September 6, 2006

A High Price to Pay

Detention of Poor Patients in Burundian Hospitals

Acronyms
Map of Burundi
I. Summary
II. Recommendations
III. Methodology
IV. Background: Health, Poverty and Conflict
Political and socio-economic situation in Burundi: Moving from conflict to post-conflict
The health sector in Burundi
Availability and access to health care
Hospital detentions in Africa
V. Detention in Public Hospitals for Lack of Payment
Numbers of hospital detainees
Medical problems leading to detention
Surgery
Patients suffering from long-term or chronic diseases, including HIV/AIDS
Maternal health problems before May 1, 2006
Infant and child health problems
"Since you have not paid, we will imprison you": Experiences of patients
Surveillance
Prince Louis Rwagasore Clinic: Detention in a lock-up
Size of bills
Conditions of detention
Lack of medical treatment
Lack of food
Losing the bed
Children in hospital detention
Mohamed S.
Noah B.
Flix M.
Adle A.
Refusal to release dead bodies
VI. Consequences of Hospital Detention
Economic pressure
Fear to seek access to health care
VII. The Government Response
VIII. Government Measures Aimed to Improve Access to Health Care
The failure of health insurance
The failure of the exemption system for the poor
The indigence card
The voucher for displaced people
Alternatives to hospital detention
Free care for women giving birth and small children: The May 1 presidential directive
An increased burden on the health system...
Impact on hospital detentions
Further government plans for health reform...
IX. Government Failure to Address Other Structural Problems of the Health System...
Starving the hospitals: The downside of hospital autonomy
Lack of transparency in health sector finance
X. Keeping the System Alive: The Dilemma of Being a Benefactor
XI. The Role of the International Community in the Health Sector
Donor aid
Debt relief
XII. Human Rights Standards
Detention
Health
XIII. Acknowledgements