XI. The Role of the International Community in the Health SectorDonor aidIn 2000, the international community set itself ambitious development targets, the Millennium Development Goals, including major progress on combating child and maternal mortality, HIV/AIDS, and malaria. The Millennium Project report on goals four and five (reducing child and maternal mortality) recommends that “bilateral donors and international financial institutions should substantially increase aid” to the health sector. It also recommends that user fees for basic health services be abolished.209 Donors committed themselves, at the 2002 Monterrey Conference210 and subsequently, to funding the initiative; in particular rich countries pledged to devote 0.7 percent of their gross national product to official development assistance. However, to date, only a few countries have done so,211 and attaining the health-related Millennium Development Goals remains a distant prospect. In Burundi, aid flows have been heavily affected by the political crisis and armed conflict. Following Pierre Buyoya’s 1996 military coup, countries in Central Africa imposed economic sanctions on Burundi, and international aid was reduced by two-thirds.212 With the Arusha Peace Agreement at least partly implemented and the political transition moving ahead, many donors recently renewed aid. In late February 2006, the government held a donor conference to request funds for improved health care, aid to drought-stricken regions, and other programs needed to help rehabilitate the damaged country.213 In the coming period, donors are expected to shift their aid from humanitarian assistance to development aid. As already noted above, in August 2006 the Burundian government was working on the final touches of the country’s Poverty Reduction Strategy Paper. The PRSP offers a long-term development plan and forms the basis for decisions about future donor funding, debt relief and loans from the international financial institutions.214 The completed PRSP will be presented to the World Bank and made public. At present, the European Commission (EC) is the most significant multilateral donor, currently providing about €72 million (U.S.$92 million) through various channels including the European Development Fund (EDF) and the European Commission Humanitarian Office (ECHO). It provides about €31 million ($39 million) in budgetary support.215 Belgium and France are the two largest bilateral donors: they support the government budget and fund particular projects in the areas of rule of law, health and education. The United States is providing approximately $30 million per year in non-food humanitarian and development assistance.216 Germany is supporting the government with about €44.5 million ($57 million), primarily in the area of improving water supply.217 The UK government provides about £10m ($19 million) to Burundi for 2006-07, of which about one-third is destined for the health sector.218 In addition, nongovernmental agencies such as Cordaid, MSF and ActionAid fund particular areas of the health sector. Despite the commitments of international donors to assisting Burundi in the area of health, donors have not pressed effectively for an end to the detention of patients, and improved access to health care for the poor. Debt reliefUnder the Heavily Indebted Poor Countries Initiative, Burundi has qualified for the initial phase of interim debt relief, subject to meeting certain conditions. During this period, the World Bank and the International Monetary Fund have imposed a limitation on the use of the funds and determined that they must go towards education, health and agriculture.219 As a result, the government has almost tripled the health budget from about $5 million to about $15 million. Burundi is currently completing the economic measures essential to finalizing the debt relief agreement in 2006. Once Burundi has permanent status, the government is in theory free to set its own spending priorities and is not required to fund key social sectors.220 Nonetheless, the government has pledged to spend the debt relief funds on health, education, infrastructure, agriculture, the settlement and reintegration of victims of civil strife, and judicial reform. It has also promised to set up an independent oversight committee composed of international and national representatives, to monitor expenditures.221 209 Millennium Project, Task Force on Child Health and Maternal Health, “Who’s got the power?” p. 15. 210 The 2002 Monterrey Conference was the United Nations International Conference on Financing for Development where donors pledged to support the Millennium Development Goals. 211 Millennium Project, “The 0.7% Target: An In-Depth Look,” http://www.unmillenniumproject.org/involved/action07.htm (accessed August 1, 2006). 212 International Crisis Group, “A Framework for Responsible Aid to Burundi,” February 2003, http://www.crisisgroup.org/library/documents/report_archive/A400901_21022003.pdf (accessed May 3, 2006). 213 “Burundi: Donors pledge U.S .$170 million for post-war recovery bid,” IRIN, http://www.irinnews.org/report.asp?ReportID=51969&SelectRegion=Great_Lakes (accessed May 3, 2006). 214 République du Burundi, “Cadre Stratégique de Croissance et de Lutte contre la Pauvreté.” 215 Délégation de la Commission Européenne au Burundi, “La Commission Européenne au Burundi,” February 1, 2006. 216 USAID, “Budget Burundi,”http://www.usaid.gov/policy/budget/cbj2006/afr/bi.html (accessed May 3, 2006). 217 €9.5 million are newly committed funds, €35 million were from previous commitments. Human Rights Watch telephone interview with Bundesministerium für Wirtschaftliche Zusammenarbeit, May 3, 2006. 218 Human Rights Watch telephone interview with DFID Burundi, May 3, 2006. 219 International Monetary Fund, Burundi: Enhanced Initiative for Heavily Indebted Poor Countries – Decision Point Document (Washington D.C.: IMF, 2005), http://siteresources.worldbank.org/INTDEBTDEPT/DecisionPointDocuments/20645009/cr05329.PDF (accessed August 1, 2006), p. 25 (box 7: Expenditure Priorities for the Use of HIPC Debt Relief). 220 Human Rights Watch telephone interview with World Bank official, March 31, 2006; “Burundi: IMF and World Bank Support U.S.$1.5 Billion in Debt Service Relief For Burundi,” World Bank news release, http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/BURUNDIEXTN/ 221 Letter from Athanase Gahungu, minister of finance, and Salvator Toyi, governor of the Bank of Burundi, to Rodrigo Rato, managing director of the International Monetary Fund, June 30, 2005. |