From the mid-1980s onwards, a wave of decentralization reforms swept across the developing world. A wide range of governments embarked on state reform processes aimed at transferring responsibilities, resources and authority from higher to lower levels of government. The Government of Burundi also embarked on a series of decentralization reforms. One of these reforms has been the decentralization of the health sector system. As important as decentralization reform is, it still lacks a clear understanding of its definition and different forms. Thus, the type of unit with which authority is shared or to which it is transferred in the decentralization process is critical for understanding the implications for good governance. The paper endeavored then to cover the different nuances of decentralization in relation to the Burundian health sector and tried to seek for the kind of decentralization forms this sector is using. Using an extensive desk review research on Burundian decentralization policy framework in general and the health decentralization policy framework in particular, the paper tried to identify the type and degree of Burundian health care decentralization. Based on the Rondinelli typology, the paper found out that although a mix of different forms of decentralization was used at different level of the Health Care System because of all the reforms endeavored in that sector (for instance the Performance-Based Financing), the Burundian Health Care is a de-concentrated system and this implies that administrative responsibilities are transferred to locally based office/s of the central Ministry in charge of Public Health, within the health system, without no real autonomy (neither political nor financial). The main policy implication of the paper is that Decentralization is not an end-to-end process, but rather a learning and re-adjustment process. A mix of decentralization and recentralization strategies and the balance between those strategies can definitely improve the Burundian health care delivery.

Keywords: Health care decentralization, Decentralization typology, Health care system, Burundi.