Tous Unis dans l Action BURUNDI BURUNDI. Millennium Development Goals Report 2012

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1 SUMMARY BURUNDI Millennium Development Goals Report 2012 Tous Unis dans l Action BURUNDI August 2013

2 United Nations system in Burundi and Government of Burundi 2012 The United Nations system in Burundi has been supported national efforts for over forty years in designing and implementing sustainable development policies and programmes. This National Report, the third in a series, assesses the progress made by the country towards the Millennium Development Goals (MDGs). It is the outcome of close cooperation between the United Nations and the government of Burundi. Photos credits: UNDP Burundi/Aaron.Nsavyimana UNDP Burundi/Aude.Rossignol Design, layout and printing by Phoenix Design Aid A/S, Denmark ISO 14001/ISO 9000 certified. The opinions and recommandations expressed in this report do not necessarily reflect those of the United Nations. Copyright 2013 United Nations system in Burundi BNUB Compound Chaussée d Uvira P.O. Box 1490, Bujumbura, Burundi Websites: Ministry of Finance and Economic Development Planning Avenue de l Indépendance no.1 P.O. Box 224, Bujumbura, Burundi All rights reserved. The contents of this publication may be reproduced in whole or in part provided the intended use is for non-commercial purposes with the attribution of authorship to rights holders. This publication was issued on August 2013

3 Tous Unis dans l Action BURUNDI SUMMARY BURUNDI Millennium Development Goals Report 2012

4 Foreword At the 55 th ordinary session of the United Nations General Assembly from 6 to 8 September 2000 in New-York, 189 countries approved the Millennium Development Declaration. This declaration is a global vision where developed and developing countries work together for the advancement of everyone, particularly the most disadvantaged nations. At the highest political level, participants committed to setting goals which, once achieved, would end extreme poverty around the world by In order to set up a development framework to measure progress, the vision was translated into eight Millennium Development Goals, 18 targets and 48 indicators. In 2007, this monitoring framework was revised to include four new targets determined by member states at the 2005 World Summit. Additional indicators to monitor progress as regards new targets were also defined. These targets, along with a calendar, constitute a true pact between the major world economic players. The poorest countries, for their part, committed to making progress in terms of domestic policies and governance and ensuring better accountability to their citizens. The richest nations committed in turn to providing support through a global partnership for development. The adoption of the Millennium Declaration raised high expectations in Africa, particularly as, in addition to defining strategic development guidelines for the world in general, it placed primary importance on issues affecting the continent. The Declaration called for a response to the particular needs of Africa, a continent where the most vulnerable populations are concentrated, with the aim to achieving sustainable peace and development, eliminating poverty and bringing Africa into the mainstream of the world economy. In Burundi, as in most poor countries, the MDGs are ambitious in terms of the deadlines set. However, there is still time to achieve some targets by 2015 if all parties take the necessary steps, namely improving governance, empowering and actively engaging civil society, promoting entrepreneurship and the private sector, mobilising domestic resources, substantially increasing development aid for priority investments required by the MDGs and implementing significant budgetary and commercial reforms. The 2012 MDG national report for Burundi is prepared and published thanks to the collaboration among UNDP, the participation of all United Nations agencies and the Government. This advocacy tool aims at sensitising various development stakeholders on the necessity to focus national debate on poverty issues, which remain at the core of policies, strategies and development programmes. It also aims to measure progress made in achieving MDG targets. The report notes that Burundi has made important progress in most MDG indicators. For instance, the likelihood of achieving the net enrolment targets in primary school, eliminating gender disparity in primary education, halting the spread of HIV/Aids, halting and reversing the incidence of malaria and other major diseases and of halving the percentage of the population without sustainable access to safe drinking water is high. Other targets can be achieved if the government makes considerable efforts with the assistance of the development partners. These relate in particular to the targets of MDG 4 and 5. However, apart from the above-mentioned progress, there is little hope of achieving the other targets by The cost of the sociopolitical crisis in the 90s continues to overshadow any real take-off in the economy. In ten years of crisis, most human development indicators regressed by 15 years, particularly poverty. ii

5 The report encourages the government to step up its initiative to mobilise resources by spending more public money on priority investments. It also urges donors to finally honour their longstanding commitments to significantly increase aid. This derives from the fact that the technical constraints weighing on achieving MDGs should not be confused with financial constraints. While responsibility for reducing poverty primarily lies with the Burundian government, achieving the MDGs calls for a substantial increase in public development aid to break out of poverty trap. We hope that the current discussions on the post-2015 framework will provide a more global approach to eradicating poverty, placing it in a wider political and economic context, covering the three economic, social and environmental dimensions of sustainable development and promoting approaches founded on the upholding of rights. As regards Burundi, the vision for 2015 shared by the Burundian people and the priorities contained in PRSP II are assets that can help drive poverty eradication. However, a number of challenges and related costs in order to realise the recommendations of this document with regard to MDGs must also be taken into account. These include the following: Controlling demographic growth, a major challenge The necessity of initiating structural reforms both in how services are delivered by favouring bottom-up development approaches that are inclusive, participatory and equitable and by focusing on strengthening human and institutional capacities. The low level of human resource qualifications is a real handicap to the employability of young people and to long-term development. Finally, mobilising resources to achieve MDGs is of capital importance. This reflects the necessity of waging advocacy and mobilisation campaigns based on participatory planning and of seizing existing opportunities, in particular all funds set up by the United Nations to support the achievement of MDGs. In view of the above-mentioned challenges, we are launching an appeal to all Burundi s development partners to strengthen the current partnership to enable the Burundian people to achieve their legitimate aspirations. His Excellency Mr Tabu Abdallah Manirakiza Minister of Finance and Economic Development Planning Ms Rosine Sori-Coulibaly United Nations Resident Coordinator and Resident Representative of UNDP Burundi Milennium Development Goals Summary of report 2012 iii

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7 TABLE OF CONTENT ii Foreword vi Acronyms 01 General situation of MDGs in Burundi 06 Chapter 1: Eliminate extreme Poverty and Hunger 08 Chapter 2: Ensure Primary education for all 10 Chapter 3: Promote Gender equality and Empowerment of women 12 Chapter 4: Reduce Mortality among Children under 5 14 Chapter 5: Improve Maternal health 16 Chapter 6: Combat HIV/AIDS, Malaria and other diseases 18 Chapter 7: Ensure Environmental sustainability 20 Chapter 8: Develop a Global partnership for Development Burundi Milennium Development Goals Summary of report 2012 v

8 ACRONYMS ACT: ARVs: BSS: CDIAC: CH4 : CHERG: CO2: CPN: CSLP: DAC: DHS: DRC: EAC: ENECEF: EU: FAD: FDI: FOSA: GAVI: GDP: GFATM: GHG: GNI: Artemisin based Combination therapy Anti-retrovirals Behavioral Surveillance Survey Carbon Dioxide Information Analysis Center Methane Child Health Epidemiology Reference Group Carbon dioxide Prenatal Care (PC) Strategic Framework for Poverty Reduction Development Assistance Committee Demographic and Health Survey Democratic Republic of Congo East African Community National Survey on living conditions of Children and Women European Union African Development Fund Foreign Direct Investment Health training Global Alliance for Vaccines and Immunization Gross Domestic Product Global Fund to fight AIDS, Tuberculosis and Malaria Greenhouse Gas Gross National Income GNP: Gross National Product HIPC: Heavily Indebted Poor Countries HIV/AIDS: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome ICT: Information and Communication Technologies IDA: International Development Association IGME: Inter-agency Group for Child Mortality Estimation IMCI: Integrated Management of Childhood Illness IMF: International Monetary Fund ISTEEBU: Institute of Statistical and Economic Studies of Burundi IUCN: International Union for Conservation of Nature IUD: Intrauterine Device LDCs: Least Developed Countries LLIN: long-lasting insecticidal nets MDGs: Millennium Development Goals MDRI: Multilateral Debt Relief Initiative MICS: Multiple Indicator Cluster Survey MMEIG: Maternal Mortality Estimation Interagency Group MPAs: Marine Protected Areas MSP/PNILP: Ministry of Public Health/ National Integrated Malaria Control Program MSPLS: Ministry of Health and AIDS Control NAS: National Agricultural Strategy vi

9 NASA: National AIDS Spending Assessments TFP: Technical and Financial Partners NC PTB: New cases of smear-positive or negative Pulmonary Tuberculosis TNCs: UNAIDS: Transnational Corporations Joint United Nations Programme on HIV/AIDS NEIC: NGOs: National Energy Information Centre Non-Governmental Organisations UNDESA: United Nations Department of Economic and Social Affairs NO2: ODA: Nitrogen dioxide Official Development Assistance UNCTAD: United Nations Conference on Trade and Development ODS: Ozone depleting Substances UNDP: United Nations Development Programme OECD: Organization for Economic Co-operation and Development UNESCO: United Nations Educational, Scientific, and Cultural Organization PBF: PLHIVs: Performance-Based Financing Persons Living With HIV UNFCCC: United Nations Framework Convention on Climate Change PMTCT: PNIA: Prevention of Mother-to-Child Transmission (HIV/ AIDS) National Agriculture Investment Plan UNICEF: UNITAID: United Nations Children s Fund International facility for the purchase of drugs against HIV/AIDS, Malaria and Tuberculosis PNLT: National Tuberculosis Control Programme UNSD: United Nations Statistics Division PNSR: National Programme on Reproductive Health UNSTAT: United Nations Statistics Division PRSP: Poverty Reduction Strategy Paper VAM: Vulnerability Analysis and. Mapping RH/FP: Reproductive Health/Family Planning WB: World Bank SNIS: National Health Information System WFP: World Food Programme SONU: Emergency Obstetric and Newborn Care WHO: World Health Organization SONUB: Basic Emergency Obstetric and Newborn Care SONUC: Comprehensive Emergency Obstetric and Newborn Care Burundi Milennium Development Goals Summary of report 2012 vii

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11 OMD 1 OMD 2 OMD 3 OMD 4 OMD 5 OMD 6 OMD 7 OMD 8 GENERAL SITUATION OF MDGs in BURUNDI As in several other African countries, there has been mixed progress in achieving MDG targets in Burundi. Remarkable progress has been made in a number of indicators such as the net enrolment rate in primary school, gender parity in primary school, vaccination coverage and slowing down the spread of HIV/Aids. However, reducing poverty remains a concern. The progress made in this area has not been sustained over time because of the socio-political crisis that engulfed the country for over a decade. Reducing inequalities in access to social services remains a crucial challenge as well. Within the context of the post-2015 agenda, the analyses contained in this report reveal recurrent concerns which should influence national consultations in Burundi. These are youth unemployment, the quality of social services, inequalities, vulnerability to shocks, the sustainability of economic, social and environmental performance and inclusive growth. The post-2015 development programme should strengthen Burundi s capacity to adapt to socio-economic and climatic shocks by addressing related vulnerabilities. Table 1 below summarises the achievements of MDGs in Burundi. Burundi Milennium Development Goals Summary of report

12 Table 1 Brief overview of MDG achievements in Burundi in MDG 1: ELIMINATE EXTREME POVERTY AND HUNGER Target Indicator Indicator status Target 1: Halve the proportion of the population with income of less than 1 dollar a day between 1990 and 2015 g Reference basis in 1990: 35% g 2015 goal for Burundi: 17.5% below the poverty line Target 2: Halve the proportion of people suffering from hunger between 2000 and basis: 30.2%; 2015 goal: 15.1% } Proportion of the population with less than one dollar a day } The poverty gap ratio [poverty rate x depth of poverty] } Share of the poorest fifth of the population in national consumption } Percentage of children under 5 underweight } Proportion of the population below the minimum level of dietary energy consumption 67% in 2006 with indicative projection of 45% in % in 2006 and 33.3% in % in % in 2010 Over 50% of the population in 2010 Likelihood of being achieved by Unlikely Unlikely MDG 2: ENSURE PRIMARY EDUCATION FOR ALL Target Indicator Indicator status Target 1: Provide all children, girls and boys, all over the world, with the means to complete a full cycle of primary schooling between 2000 and 2015 } Net enrolment rate in primary school } Proportion of schoolchildren starting their first year and completing their fifth of primary schooling } Literacy rate among those aged % in 2006 with indicative projection of 45% in % in 2006 and 33.3% in % in 2006 Likelihood of being achieved by 2015 Likely Unlikely Possible MDG 3: PROMOTE GENDER EQUALITY AND EMPOWERMENT OF WOMEN Target Indicator Indicator status Target 1: Eliminate gender inequalities in primary and secondary school between 2000 and 2005, if possible and at all levels of schooling by 2015 at the latest } Ratio of girls to boys in primary, secondary and higher education } Literacy rate among women aged compared to men } Percentage of female employees in the non-agricultural sector } Proportion of seats held by women in the national parliament Primary 99% in 2011 Secondary 72% in 2011 and Higher 54% in % in 2011 Not available 32% in 2010 Likelihood of being achieved by 2015 Likely in primary school Possible in secondary school Unlikely in higher education 2 1 All data sources on indicator status are provided in the text 2 LIKELY = high possibility; POSSIBLE = average possibility; UNLIKELY = low possibility

13 MDG 4: REDUCE MORTALITY AMONG CHILDREN UNDER 5 Target Indicator Indicator status Likelihood of being achieved by 2015 Target 1: Reduce the mortality rate of children under five by two thirds between 1990 and 2015 g 1990 basis: 183; g 2015 goal for Burundi: 67 } Mortality rate among children 142 per thousand in 2010 under five (5) } Neonatal mortality rate 96 according to 2010 DHS } Proportion of children vaccinated against measles. 42 per thousand in % in 2010 Possible if additional efforts are made MDG 5: IMPROVE MATERNAL HEALTH Target Indicator Indicator status Likelihood of being achieved by Target 1: Reduce the maternal mortality rate by three quarters between 1990 and 2015 g 1990 basis: 1100 g 2015 goal for Burundi: 275 Target 2: Ensure universal access to reproductive health by 2015 } Maternal mortality rate (deaths out of 100,000 live births) 800 in 2010 according to MMEIG 500 according to 2010 DHS } Proportion of births attended by 68% in 2011 skilled health personnel } Contraceptive prevalence rate 26.9% in 2010 } Adolescent fertility rate 11% in 2010 (DHS) } Prenatal care (at least one visit and at least 4 visits) At least one visit: 100% in 2012 (PNSR report) At least 4 visits: 79.9% in 2012 (PNSR report) } Adolescent fertility rate 31% in 2010 (DHS) Possible if additional efforts are made Possible MDG 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES Target Indicator Indicator status Target 1: Have halted the spread and begun to reverse the incidence of HIV/Aids by 2015 } HIV prevalence among pregnant 1.4% in 2011 women between the ages of 15 and 24 } Condom use 21.9% in 2010 } Number of children orphaned 140,000 in 2010 by AIDS Likelihood of being achieved by Possible Target 2: Have halted and begun to reverse the incidence of malaria and other major diseases between 2000 and 2015 Malaria } Prevalence rate of malaria and mortality rate relating to this disease } Proportion of the population living in areas at risk using effective malaria protection and treatment measures Tuberculosis } Prevalence rate of tuberculosis and mortality rate relating to this disease } Proportion of the population living in areas at risk using effective malaria protection and treatment measures Death rate: 1.9% in % of the general population, 45.3% of children under the age of 5 and 50% of pregnant women sleep under insecticide-treated mosquito nets in per 100,000 inhabitants in 2010 Detection rate in 2010: 70%; rate of treated cases: 79% in 2005 compared to norm of 85% Possible Burundi Milennium Development Goals Summary of report

14 Table 1 Brief overview of MDG achievements in Burundi in 2012 (continued) MDG 7: ENSURE ENVIRONMENTAL SUSTAINABILITY Target Indicator Indicator status Target 1: Integrate the principles of sustainable development in national policies and reverse the loss of environmental resources } Proportion of land area covered by forest } GDP per unit of energy used (energy efficiency) 6.7% in % in 2008 Not available Likelihood of being achieved by 2015 Unlikely } Carbon dioxide (CO2) emissions, metric tons of CO2 per capita (Source: CDIAC) in 2010 Target 2: Halve the percentage of the population without sustainable access to safe drinking water between 2000 and 2015 g Objective 2015: 73.5% with access to safe drinking water } Proportion of the population with access to an improved water source 72.72% in 2010 Possible Target 3: Have achieved a significant improvement in the lives of at least 100 million slum dwellers between 2000 and 2015; } Proportion of the population with access to improved sanitation 46% in 2010 Unlikely } Proportion of the population with access to secure tenure Not available 4

15 MGD 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Target Indicator Indicator status Target 1: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system. } ODA received by developing countries as a percentage of their gross national income } Market access: Proportion of exports 39.64% in 2010 Trade, coverage rate: 20% in 2010 Likelihood of being achieved by 2015 Unlikely Target 2: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term } Debt sustainability: Debt service as a % of exports of goods and services 1.2% in 2010 Possible Target 3: In cooperation with developing countries, develop and implement strategies for decent and productive work for youth } Unemployment rate among those aged Not available Target 4: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries } Proportion of the population with sustainable access to affordable essential drugs on a sustainable basis Not available Level of access remains low due to poverty Target 5: In cooperation with the private sector, make available the benefits of new technologies, especially information and communications to all. } Number of telephone lines per 1000 inhabitants } Number of internet users per 1000 inhabitants Fixed-line: 3.9 per 1000 inhabitants in 2010 Mobile: per 1000 inhabitants in of the population in 2008 Unlikely Burundi Milennium Development Goals Summary of report

16 Chapter 1 ELIMINATE EXTREME POVERTY AND HUNGER

17 In Burundi, progress in achieving all MDG 1 targets is below expectations. Performance in economic growth observed since 2006 is good and above 4% per annum. However, it is not sufficiently strong and is still well below the 7% required to halve the proportion of the population with income of less than one dollar a day by Economic performance therefore remains fragile. After the 2000 Arusha Accords, the Burundi economy expanded by 5.1% in This performance was not sustained in the long term after the economic recession and the international financial crisis worldwide which affected the volume of development aid to African countries. Economic growth in Burundi fell to 3.5% in 2009 before gradually rising again, reaching 4% in Projections show that progress is set to continue in 2012 and 2013 with growth rates of 4.8% and 5.3% respectively. The figure below shows trends in economic growth in Burundi between 2003 and Burundi s performance in terms of economic growth has not resulted in a proportional reduction in poverty and hunger. It has also not fostered job creation. From a level of 35% in 1990, the proportion of the population living below the poverty threshold reached a record 81.3% in 1998 following the persistence of armed conflicts which led to a drastic slump in the country s output. As peace was gradually restored, the country returned to low economic growth. This meant that the incidence of poverty also gradually fell, reaching about 67% in However, the incidence of poverty is unequally distributed across the country, with the rate at 69% in rural areas compared to 34% in urban areas. This inequality is also observed between provinces. For instance, the poverty rate is 30.4% in the province of Bururi compared to 90.4% in the province of Ruyigi. Linearisation of the pace at which the proportion of poor people is falling under the current wealth creation conditions shows that by 2015 the incidence of poverty in Burundian society will be about 45%. This is obviously far off the target of 17.5%. As regards hunger, the 2010 Demographic and Health Survey reveals an underweight rate of 29% and a rate of chronic malnutrition of 58% among children under 5 in Burundi. Although this underweight rate is an improvement on 2007 levels, which was 35.2%, it remains higher than the 21% rate accepted by the WHO. The rate of chronic malnutrition rose from 46% to 58% between 2007 and 2010, much more than the 40% emergency threshold. Figure 1.1 Trends in the incidence of poverty between 1990 and 2015 in Burundi , , Current Evolution MDG desirable path Data source: (i) 2010 Report on MDGs, (ii) Second report on the implementation of PRSP I (December 2009) Burundi Milennium Development Goals Summary of report

18 Chapter 2 ENSURE PRIMARY EDUCATION FOR ALL

19 The net enrolment rate in primary school in Burundi has improved remarkably since the adoption of MDGs in It rose from 52.88% in 1990 to 96.1% in However, this relatively satisfactory overall situation masks disparities between provinces. The provinces of Bururi, Kayanza, Makamba, Kirundo, Muramvya, Cibitoke and Rutana are accommodating the children of repatriated citizens and have rates over 100%. The rate of primary school completed has considerably declined since 1990, falling from 54% to 36% in 2005 before gradually rising after peace was restored, reaching 51.20% in This performance does not reflect the efforts made by Burundi to improve children s access to education. The reasons for this counter-performance can be traced to the high grade-repetition (38.4%) and drop-out rates (6.5%) according to the report on education indicators in Burundi. The country ranks low compared to other east African countries. On the other hand, the literacy rate among men and women aged has improved, from 51.8% in 1990 to 77.6% in Figure 2.1 Net enrolment rate in primary school by province and by gender in 2010/2011 Burundi 96,1 Bururi 121,3 Makamba 120,4 Kayanza Cankuzo Rutana Cibitoke Bujumbura rurale Muramvya Bubanza Kirundo Mwaro Ruyigi Karuzi Muyinga Gitega Ngozi Bujumbura Mairie ,6 90,9 101,8 101,5 91,9 100,4 87, ,4 93,3 91,8 93,6 88,7 87,7 Boys 82,6 Girls Sources: 2010/2011 Education Indicators in Burundi. Bureau of Educational Planning and Statistics. Burundi Milennium Development Goals Summary of report

20 Chapter 3 PROMOTE GENDER EQUALITY AND EMPOWERMENT OF WOMEN

21 The data available shows that Burundi is performing well in terms of the ratio of girls to boys in primary and secondary school education, at 97% and 72% respectively in Between 2010 and 2011 parity in primary school was about 1.02% while the trend in secondary school was slow, at about 76% in However, the march towards gender parity remains a key challenge in Higher education. The ratio rose from 40% in 1999 to 54% in This rate varies depending on educational fields. For instance, 70% of girls are enrolled in service sector courses and 15% in agroindustrial and industrial courses. This negative performance is due to the lack of private offerings in higher education, but also to the relatively high cost of schooling compared to people s income levels in general. Literacy rates among young women aged in Burundi rose slightly between 2000 and 2011, from 70.40% to 77.6%. Although performance in 2010 was good, the figures show that Burundi still lags behind other east African countries in this area. Rights-based approach: just as there is a right to education, there should be a right to literacy. Reducing illiteracy rates would have a positive impact on poverty reduction. Social approach: this sees literacy as a tool to combat social or cultural inequalities. This was the approach favoured by Burundi. Functional approach: this aims to sustain economic growth and increasing labour productivity, because it focuses on preparing young people for working life, on creating their own jobs, on access to microloans (particularly for women) and on environmental management to improve productivity. As regards the proportion of women with access to paid employment, Burundi continues to lag behind other countries in the sub-region. However, considerable efforts are being made to comply with legal provisions in this area. Finally, Burundi has made very laudable efforts in terms of the proportion of seats occupied by women in the National Parliament. This figure rose from 12.3% in 1993 to 32% in The acceleration in economic growth as recommended by PRSP II requires sustained efforts in improving literacy rates among young women of working age. These efforts could be articulated around the following strategies: Figure 3.1 Gender parity index in primary and secondary school education in Burundi 1,2 1 0,896 0,97 0,99 0,99 0,8 0,6 0,78 0,732 0,72 0,72 0,72 0,4 0,2 0 Moyenne Moyenne Gender Parity Index in primary education Gender Parity Index in secondary education Source: UNSTATS, 2012 African Statistical Yearbook Burundi Milennium Development Goals Summary of report

22 Chapter 4 REDUCE MORTALITY AMONG CHILDREN UNDER 5

23 According to United Nations Inter-Agency Task Force estimates, the infant and child mortality rate in Burundi fell from 183 deaths per 1000 births in 1990 to 142 in The annual average reduction over this period was between 1.3% and 2.8%. However, the 2010 Demographic and Health Survey estimates this rate at 96 deaths for 1000 live births. While infant and child mortality rates have fallen over the last decade, neonatal mortality remains stagnant for several reasons, particularly the low quality of maternal and new-born care and the failure to implement a number of essential interventions with high impact on the survival of new-borns despite improved access to care for pregnant women and children due to the national free care policy for these targets. As regards vaccination coverage, improvements have been observed since 2005 across the country. Systematic measles vaccination coverage were respectively 91% in 2009 and 92% in 2010 et This performance was achieved thanks to the conduct of routine vaccination campaigns and national remedial and monitoring campaigns with the technical and financial support of partners such as GAVI. This performance had a positive impact on infant mortality rates, which stood at 102 per thousand live births in Unfortunately, this progress was hampered by the deterioration in household living conditions during a long period of socio-political crisis. Furthermore, this mortality rate remains high due to the poverty rate in general and undernourishment in particular, and because of diseases such as malaria, malnutrition, respiratory infections and diarrhoea-related illnesses. In Burundi 58% of children under 5 are chronically malnourished Demographic and Health Survey (DHS) Figure 4.1 Infant and child mortality rate trends in Burundi (deaths per 1,000 live births) Current Evolution MDG desirable path Data source: IGME Burundi Milennium Development Goals Summary of report

24 Chapter 5 IMPROVE MATERNAL HEALTH

25 Maternal health is an ongoing concern in Burundi. According to Maternal Mortality Estimation Interagency Group (MMEIG) estimates, the maternal mortality rate fell from 1100 to 800 maternal deaths per 100,000 live births between 1990 and 2010, an overall reduction of 27%. In view of the trends, achieving this MDG target is possible if significant efforts to invest in this area are made by the Government and Burundi s development partners in This is the main reason why MDG 5 was retained in the MDG Acceleration Framework adopted consensually by the Government and the United Nations. The data available on family planning shows increasing use of modern contraceptive methods: from 4% in 1990 to 21.9% in This trend is related notably to the lack of shortages in stocks of contraceptives since 2006, to the training of service providers in long-acting methods of contraception (IUDs and implants) and to performance-based funding. However, despite the positive performance of most of the abovementioned indicators, there are significant disparities between Burundi regions and provinces. According to the assessment of EmONC needs carried out in 2010, maternal deaths are due mainly to direct obstetrical complications such as haemorrhaging, obstructed labour and infections. Haemorrhaging is the most common cause of maternal death and post-partum haemorrhaging occurs in over 72% of haemorrhage cases. The EmONC needs assessment showed that uterine rupture was the main cause of death. The case fatality rate per haemorrhage (3.3%) is three times higher than the acceptable case fatality rate (1%). Figure 5.1 Maternal mortality trends in Burundi Current Evolution MDG desirable path Source: Constructed by the authors using 2010 MMEIG data Burundi Milennium Development Goals Summary of report

26 Chapter 6 COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

27 HIV/AIDS remains a major public health problem and Burundi ranks among the countries most affected in eastern and central Africa. According to the 2007 seroprevalence survey, average seroprevalence was 2.97% in those aged 18 and over, predominantly among females. Since then, significant progress has been made in terms of prevention and treatment with positive effects on reducing seroprevalence and reducing mortality. Despite this progress, additional efforts still need to be made to deal with the worrying rise in the disease in rural areas, where over 90% of the population live, and to increase the coverage of key interventions contained in the national strategic plan to combat HIV/Aids. Malaria accounts for 74.7% of all external consultations recorded in medical units in 2010 and 62.6% among children under 5. The data available for the period shows fluctuating trends in the number of cases of malaria due to the combination of factors such as improvements to the reporting system as well as an increase in healthcare service utilisation following the introduction of free healthcare for the under fives (2006) and first-line anti-malaria drugs to all categories of patients. The death rate from malaria was at 1.9% in 2006 against 7.6% in 1990 (ISTEEBU). Tuberculosis is circulating in an endemo-epidemic pattern with annual overall incidence of 88 cases notified per 100,000 inhabitants (Global Tuberculosis Control, WHO Report OMS 2010). Taking into account the annual risk of infection, the prevalence of tuberculosis in Burundi was 212 cases per 100,000 inhabitants in 2009, 239 cases per 100,000 inhabitants in 2000 and 162 cases per 100,000 inhabitants in These figures are below the actual figures because the detection rate for 2011 was 47%, far below the WHO target of 70% (PNLT report 2011). Tuberculosis mainly affects the age bracket of the productive population aged 15-44, which impedes the fight against poverty and development in general. The fight against this disease is currently made more difficult by two new challenges, namely TB/HIV coinfection (26% of those suffering from TB are also coinfected with HIV (2007 national seroprevalence survey on HIV infection) and multi-drug resistant TB of which an average of 20 cases are diagnosed each year. Overall, the pace of progress recorded in Burundi in the fight against HIV/Aids, TB and malaria has been sustained. Figure 6.1 HIV prevalence trends ,3 5,1 3,9 2, ,1 1,9 1, Current Evolution MDG desirable path Data source: UNSTATS Rapport sur les Objectifs Burundi du Millénaire Milennium pour Development le Développement Goals Summary au Burundi of report édition

28 Chapter 7 ENSURE ENVIRONMENTAL SUSTAINABILITY

29 The decisive role of the environment in achieving the other MDGs requires that Burundi incorporate sustainable environmental regulations in its policies and programmes. Therefore, the public authorities must devote a significant proportion of the national budget on environmental preservation instead of continually expecting external funding. In addition, it is important that national and sub-regional environmental preservation programmes also include measures to promote the creation of green jobs for young people. Reducing poverty and achieving sustainable development must go hand in hand with a healthy planet. The Millennium Development Goals recognise that environmental preservation is an integral part of global prosperity and social well-being. Failure to preserve biodiversity for example, would compromise socio-economic development efforts. The anarchic exploitation of natural resources such as forests, soil, water and fish (often by a minority of the most powerful) has caused much devastating damage to nature over the last few decades, affecting the most vulnerable populations. Burundi is not on the right track to reverse the loss of environmental resources. Forestry areas have declined in the last twenty years. Between 1990 and 2010, the area covered by forests fell from 11.3% to 6.7% of the total surface of the country, an average deforestation rate of 64 km 2 a year. If this pace is maintained, Burundi will have no more forests within 29 years However, despite the relatively high rate of deforestation in Burundi, carbon dioxide emissions have constantly fallen over the last twenty years, from to metric tons per capita between to As regards access to safe drinking water, the proportion of population with sustainable access to safe drinking water remains low and is rising slowly in Burundi, with the percentage growing from 70% to 72.5% in 20 years. The situation is similar when it comes to the proportion of the population using a better sanitation system, which remained stagnant at about 46% between 1990 and Figure 7.1 Trends in the proportion of area covered by forests , ,3 7,6 6, Current Evolution MDG desirable path Data source: UNSTATS Burundi Milennium Development Goals Summary of report

30 Chapter 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

31 The mobilisation of internal funds, essentially through fiscal efforts and national borrowing, is far from sufficient in view of the development funding needs of Africa in general and Burundi in particular. A number of reasons have been put forward to explain this situation. These include the low tax burden, low savings and mobilisation arrangements. This is why the MDGs advocate strengthening the global development partnership based on an open international commercial and financial system and on prioritising the specific needs of the least advanced countries and island developing states. The point is to increase aid and improve its effectiveness through efficient use and targeting of the most vulnerable; taking measures to ensure the long-term debt sustainability and facilitating access to global markets for products. The partnership envisaged also proposes international cooperation in favour of poorer countries to promote decent jobs for young people, the availability of affordable essential drugs and access to new technologies, particularly information and communication technologies. In Burundi the ODA flow does not seem equal to the MDG ambitions. In terms of FDI, Burundi is by far the worst performer among east African states. While other countries have recorded constant progress since 2000, Burundi continues to have annual flows under 2 million dollars per year, apart from the peaks in 2000 and 2008 when 11.7 and 3.8 were recorded respectively. As regards debt, total outstanding government debt in Burundi (from all sources) in 2010 rose 3.2% compared to Burundian debt remains essentially an external debt, with multilateral debt taking up the largest share. Overall, the analyses conducted cast doubt over the capacity of the global development partnership, as it currently stands, to facilitate the achievement of MDGs in Burundi by The country s low capacity to mobilise the resources needed in such a short timeframe makes achieving the MDGs a real challenge. This concern is all the more justified given that western countries, western Europe in particular, are dealing with financial difficulties that could affect the momentum of ODA, FDI and migrant workers remittances as well as the handling of external debt. Figure 8.1 General trend in aid volumes Source: Aid Management Platform (AMP) Burundi Milennium Development Goals Summary of report

32 Tous Unis dans l Action BURUNDI United Nations system in Burundi BNUB Compound Chaussée d Uvira P.O. Box 1490, Bujumbura, Burundi Websites : Ministry of Finance and Economic Development Planning Avenue de l Indépendance no.1 P.O. Box 224, Bujumbura, Burundi