahizi, Specialist, Democratic Governance Programme, UNDP

Pedro Guerra, Child Protection Specialist, UNICEF

Cinthia Acka-Douabélé, Education Specialist, UNICEF

NGOs

Cyprien Ndayisaba, CARE International

Alessandro Bini, Concern Worldwide

Germain Niragira, CRS

Jean Claude Nkezimana, FVS-AMADE

Wim Overbeeke, Chef de Mission Burundi, HealthNet TPO

A.2. Field visits

Province of Bujumbura Mairie

‘Nawe Nuze’ solidarity groups, commune of Buyenzi: Sandrine Irambona and Flora Nzitonda, coordinateurs de terrain, and members of solidarity groups

Province of Bujumbura Rural

Sites of the Programme Transitoire de Reconstruction Post-Conflit (PTRPC), commune of Mutimbuzi, for microcredit operations, labour-intensive public works and cattle solidarity chain: Augustin Bisereka, PTRPC/IFAD agronomist, Marie-Viola Nduwayezu, WISE credit officer, and beneficiaries


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Province of Gitega

‘Nawe Nuze’ solidarity groups, commune of Itaba: Léonard Ndirahisha, official responsible for community structures, and Dauphin Sibomana, field officer, FVS-AMADE; Raphaël Nduwingoma, credit officer, Dukuze Ibibondo Micro-Finance; and members of solidarity groups

Provincial Government of Gitega: Monfort Bigirimana, technical advisor in charge of development, and Vincent Ndayisaba, socio-cultural advisor

Gitega health centre: Jocelyne Ntirampema, nurse-in-charge

Family and Community Development Centre (CDFC): Emma Nkeshimana, Coordinator

UNICEF Sub-Office: Seydou Camara, head of sub-office

Twitwararikane mutual health organization (of the Catholic Archdiocese of Gitega): Pierre Muzehe, MHO organizer

Province of Kirundo

Terintambwe Programme (cash transfers, training and microfinance) of Concern Worldwide, commune of Busoni: Alessandro Bini, Director, and Emanuela Burello, Programme Officer, Jean Kayoya, project chief in Kirundo, Pascal Nzigirabarya, project supervisor in commune of Busoni, project field staff, beneficiaries and the head of the Busoni post office

Gikuyo Primary School, commune of Kirundo (school feeding): Marie-Rose Bimenyimana, School Director, Laurent Kamulete, Programme Assistant, Health-Nutrition-Education, WFP Sub-Office in Ngozi, and Isidore Hatungimana, Coordinator, Agro-Action Allemande

Province of Ngozi

Projet de Développement des Filières (PRODEFI): Jean-Pierre Nkunguzi, head of the provincial office of PRODEFI/IFAD in Ngozi

Tugarukire Amagara Y’Imiryango mutual health organization: Simon Pierre Ntirampeba, officer in charge of nutrition and mutual health organizations, and Felix Banyankindagiye, technical officer in charge of monitoring and evaluation, Louvain Coopération pour le Développement

Child Protection Committee (CPE), Mivo colline, commune of Ruhororo: Lucien Nimbona, Project Coordinator, Fondation Stamm, Pedro Guerra, Child Protection Specialist, UNICEF Bujumbura, and CPE members

Province of Makamba

Programme de Réintégration Socioéconomique des Rapatriés du Camp de Mtabila, commune of Nyanza-Lac: Guy Vivien Ndayikeje, Provincial Coordinator, UNDP, and visits to sites of labour-intensive public works


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ANNEX B SUPPLEMENTARY DATA TABLES

Table B 1: Selected human development indicators by quintiles, 2012/2013

Total Q1 Q2 Q3 Q4 Q5

Under-nutrition (% of children under 5)

Chronic under-nutrition (global) 46.3 50.9 49.8 49.1 43.4 37.1

Chronic under-nutrition (severe) 22.8 28.9 24.6 24.1 20.0 15.0

Acute under-nutrition (global) 5.8 7.0 5.9 5.7 5.1 5.0

Underweight (global) 23.6 29.9 26.5 24.4 19.7 16.4

School net attendance ratios

Class 1 (% of children aged 7) 55.3

Primary (% of children aged 7-12) 84.6 77.9 82.3 87.6 88.9 88.8

Secondary (% of children aged 13-18) 21.0

Use of health services

% of children under 5 ill in previous 4 weeks who consulted a health provider 85.6 85.4 83.9 86.6 87.8 84.4

% of women with a live birth in previous 2 years who received antenatal care in a health facility 98.0

% of women with a live birth in previous 2 years who delivered with the assistance of a health professional 82.0

% of women with a live birth in previous 2 years who delivered in a health facility 79.3 74.2 75.5 81.0 79.0 87

% of women aged 15-49 who took an AIDS test and received results 55.3

% of households with an insecticide-treated bed-net 66.2

Access to water and sanitation (% of population)

Use of improved drinking water sources 83.6 81.6 82.5 82.9 84.9 86.0

Use of improved sanitation facilities 26.2 22,7 24.4 27.7 23.3 32.8

Access to information (% of households)

Owning radio 53.1

Owning TV 3.6

Owning mobile telephone 35.2

No means of communication 59.0

Birth registration

Children under 5 with birth registered (%) 83.3



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Table B 2: Human development indicators by areas of residence and regions, 2012/2013

Rural Urban North South Centre-

East West

Bujum-bura

Mairie

Under-nutrition (% of children under 5)

Chronic under-nutrition (global) 47.7 29.2 50.1 46.0 47.1 44.2 23.9

Chronic under-nutrition (severe) 23.8 9.1 25.9 22.9 22.5 20.9 8.3

Acute under-nutrition (global) 6.0 3.0 8.1 4.1 4.6 5.2 2.9

Underweight (global) 24.4 13.2 27.1 22.6 25.1 19.1 10.4

School net attendance ratios

Class 1 (% of children aged 7) 54.8 62.8 52.5 55.4 57.9 56.3 54.7

Primary (% of children aged 7-12) 83.9 92.3 79.7 87.9 84.1 88.3 91.4

Secondary (% of children aged 13-18) 19.2 41.5 14.2 24.8 20.0 23.1 44.7

Use of health services

% of children under 5 ill in previous 4 weeks who consulted health provider 86.0 80.4 88.6 75.2 85.6 85.7 77.4

% of women with a live birth in previous 2 years who received antenatal care in a health facility 97.8 100.0 97.8 97.9 97.4 98.9 100.0

% of women with a live birth in previous 2 years who delivered with the assistance of a health professional 80.7 96.3 76.9 81.3 83.7 85.8 97.2

% of women with a live birth in previous 2 years who delivered in a health facility 77.4 95.1 73.5 79.1 80.5 81.8 96.6

% of women aged 15-49 who took an AIDS test and received results 54.8 61.0 59.9 49.6 52.4 55.9 60.8

% of households with an insecticide-treated bed-net 66.0 68.4 64.0 69.0 65.4 67.5 71.2

% of children under 5 with fever in previous 2 weeks who were examined at a health facility 67.9 56.6 75.6 48.4 69.4 63.8 41.0

% of children under 5 with symptoms of ARI in previous 2 weeks who were examined at a health facility 19.4 16.3 25.2 10.6 19.8 11.5 13.3

% of children aged 12-23 months fully immunized (BCG, [pentavelent 3, polio 3, measles) 65.8 60.9 68.6 63.0 66.6 62.4 54.4

Access to water and sanitation (% of population)

Use of improved drinking water sources 83.3 86.5 85.0 72.2 89.2 81.3 85.7

Use of improved sanitation facilities 26.3 25.3 16.9 57.3 22.5 19.0 28.0

Access to information (% of households)

Owning radio 52.4 60.3 50.2 54.0 54.7 51.9 62.3

Owning TV 1.1 31.4 0.8 1.7 1.6 2.9 39.1

Owning mobile telephone 31.7 73.1 26.4 39.2 28.7 45.7 78.2

No means of communication 62.2 23.6 69.9 55.5 60.2 51.5 20.9

Birth registration

Children under 5 with birth registered (%) 83.3 83.2 78.0 86.1 84.6 87.4 88.1



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Table B 3: Composition of government expenditure on non-contributory social protection, 2010-2012 (BIF)

2010

Allocation Obligation Liquidation Authorization Payment

Central administration 718 517 380 723 000 404 712 589 881 669 165 058 669 255 564

CDFCs 272 739 116 250 144 211 250 144 211 255 833 213 257 628 277

Food/humanitarian assistance 1 820 649 530 1 727 996 700 1 727 996 700 1 727 996 700 1 727 996 700

Repatriation assistance 3 000 000 000 2 985 241 100 1 459 847 300 1 459 847 300 1 459 847 300

Aid to persons affected by HIV/AIDS 900 000 000 833 356 214 833 356 214 833 356 214 833 356 214

Services for vulnerable children 483 070 025 464 260 646 463 199 906 447 202 833 447 202 833

Services for persons with disabilities 2 596 361 168 2 505 607 595 2 505 607 595 2 499 812 615 2 499 812 615

School feeding 6 010 000 000 0 0 0 0

Higher education scholarships 11 872 542 773 10 039 401 580 10 039 401 580 10 039 401 580 10 039 401 580

Medical assistance 1 300 000 000 1 298 585 057 1 296 862 449 1 296 643 512 1 296 643 512

Labour-intensive public works & distribution of livestock & agricultural inputs

269 598 000 269 089 074 269 089 074 269 089 074 269 089 074

Protection of women & gender equality 88 000 000 87 960 200 87 960 200 87 960 200 87 960 200

Promotion and protection of human rights 266 397 867 116 397 867 116 397 867 116 397 867 116 397 867

Other social assistance 2 160 000 000 2 131 224 997 2 131 224 997 2 127 058 331 2 127 058 331

Total 31 757 875 859 23 432 265 645 21 893 677 974 21 829 764 497 21 831 650 067

2011



CDFCs 16 020 000 10 924 600 10 924 600 9 012 600 9 012 600






School feeding 3 000 000 000 3 000 000 000 3 000 000 000 3 000 000 000 3 000 010 005




397 098 000 396 764 305 396 764 305 396 764 305 396 764 305




Total 27 197 823 695 25 870 309 830 25 732 644 090 24 770 634 611 24 642 059 428


88

Burundi

2012



CDFCs 64 418 000 64 196 900 64 196 900 64 196 900 64 196 900






School feeding 3 000 000 000 3 000 000 000 3 000 000 000 3 000 000 000 3 000 009 994




364 930 500 362 153 900 361 973 900 361 973 900 362 005 005




Total 32 383 333 905 31 079 497 073 31 025 328 432 30 999 340 732 31 035 985 776

Source: Government accounts (SIGEFI).

Table B 4: Composition of government expenditure on non-contributory social protection, 2010-2012 (%)

2010


Central administration 2,3 3,1 3,3 3,1 3,1

CDFCs 0,9 1,1 1,1 1,2 1,2

Food/humanitarian assistance 5,7 7,4 7,9 7,9 7,9

Repatriation assistance 9,4 12,7 6,7 6,7 6,7

Aid to persons affected by HIV/AIDS 2,8 3,6 3,8 3,8 3,8

Services for vulnerable children 1,5 2,0 2,1 2,0 2,0

Services for persons with disabilities 8,2 10,7 11,4 11,5 11,5

School feeding 18,9 0,0 0,0 0,0 0,0

Higher education scholarships 37,4 42,8 45,9 46,0 46,0

Medical assistance 4,1 5,5 5,9 5,9 5,9


0,8 1,1 1,2 1,2 1,2

Protection of women & gender equality 0,3 0,4 0,4 0,4 0,4

Promotion and protection of human rights 0,8 0,5 0,5 0,5 0,5

Other social assistance 6,8 9,1 9,7 9,7 9,7

Total 100,0 100,0 100,0 100,0 100,0


89

Burundi

2011



CDFCs 0,1 0,0 0,0 0,0 0,0






School feeding 11,0 11,6 11,7 12,1 12,2




1,5 1,5 1,5 1,6 1,6




Total 100,0 100,0 100,0 100,0 100,0

2012



CDFCs 0,2 0,2 0,2 0,2 0,2






School feeding 9,3 9,7 9,7 9,7 9,7




1,1 1,2 1,2 1,2 1,1




Total 100,0 100,0 100,0 100,0 100,0

Source: Government accounts (SIGEFI).


90

Burundi

Table B 5: Total internally and externally financed expenditure on non-contributory social protection

2010 2011 2012 Total

In million BIF

Humanitarian assistance 37.572.498.557 33.409.610.758 38.825.843.025 109.807.952.340

Aid to persons affected by HIV/AIDS 4.638.090.687 1.390.639.244 1.814.440.116 7.843.170.047

Aid to vulnerable children 6.571.290.414 7.755.476.193 7.722.963.206 22.049.729.813

Aid to persons with disabilities 2.499.812.615 4.083.913.185 2.186.851.852 8.770.577.652

School feeding & school kits 21.824.539.083 14.984.728.408 19.283.258.402 56.092.525.892

Labour intensive PWPs 23.278.859.673 41.749.002.601 51.364.630.029 116.392.492.303

Distribution of livestock and agricultural inputs 3.895.094.776 5.268.253.052 9.372.488.873 18.535.836.700

Food supplements (malnutrition) 12.694.274.783 24.705.248.028 12.381.776.230 49.781.299.041

Medical assistance 2.424.288.910 3.884.392.567 5.327.188.133 11.635.869.610

Scholarships for higher education 10.039.401.580 8.384.960.674 11.314.706.107 29.739.068.361

Other 3.649.287.254 5.368.944.522 6.191.585.793 15.209.817.568

Total 129.087.438.331 150.985.169.232 165.785.731.765 445.858.339.328

As % of GDP 5,17 5,08 4,65

% of total

Humanitarian assistance 29,1 22,1 23,4 24,6

Aid to persons affected by HIV/AIDS 3,6 0,9 1,1 1,8

Aid to vulnerable children 5,1 5,1 4,7 4,9

Aid to persons with disabilities 1,9 2,7 1,3 2,0

School feeding & school kits 16,9 9,9 11,6 12,6

Labour intensive PWPs 18,0 27,7 31,0 26,1

Distribution of livestock and agricultural inputs 3,0 3,5 5,7 4,2

Food supplements (malnutrition) 9,8 16,4 7,5 11,2

Medical assistance 1,9 2,6 3,2 2,6

Scholarships for higher education 7,8 5,6 6,8 6,7

Other 2,8 3,6 3,7 3,4

Total 100,0 100,0 100,0 100,0

Sources: SIGEFI (Ministry of Finance and Econmic Development Planning), CNCA, other government agencies, donors, UN agencies, NGOs.


91

Burundi

Table B 6: Personnel of Ministry of the Civil Service, Labour and Social Security

Civil service

status Under

contract Total

Cabinet 17 11 28

Directorate General of the Civil Service 10 6 16

Directorate of Career Management 83 14 97

Directorate of Salary Management 39 6 45

Directorate of Personnel Recruitment and Control 14 3 17

Directorate of Regional Civil Service Offices 39 11 50

Inspectorate General of the Civil Service 11 2 13

Inspectorate General of Labour and Social Security 23 5 28

Directorate General of Labour 14 2 16

Directorate of Employment Promotion 9 0 9

Directorate of Professional Advancement 6 0 6

Directorate General of Social Protection 7 0 7

Directorate of Studies and Promotion of Social Protection Regimes 12 1 13

Directorate of Control, Monitoring and Evaluation of Management Bodies of Social Security Regimes and Mutual Health Organizations 7 2 9

Total personnel 291 63 354

Source: Ministry of the Civil Service, Labour and Social Security.

Table B 7: Personnel of Ministry of National Solidarity, Human Rights and Gender

Category 1 Category 2 Category 3

Total

Secondary + 2 years more

Class 10 + 1 year more

Primary or more

Central level 70 63 65 198

Cabinet 13 12 11 36

DG National Solidarity 4 4 2 10

Dir. Social Integration 4 25 32 61

Dir. Humanitarian Action and Assistance to Victims of Catastrophes 2 3 2 7

Dir. Children and Family 4 4 2 10

DG Repatriation and Reintegration of War Victims 5 1 2 8

Dir. Repatriation and Reinstallation of War Victims 5 1 2 8

Dir. Reintegration of War Victims 3 1 2 6

DG Human Rights, Peace Education and National Reconciliation 5 2 3 10

Dir. Promotion and Protection of Human Rights 4 1 1 6

Dir. Legal Aid to Victims of Human Rights Violations 3 1 1 5

Dir. Peace Education and National Reconciliation 4 1 1 6

DG Promotion of Women and Gender Equality 5 1 2 8

Dir. Promotion of Women 4 3 1 8

Dir. Gender Equality 5 3 1 9


92

Burundi

CDFC 30 111 28 169

Kayanza 2 6 0 8

Rutana 1 5 2 8

Ngozi 2 5 3 10

Muramvya 2 6 3 11

Muyinga 2 7 2 11

Karusi 1 3 0 4

Bururi 2 9 3 14

Cibitoke 2 7 3 12

Kirundo 2 7 1 10

Gitega 1 12 1 14

Mwaro 2 3 1 6

Cankuzo 2 4 2 8

Bubanza 1 4 1 6

Ruyigi 2 8 3 13

Bujumbura Mairie 2 14 2 18

Bujumbura Rural 2 11 1 14

Makamba 2 0 0 2

Other de-concentrated centres and projects 37 151 117 305

Projet Enfants Soleil 2 11 6 19

Centre d'Encadrement des Enfants Soleil (CERES) 2 10 18 30

Centre Multifonctionnel 0 12 10 22

Projet d'Appui au Rapatriement et à la Réintégration des Sinistrés

Bujumbura 8 6 8 22

Makamba 1 13 6 20

Centre de Promotion des Droits de la Personne Humaine et de Prévention du Génocide (CPDHPG)

5 4 5 14

Projet Maison des Femmes au Burundi 4 2 5 11

Projet Genre/APF 5 2 3 10

Centre Humura 4 7 6 17

Centre National d'Appareillage et de Rééducation (CNAR) 2 38 37 77

CNRSP Bujumbura 1 34 9 44

CNRSP Ngozi 1 12 4 17

Support to the coordinated implementation of the National Strategy for the Fight against Gender Based Violence

2 0 0 2

Total personnel 137 325 210 672

Source: Ministère de la Solidarité Nationale, des Droits de la Personne Humaine et du Genre.

assessment of social safety nets in burundi · 2020-04-29 · assessment of social safety nets ii...

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