Burundi

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"Burundi is in a transitional phase which, once it has stabilised, will lead to the development and taking over by national organisations of the policy of support for disabled people."
Pascal MARTIN, Programme director in Burundi

"We are not demanding specific rights, but mechanisms that will enable disabled people to benefit from the acknowledged rights of every human being."
Pierre-Claver SEBEREGE, representative of the Burundi Union of Disabled People.

In Burundi, Handicap International works on

• HIV/AIDS
• Assistance to disabled people, mainly in the areas of rehabilitation and multiple disabilities
• Disability awareness / prevention campaign
• Mine Risk Education

CONTEXT
Burundi is a small country located in the Great Lakes region, in the North-Eastern part of the Tanganyika Lake, and shares borders with the Democratic Republic of Congo, Rwanda and Tanzania.

The country’s capital – Bujumbura –, located on the North-Eastern end of the Tanganyika Lake, harbours between 300,000 and 400,000 inhabitants.

Burundi has just emerged from more than 10 years of war and is facing a very complex humanitarian situation with approximately 840,000 Burundian refugees (almost all in Tanzania), dozens of thousands of displaced people and 27,000 refugees (mainly Congolese) on Burundian territory. The number of refugees amounts to more than 10% of the country’s total population.

It is estimated that the conflict has led to 300,000 deaths since its beginning. In addition, Burundi is one of the 15 countries in the world most affected by HIV AIDS. In the past two years, in some provinces, chronic starvation has tended to spread because of poor agricultural seasons. This is in addition to pressure on land property, due to the population being the highest density in Africa, limiting the capacity for self-sufficiency with food.

In this predominantly agricultural country where infrastructures are almost inexistent, more than 90% of the population is rural. The 10 years of war (ended in 2003) and the embargo that the country has undergone between 1996 and 1999 have jeopardised the developing economy that the country was beginning to display. In 2006, the country came 169th – out of a total of 175 countries – on the list of Human Development Indicator (HDI).

In 2005, the first democratically elected government since 1993 took power. The many years of civil war, however, have resulted in a large number of refugees, a decline in the living standard and a change in the family structure.

At-risk populations are mainly composed of refugees and internal displaced people, for they have lesser knowledge of suspect areas in comparison to the local population. The three most affected areas appear to be the following:

• Border with Tanzania (provinces of Makamba, Rutana and Ruyigi) with an important return of refugees and displaced people
• Border with the Democratic Republic of Congo (provinces of Cibitoke and Bubanza)
• Province of Rural Bujumbura.

War victims are numerous in these border provinces with Tanzania; either they have been injured during the conflict, or they are victims of unexploded ordnances or grenades or, because of isolation, the lack of access to treatment to cure infections or malnutrition, they have become crippled. The social state of the country, significantly impoverished by ten years of conflict, has further worsened the conditions for people with disabilities: every man is looking for himself and solidarity with the weakest tends to disappear.


ACTIVITIES

1) Support to local associations in the fight against HIV/AIDS
Our support takes the form of technical and financial support for their activities. Handicap International assists in the following areas:

• Support to the national network of the centres for advising and AIDS voluntary screening : ensuring a better coordination of activities and developing advocacy
• Programming: training in project writing and organisational capacity building
• Financial support for staff
• Equipment and medication
• Technical support for the development of adapted working methods for income-generating activities
• Technical support for networking the care-management team
• Awareness-raising and prevention: financial and technical support for prevention campaigns.

2) Community Health
The promotion of community health in Ngozi involves providing support to a network of health centres, as well as empowering the communities to take on the management of the centres and participate in resolving certain health issues:

• Capacity building of the population and health staff to improve the management of the centres and the quality of the care provided
• Rehabilitation of health centres, provision of equipment and essential medicines, and also means for treating opportunistic infections
• Improvement of the prevention of communicable diseases and the care-management of HIV infection by including it in primary health care
• Strengthening reproductive health activities

3) Rehabilitation
At the National Center for Equipment and reeducation in Gitega, St Kizito Institute in Bujumbura and Jan-Bosco Center in Muyinga, Handicap International provides:

• Training and follow-up for appliance technicians and physiotherapists
• Supply of equipment and consumables
• Technical support in the production of appliances: mostly orthoses and artificial limbs
• Technical support in the production of mobility aids (e.g local production of tricycles, walking sticks and crutches)
• Support to the transition from leather / wood technology to polypropylene technology at the Centre Saint Jean Bosco in Muyinga
• Training in centre management

Between 2002 and 2005, Handicap International began supporting to several physical disability centres (including multiple disabilities) disseminated across the country. Handicap International is now engaged into a second stage through support to four physical rehabilitation centres and one centre for people with multiple disabilities. It primarily aims to help centres become autonomous (technically, logistically, in management etc…), establish a solidarity fund to enable access for all patients to the available services, helps produce and distribute through the centres and DPOs around 300 wheelchairs a year and raise awareness in the public institutions and the civil society of their respective roles towards people with disabilities.

In close collaboration with local rehabilitation centres, Handicap International produces walking aids (wheelchairs, crutches, artificial limbs and orthoses) and trains local personnel in the production of mobility aids and the provision of rehabilitation.

The project also aims to facilitate disabled access to rehabilitation centres which are autonomous and close and offer quality services. Four centres for physically disabled people and two for those with multiple disabilities also receive our support in improving their services through training, scholarships for physiotherapists and orthopaedic technicians and donations of equipment.

Finally, effective campaigning on behalf of disabled people has been aimed at the Burundi government and general public to improve disabled people's inclusion and greater awareness of their rights.

4) Networking of disabled people organisations (DPOs) and networking of disability reception centres
Since 2005, Handicap International began a project of empowerment of DPOs through networking. We are now facilitating the meetings once a month, which will lead to the official recognition of the network and the elaboration of their activity plan, that is essentially oriented in capacity building of their members, the Burundian DPOs through training in management of organisations, vocational training , sharing experiences, fundraising and advocacy.
 
5) Advocacy on the rights of disabled people
The advocacy project of Handicap International is essentially based around the diffusion of the recently adopted United Nations convention on rights of disabled people. The advocacy work uses different media like radio, theatre, little films, leaflets, posters, organisation of events, special conferences. We also developed more technical discussions with different stakeholders such as a seminar on community based rehabilitation, disability prevention through early detection.

• Translation of the UN Convention of the rights of disabled people in Kirundi and distribution in all the provinces
• Distribution of posters advocating for a better inclusion of disabled people
• Organisation of a special training on the rights of disabled people to train more than 300 community leaders
• Awareness raising activities: three theatre campaigns, with more than 30 representations and diffusion of 13 radio shows on the rights of disabled people and on prevention of disability
• Awareness raising around the day of disabled people every year: two weeks of activities with conferences, expositions, sport events and theatre.

6) Mine risk education and victim assistance
In order to prevent the apparition of disabilities and broaden support to the management of people with disabilities, in particular of mine & UXO victims, our organisation has undertaken in November 2004 an intervention in the field of mine risk prevention, with a second phase in march 2006 of victims and disabled people assistance. The intervention was conducted in three provinces: Makamba, Ruyigi and Rutana. It targeted refugee, repatriated and displaced populations as well as the local population and the humanitarian agents in Burundi in order to facilitate the implementation of emergency humanitarian field activities.
Prevention was aimed at at-risk people. The project aimed at mine risk but also tries to rectify a lack of knowledge which can lead to certain disabling pathologies: early identification of club-feet, etc. We try to raise awareness of health care personnel, communities and families; the effects of this will lead to a behavioural change within the population. By bringing direct support to the poorest and above all by developing a spirit of solidarity and social/community dialogue, this project opens a space for positive discussion encouraging social cohesion.
Victim assistance, the second part of the project, intends to tackle the two causes of disabilities: physical deficiency, via referral and specific aid to the poorest and social isolation via the reconditioning of society and mobilisation regarding management of people with disabilities and development of initiatives in solidarity. By facilitating access to treatment, it will enable more patients to gain autonomy and thus possibly carry out day-to-day activities. The project aims to improve physical, social and material conditions to limit extremist deviations at the origin of conflicts in the Great Lakes region.        

BENEFICIARIES
For the HIV/AIDS project, the direct beneficiaries are people infected or affected by AIDS and young people, via awareness-raising and prevention activities.
The project for the promotion of community health benefits populations in Nyamurenza, Marangara et Tangara (about 150 000 people). It is run in partnership with the provincial Health bureau (Ministry of Health) and communal authorities.
Handicap International is the only organisation in Burundi to produce technical walking aids and to provide rehabilitation services to disabled people. These services have already improved the lives of 10,000 people.
The beneficiaries of the other projects are disabled people who will receive an orthopaedic appliance, appropriate retraining, guidance or technical assistance. The indirect beneficiaries are appliance technicians, physiotherapists and their assistants, trainers and community agents and personnel at health centres.