Just as the COVID-19 global pandemic began one year ago, Pathfinder launched a new project in Burundi – Tubiteho, or “Let’s Take Care of Them.” The project has built a foundation to accelerate the delivery and uptake of family planning, maternal, newborn, child and adolescent health, nutrition, malaria, and gender-based violence prevention (GBV) and treatment services across six provinces in Burundi: Buriri, Kirundo, Karusi, Makamba, Muyinga, and Rumonge.
Tubiteho did this despite the onset of the pandemic, a tumultuous presidential election, the formation of a new cabinet, and the sudden death of the outgoing president of Burundi. It was a year of challenges, but Pathfinder’s staff and our extraordinary community of frontline health workforce partners strengthened health systems, creating a strong foundation for delivering health care to Burundians.
Snapshot: Tubiteho’s First Year
- Procured medical equipment for distribution at 412 health facilities in six provinces of Burundi.
- Trained 830 community health workers on community Integrated Management of Childhood Illness in Matana, Makamba and Bugarama health districts.
- Conducted 12 community awareness-raising sessions to prevent and limit the spread of COVID-19, in the 12 health districts; these community awareness sessions reached an estimated 20,000 community members.
- Trained 31 focal points (all women) and 216 community animators on identifying, referring, and accompanying gender-based violence survivors to holistic care.
When a Pathfinder project launches, the first thing it needs to do is set the groundwork for success. In Burundi, where the maternal mortality rates and fertility rates are some of the highest in the world, Pathfinder first needed to ensure that health facilities had the equipment they needed to provide quality family planning services and maternal health care.
“This year, we are making a big donation of medical equipment – $450,000 USD of it,” said Salomon Rakotovazaha, Chief of Party for Tubiteho. “This is extremely important. We are donating equipment to health facilities where they were under-resourced, and this will contribute greatly to Tubiteho’s overall goals and the health indicators of Burundi. What we’ve experienced during our first year is that the mortality and morbidity rates for maternal and child health are really high. And the lack of equipment is one of the major reasons for that. With COVID-19, it was challenging to lay this groundwork – flights and shipments were delayed for months. But we got them, and are working to distribute them. And by the end of 2021, we will see the effects.”
The Tubiteho project also spent the last year building the capacity of community health workers throughout the country in maternal and neonatal health, child health, family planning, malaria management, social behavior change and GBV interventions. “Capacity building has been our success,” says Rakotovazaha. “We did a lot of trainings, transferring knowledge – then worked to translate this into service provision.”
The trainings were informed by needs identified in consultation with the Ministry of Health. Across the six provinces where Tubiteho works, Tubiteho reached health providers, pharmacists, local administrators, commodities managers, and worked with key organizations and partners to embed knowledge locally.
For Simbuga Samuel, the President of the Health Committee or Comite de Sante (COSA) at the Mika Health Center in the Giteranyi Health District, Tubiteho’s trainings made an immediate impact. “I have spent two years as president of the COSA of this health center,” he says. “No organization or project had ever thought of training us on our responsibilities as members of the COSA.”
And how do these types of trainings translate for community members?
For Christine Niyonkuru and her husband Gabriel Sindayihebura, it meant the difference between extreme struggle and managing their health and well-being on a daily basis.
Christine and Gabriel have five children, and were struggling to provide for them and find energy to manage the families’ needs. Where they live, in the Southern province of Makamba, Burundi, 36% of women have an unmet need for family planning. That’s why Tubiteho has been working to build the capacity of health providers in the region, and to raise awareness about family planning methods.
A baby on my shoulder plus another in my womb, that’s too much. I was always weak, my children were often sick, and I had no time, nor energy, to cater for my families’ needs. Two of my children were malnourished. It was so bad. At some points, I felt helpless and useless.”Christine Niyonkuru
In Christine’s town, Eliphaz Nyandwi, a community educator, started to visit Christine and her husband regularly.
“After several talks with Eliphaz, my husband and I understood that having many children is not inevitable, and we could do much about it…I (went to the health center) and opted for the injections that happen every three months. From that day on, I have no problems anymore. I feel healthy, my last born is one-year-old and I have no problems breastfeeding. Above all, I AM NOT PREGNANT!”
Giving families options for reproductive health is one of Tubiteho’s key goals. First, the program works to increase access to quality essential health services. Second, Tubiteho aims to increase the adoption of positive health behaviors. And third, Tubiteho works to strengthen the health system overall.
Today, Christine goes beyond adopting what she calls ‘salutary’ family practices. She shares her experience with her friends, neighbors, and relatives with unbridled enthusiasm. She takes every opportunity to give her testimony to other women because she feels it is each one’s responsibility to help families break the vicious circle. Today, four women have taken family planning methods thanks to Christine’s involvement. Eliphaz, the community health worker, confirms this and hopes seeing other women assist him will ultimately induce change in the community.
With a smile on her face, Christine concludes: “I don’t need to talk much. I show facts, I display my energy and my appearance, and many people have seen change in my family’s wellbeing. Those are my main arguments, and they seem to work. I am confident: the best is yet to come…”
This is how Tubiteho is meant to work. In the upcoming years, Tubiteho will foster sustainability and ownership by the government to ensure that the program is locally owned and driven. By focusing on the district as the key intervention point, Tubiteho balances national priorities and the community’s needs.