Vaccination has made an astounding improvement in Burundian public health, even in the midst of civil war. The question is how Burundi vaccinated so many in the midst of so much instability. Below is a graph of disease incidence, indexed so that the number of cases in 1980 is set equal to 100.
There is some sad information in the data: most of the improvement occurs before the outbreak of civil war in 1993. (The Buyoya regime killed its opponents with impunity, but the state still functioned. Mostly.) Then there are disease outbreaks until 1997, which happens to be around the time the fighting started to trail off, right before the '98 peace agreement. After that, disease resumes its downward trend, save for an outbreak of measles in 2000.
Burundi has not been peaceful since 1998, but nor has it been the scene of full-fledged civil war. The state functioned. In 2002, the vaccination program went into high gear, with many rebels even agreeing to respect the “Days of Tranquility,” during which the government set up 990 different vaccination sites around the country. Here is a brief discussion of the logistics of vaccination campaigns in Africa. Things were slightly easier in Burundi, where 77 percent of the population had access to health services in 2002 and foreign aid workers operated relatively freely.
None of this is to minimize the accomplishments of the Burundian public officials who travelled off into the hinterlands to vaccinate the population. It is simply to say that Burundi is not the worst of the worst in Africa, and the civil war was a terrible setback in a place where public health had been improving. Backsliding is still a real worry. Chronology here.
Doug, I would very much like to know more about the role of foreign officials in managing Burundian affairs. There are countries (like Liberia and Afghanistan) where you can't turn around without encountering a foreign manager or a foreign agency carrying out state functions. That happens even in Angola and Mozambique. Elsewhere, foreigners are advisers, facilitators, and funders, but not managers. What's the situation in Burundi?