92. In order to achieve these objectives, emphasis has been placed on neonatal care, integrated management of childhood illnesses at the health facility level and at the community level, child nutrition (MDG4), as well as emergency obstetric and neonatal care and birth spacing (MDG5). The main policy documents related to health are: - Burundi Vision 2025; - Strategic Framework for Poverty Reduction I & II successively in 2006-2011 and 2012-2016; - National Health Policy 2006-2015; - National Health Development Plan (PNDS) 2006-2010 and 2011-2015; - National Strategy for Reproductive Health 2010-2015; - Multi sectoral Strategic Plan for Food and Nutrition Security 2014-2017. 93. To implement these policies, the Government of Burundi, through the Ministry of Public Health and the Fight against AIDS (MSPLS), has adopted the following strategies: - Care subvention for children under 5 and pregnant women, including free deliveries in health care; - Scaling up of performance-based funding in health facility (health centres and hospitals) from 2011; - Specific health programmes in health facilities derived from the PNDS 2011-2015 such as the management of childhood illnesses (2011-2014) and the management of acute malnutrition (2010); - Different national guidelines or high-impact interventions have been developed and scaled up at national level such as community-based management of childhood illnesses and the introduction of new vaccines. Access to health care 94. The network of health centres and hospitals is well developed in Burundi for the population living less than 5 kilometres from a health facility. 95. Because of the free treatment for pregnant women and children under 5, health centres are often overwhelmed. In addition, significant problems of quality of service occur (reinforcement of the necessary technical capacities, lack of adequate equipments, need to improve the sanitary infrastructures, etc.). This affects the right of access to care, but the Government is making efforts in the fight against maternal and infant mortality. Maternal health 96. In Burundi, the fertility of adolescent girls is high.18 Indeed, one in ten (11%) 15-19 year old girls have already had a child: 7% are already mothers and 3% are pregnant for the first time. Early motherhood is higher among uneducated girls (23%) than girls with secondary education or higher (6%). 97. Nearly all pregnant women received prenatal care from a health provider, but only 29.8% paid the recommended number of visits (at least 4) and only 19.9% made their first antenatal visit to an early stage of pregnancy (in the first trimester of pregnancy).19 In addition, few women receive a full package of quality services during antenatal care (94% weighting, 61% blood test, 55% blood 18 19 EDS 2010 Ditto 25