Effects of Administrative Structure on Policy Performance

Burundi is currently implementing two health policies: the user fees exemption and medical assistance card (CAM) to enable vulnerable groups of people inlcuding children, pregnant women and aging people to have access to basic health care with the aim of reaching in the long-term universal health care coverage. The government reimburses health centers that implement these two policies for health care services provided to beneficiaries. Despite the fact that all the four health centers surveyed have some pending bills waiting to be paid by government and that they are facing budget deficits challenges, they have not experienced shortages of drugs in their respective stores. This is because non-beneficiaries of these two policies pay in cash all the health care services they receive. The process to fill in the order forms and to purchase drugs is decentralized at the health center and health district levels. This paper analyses the effects of local health care administrative structure on the performance of these two health care policies. The paper argues that health care administrative structure has no negative effects on the procedures of buying drugs at the district pharmacy that can affect the performance of these policies.