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BRIEF May 19, 2021

Burundi: Climate of fear and new ways of scaling up family planning methods in Burundi

The Government of Burundi wants to reduce the fertility rate by 2025 to three children per woman, from the current rate of 5.5 children per woman. Because there is a strong opposition to birth control from faith leaders, and because women who use birth control risk social isolation as a result, the government wants to introduce self-injectable contraceptives. But getting community health clinics ready to prescribe self-injectables and ensuring privacy for women will be challenging. Using data from Burundi’s health monitoring and information system, this evaluation will test different approaches for increasing adoption of these contraceptives, including financial incentives for community health volunteers and authorization for volunteers to provide the service in patients’ homes and instructions for patients to implement the necessary procedure themselves.

Study title:Climate of fear and new ways of scaling up family planning methods in Burundi. 
Research question:Can monetary incentives for health workers or home-based delivery of contraceptives increase utilization of self-injectable contraceptives? 
Policy problem:Women are ashamed and afraid of being seen by others when seeking family planning services because contraception is condemned by the leaders of various faith-based organizations. 
Evaluation design:Treatment 1 Health centers will receive performance-based incentives for community health volunteers for every woman covered by a self-injectable contraceptive who had been referred to the health clinic by the health volunteer.
Treatment 2 Health centers will provide in-home delivery of self-injectable contraceptives by community health volunteers
Control Traditional injections in health centers and in communities through specialized health staff
Data sources:Health management and information system (HMIS) data on contraception coverage, referrals, contraception choice and number of injectables requested at health centers. 
Researchers:Arndt Reichert, Victor Hugo Orozco Olvera