Plan d’Action National pour la Sécurité Sanitaire au Burundi 2019-2023

Objectives

Burundi’s National Action Plan for Health Security, covering 2019–2023, aims to strengthen and sustain national capacities to implement the International Health Regulations (2005), prevent and manage public-health emergencies, and reduce associated morbidity and mortality.[1][2]It frames health security as a shared national responsibility for preventing, detecting and responding to emergencies, contributing to the wellbeing of the Burundian population and to regional and global health security.[3][4]

• Strengthen capacities to prevent health emergencies, prepare for them, detect outbreaks and other events promptly, report and confirm them rapidly, and mount an effective response.[5][2]
• Achieve at least level 3 for each of the 48 Joint External Evaluation indicators within five years, while embedding health-security priorities in relevant national sectoral plans.[5][2][6]
• Address communicable-disease and epidemic risks, including cholera, malaria, meningitis, measles, Ebola virus disease, zoonoses, foodborne threats, antimicrobial resistance, and chemical, radiological and nuclear hazards.[7][8][9]
• Apply an all-hazards and One Health approach that connects human health, animal health, agriculture and environmental services.[10][2]
• Strengthen legal and institutional arrangements, national coordination, surveillance, laboratories, vaccination, workforce capacity, points of entry, emergency operations, risk communication, medical countermeasures and resource mobilisation.[11][12]
• Prioritise preparedness for cross-border threats, including Ebola virus disease in the 10 health districts bordering the Democratic Republic of the Congo, where movement of people, goods, refugees, travellers and patients creates elevated transmission risks.[13][14]

The plan is organised around 19 International Health Regulations action areas and the broad components of prevention, detection, response and other hazards.[5][15]Its stated principles include country ownership, government leadership, intersectoral collaboration, community participation, gender equality, human rights, accountability, transparency and regional cooperation.[2]

Resource mobilisation is an explicit strategic purpose.[16][1]The overall costed plan totals 64,871,926,987 Burundian francs, allocated to Prevent, Detect, Respond and Other hazards, although the supplied material does not identify confirmed funding commitments or the remaining financing gap.[5]

Implementation

Implementation uses a participatory, multisectoral and multidisciplinary delivery model led by the Ministry responsible for Public Health and its National International Health Regulations Focal Point, with technical and financial support from national partners and the World Health Organization.[17][3]Planning drew on national assessments, the Joint External Evaluation and the Performance of Veterinary Services evaluation, and used a World Health Organization Excel matrix to identify, cost and sequence actions across the 19 technical areas.[1][5][3]

• Coordinate strategically through the Interministerial Commission for Risk Prevention and Disaster Management, which defines policy, promotes One Health collaboration, mobilises resources, coordinates interventions and monitors stakeholder commitments.[18]
• Manage operations through a Technical Committee chaired by the Permanent Secretary of the Ministry responsible for Public Health, supported by focal points for the 19 action domains and responsible for implementation follow-up, capacity strengthening, resource mobilisation, annual reporting and monitoring.[18][19]
• Operationalise activities through three-month micro-plans that assign sectoral roles, responsible budget-holders, implementation scale, annual frequency and activity-level monitoring indicators.[20][21]
• Deliver implementation through central, provincial, district and community levels, with 18 Provincial Health Bureaux coordinating provincial work and 46 health districts coordinating operational delivery with relevant sectors and community structures.[20]
• Engage community health workers, health committees, local associations, traditional birth attendants and traditional practitioners as links between communities and health facilities.[20]

Operational measures include reviewing International Health Regulations-related legislation; establishing coordination procedures and cross-border agreements; strengthening national focal points and points of entry; developing interoperable electronic indicator-based, event-based and syndromic surveillance; and linking human, animal and environmental health information.[22][23][24]The approach also includes laboratory-network strengthening, secure specimen transport, quality assurance, antimicrobial-resistance surveillance, priority-zoonoses management, food-safety systems, vaccination and cold-chain capacity, and applied field epidemiology training.[25][23][26][27]

Emergency preparedness is to be supported by multisectoral risk and resource mapping, an updated multi-hazard preparedness and response plan, a functional National Public Health Emergency Operations Centre, rapid-response teams, simulation exercises, after-action reviews, case-management procedures, and systems for deploying or receiving medical supplies and health personnel.[28][29][30]Risk communication is intended to involve government, partners, media and communities, including active listening, rumour management and mechanisms to scale up during emergencies.[31][32]

Accountability arrangements combine continuous technical monitoring, three-monthly implementation reviews, periodic and annual progress reports, and annual International Health Regulations reporting.[33][34][15]Activities are categorised as not implemented, partially implemented or fully implemented, and monitoring draws on activity and financial reports.[34]The plan provides for an internal mid-term evaluation in 2021 and a joint external final evaluation at the end of 2023 using the 48-indicator Joint External Evaluation tool.[34]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation architecture linked to implementation of the International Health Regulations (IHR), using 48 indicators across 19 technical areas and aiming for at least score 3 on every indicator within five years.[5][10][2]Monitoring combines routine surveillance, periodic progress reporting, score tracking, simulation exercises, after-action reviews and internal and external assessments.[4][34]

• Maintain indicator-based, event-based and syndromic surveillance, integrating laboratory information and interoperable real-time notification between human, animal and environmental health systems.[25][23][24][35]
• Report implementation annually to the World Health Organization, while technical leads prepare periodic reports for their action areas and share relevant sectoral reports with the National IHR Focal Point.[9][15][36]
• Track implementation through activity-level indicators in the planning matrix, including responsible budget-holders, implementation scale, estimated local-currency cost and annual frequency.[21]
• Classify activity progress as not achieved, partially achieved or fully achieved, generally corresponding to 0%, above 0% but below 100%, and 100% completion.[37][38][39]
• Conduct quarterly implementation-monitoring meetings with focal points for action domains, using activity and financial reports to identify barriers and adjust actions.[34]
• Undertake an internal mid-term evaluation in 2021 and a joint external final evaluation at the end of 2023 using the Joint External Evaluation tool and its 48 scored indicators.[34]
• Test coordination and response arrangements through annual simulation exercises, emergency operations-centre activation exercises, and after-action reviews that generate corrective measures.[6][40][41]
• Hold strategic coordination accountable for stakeholder commitments and assign the Technical Committee responsibility for implementation follow-up, monitoring, evaluation, reporting and technical assistance.[18]

The monitoring framework includes disease-specific and capacity indicators for antimicrobial resistance, zoonoses, food safety, vaccination, laboratories, emergency operations, points of entry, chemical incidents, radiological events, risk communication and workforce development.[42][43][44][29][45]It also specifies surveillance reporting completeness, timely notification of potential international public-health emergencies to the World Health Organization within 24 hours, and notification of relevant animal-health events to the appropriate international authority.[46][35]Detailed reporting templates, complete indicator definitions and independent accountability arrangements are not consistently specified in the supplied material.[15][47][19]

Costing & Financing

The National Action Plan for Health Security is costed at 64,871,926,987 Burundian francs for 2019–2023, with the largest allocation assigned to prevention.[5]The plan also presents resource mobilisation as a core implementation function, including advocacy to secure resources from the State, partners, humanitarian actors and, where relevant, the private sector.[1][21][18]

• Allocate 29,044,389,547 Burundian francs to Prevent, 16,016,354,000 Burundian francs to Detect, 4,839,562,500 Burundian francs to Respond, and 14,971,620,850 Burundian francs to Other hazards.[5]
• Prioritise prevention spending, which represents 45% of the total budget and is partly attributed to antimicrobial-resistance activities, vaccination campaigns, cold-chain equipment and logistics.[5]
• Establish a permanent fund financed by the State and partners for managing public-health events and emergencies, although its monetary value and financing shares are not specified.[22][6]
• Integrate health-security priorities into national development plans and State budgeting, while seeking private-sector participation in financing measures for personnel and their families.[21]
• Use activity-level budgeting through the World Health Organization Excel planning matrix, which records estimated local-currency costs and was designed to facilitate budgeting across 19 action areas.[3][21]
• Strengthen domestic financing for the Expanded Programme on Immunisation, for which the annual voted and allocated budget is itself a monitoring indicator.[44]

Burundi’s financing context includes a 10.85% State-budget allocation to health in 2013, below the 15% Abuja commitment, while external financing represented 62% of the health budget.[21]Veterinary services are reported to depend entirely on external financing, with vaccination activity constrained by vaccine availability and generally fee-paying.[16]Humanitarian actors announced mobilisation of 106 million US dollars for Burundi in 2019.[20]Numerous operational requirements are identified, including laboratories, surveillance, workforce, emergency operations, risk communication, medical-resource deployment and points of entry, but the supplied excerpts do not consistently specify confirmed contributions, disbursement schedules, funding gaps, unit costs or economic assumptions.[25][28][29][48]