Page last updated at 16:34 GMT, Wednesday, 23 September 2009 17:34 UK

Burundi's free healthcare struggle

Burundian women queue outside a Bujumbura clinic
Clinics may be free, but they are also very popular

As international donors announce more funding for a campaign to build free health-care systems in the developing world, the BBC's Prime Ndikumagenge reflects on the experience of Burundi, which has already benefited from the scheme.

It has been three years since children under five years of age and new mothers in Burundi were granted free access to medical care.

Doctor at Prince Regent Charles hospital in Bujumbura (Archive)
Some doctors are feeling over worked and under paid

When the scheme was set up, international donors pledged $40m (£24m) a year - and that figure is set to rise.

It has come as a relief to many families in a country where the majority of people live on less than $1 a day.

Before the changes many people could not afford to take their children to hospital.

Pregnant women in rural areas often had their babies at home.

Some families had to sell their property to pay the medical bill for a caesarean section - which would typically cost about $300.

And patients including women and children who were unable to pay were detained in hospitals until their bills were settled.

Ordinary people say those stories are now consigned to history.

But it is not all good news.

Long queues

The implementation of the much-acclaimed scheme has been dogged by lack of preparation - both in medical facilities and personnel.

Unhappy patients at Prince Regent Charles hospital
Some of us have been here since six in the morning
Patient at a Bujumbura hospital

Alongside the public healthcare system, there are also private clinics which still charge for treatment.

And much of the population - women who are not pregnant, children older than five and all men - still have to pay for their healthcare.

Access to public healthcare has also become much more difficult and the service much poorer.

"Some of us have been here since six in the morning," says one woman as she waits for consultation for her sick child at Prince Regent Charles, one of the major hospitals in the capital, Bujumbura.

"It's 11 o'clock now but we haven't seen the doctor. The queue was so long."

Dr Skola, who works in the paediatrics department, says she often sees more than 50 patients in one day.

"We are only a couple of doctors as the rest have gone to the private sector to look for better pay," she says.

"I cannot hide it from you, these people lining up outside my room will one day find it closed, without a doctor inside."

Five-fold increase?

Catherine Kabura, a 30-year-old who recently gave birth at the hospital, says it is common to find a single bed being shared by two mothers and two new-born babies.

Map of Burundi

"Some [mothers] even simply lie on the floor for a few hours after delivery before they are sent home," she says.

Since the free service was introduced, the hospital has been overwhelmed by new patients.

Some suggest the number of people seeking treatment increased five-fold after the changes came in.

But the number of beds available - and the already insufficient number of nurses and doctors - remained the same.

One doctor in another hospital says the number of caesarean sections has increased by more than seven times in recent years.

The doctor says they cannot escape from dealing with such cases.

But he says they turn away dozens of people coming for consultations - not necessarily because they are exhausted, but because they are reluctant to take on more work.

They believe the government did not consider increasing their salaries when it took a decision that doubled or even tripled their workload.

So while free healthcare has positively changed the lives of millions of Burundian children and mothers, critics say the scheme should have been better planned and thought through more thoroughly before it was implemented.

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