UNIVERSAL HEALTH COVERAGE:
A Scoping Report: Burundi
Universal Health Coverage (UHC) endeavours to ensure that everyone obtains the health care that they need, but that it is affordable to everyone. Simultaneously, the health care received by citizens must be of a good quality, according the WHO.
Universal Health Coverage is divided by the World Health Organisation into two components: Health Service Coverage and Financial Risk Protection, of which there are numerous indicators used to measure the programme’s progress. Of these many indicators, I have analysed and selected a few which I believe are relevant for the chosen country, Burundi. Burundi is classed as a low income country by the World Bank (less than $1035) and its struggles with former healthcare schemes and civil wars make it an interesting country to review.
The indicators I have chosen to use are bullet pointed in the ‘Data Review’ section, combined with a critical appraisal.
• Under-five mortality rate, per 1000 live births
As shown in the population pyramid (figure 1) below, Burundi’s population is extremely young, the most dominant age category being 0-4 years, with approximately 960,000 people. Consequently, it is appropriate to measure the progress of Universal Health Coverage via the under-five mortality rate. Considering that such a large proportion of the population is young, the aforementioned indicator is a relevant determinant of UHC. This is imperative as the productivity of human capital is dependent on health.
In addition, U5MR does not account for the number of stunted or otherwise unhealthy live children. Consequently, the decrease in U5MR could be considered a misleadingly huge achievement, if a significant amount of children are not in healthy conditions. Furthermore, the statistic does not disclose the cause of death, so aids little with regard to improvement to healthcare. A more useful indicator could be the prevalence of underweight children under five years of age, as it takes a preventative stance and allows us to actually monitor health over mortality.
• Maternal Mortality Ratio (MMR), per 100, 000 live births
The MMR in Burundi was 800 in 2010 (World Bank, n.d.) rating it 6th highest in the world (CIA World Factbook, n.d.) A reduction in maternal mortality will increase the quantity of breast feeding, thereby decreasing levels of malnutrition. This will have a positive effect on the under-five mortality rate. This, combined with the fact that Burundi’s youth dependency ratio is 84% (CIA World Factbook, n.d.), implies that the MMR is a relevant indicator of UHC. However, Maternal Mortality is hard to measure because maternal deaths tend to be underreported, especially in developing countries. Again, the lack of an efficient vital registration system also presents the problem of no-sampling errors and confidence intervals, according to the United Nations. So, whilst MMR is relevant, it is not necessarily...