Community-Based Health Insurance, Healthcare Utilization, and Financial Protection in Burundi: The Effects of Co-payments and Household Ability to Pay on Progress Toward Universal Health Coverage

Despite global efforts to achieve universal health coverage (UHC), financial barriers remain a major constraint to healthcare access in Burundi. Though Community-Based Health Insurance (CBHI) has been promoted as a mechanism to increase healthcare utilization and strengthen financial protection, longitudinal evidence on its performance in Burundi remains very limited. This study analyzes trends in Community-Based Health Insurance coverage, healthcare utilization, and financial protection indicators in Burundi from 2019 to 2025 using a time-series analytical approach. Drawing on empirical evidence from global health financing research, the study examines temporal changes in insurance participation, healthcare service use, and exposure to financial hardship associated with healthcare costs. Trend analysis and forecasting methods are applied to assess historical patterns and estimate future trajectories. The study provides evidence on the evolving role of CBHIs within Burundi’s health financing landscape and identifies factors influencing their effectiveness, sustainability, and equity. The findings are intended to inform policy strategies for strengthening insurance coverage, improving utilization of the Paquet Minimum d’Activités (PMA), and reducing financial vulnerability among underserved populations, particularly given that patient co-payments are unilaterally determined without adequately considering the ability of CBHI members to pay. The research contributes to broader discussions on sustainable health financing and pathways toward achieving equitable universal health coverage in resource-constrained settings.