This chapter investigates the impediments to mHealth adoption in Burundi. A survey was conducted with 212 healthcare professionals from 48 primary healthcare centres in Burundi. The findings reveal that although there is a high acceptance of mHealth capabilities from the primary healthcare workers, a host of factors mitigate against the implementation of mHealth interventions in Burundi. Amongst these are lack of skills to develop mHealth applications, high cost of mobile devices, low rate of cellphone and other mobile devices penetration, unreliable network coverage in rural areas, and a high cost of network connection. These factors have a low effect size on the acceptance of mHealth capabilities by primary healthcare workers in Burundi. Partnerships between Burundi's Ministry of Health and mobile service providers, extensive consultation with potential users of mHealth systems, and a performance-based system are further factors that need to be considered for the successful implementation of mHealth projects in Burundi.
TopCountry’S Profile
Burundi was classified as the fourth poorest country in the world (ADBG, 2011). It is believed that 69% of people living in rural areas are poor while the poverty level in urban areas sat at 34% (ADBG, 2011). In 2014, the ratio of doctors to inhabitants was 1:19,231, far below the World Health Organization’s (WHO) recommended ratio of 1:10,000. For nurses, the ratio was 1:11,349 which is far less than the 1:3,000 WHO’s recommended ratio (Burundian Ministry of Health, 2014). Furthermore, qualified doctors and nurses were unequally distributed across the country with 50% of doctors and 21% of qualified nurses based in the capital city Bujumbura. In 2006, The Government of Burundi (GoB) introduced free healthcare services for infants and mothers, but still the country is far from achieving the Sustainable Development Goals in terms of access to healthcare (Burundian Ministry of Health, 2014). In 2010, the maternal mortality rate was still very high with 800 deaths per 100,000 births (UNICEF, 2013) (see Figure 1), ranking it the fifth-highest for maternal mortality in the world (after Chad, Somalia, Sierra Leone and the Democratic Republic of Congo).
Figure 1. Trend in Maternal mortality (deaths per 100,000 live births): 1990-2015
The rate of deaths of newborn babies and children below the age of 5 is still high. In 2011, the rate was 139 deaths per 1,000 live births (UNICEF, 2013). The major causes of death are pneumonia and diarrhoea which are mainly caused by malnutrition (58% of children under 5 years suffer from vitamin D deficiency), poor healthcare, and poor feeding practices.
Figure 2. Children (under 5 years) mortality rate: 1990–2015
TopKey Challenges Within The Burundian Health Sector
According to the Global health initiative strategy 2011-2015, the following are the key challenges that the country face: