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Niger's Child Survival Success: Contributing factors to health system resilience and challenges to sustainability
Niger is challenged with persistently high fertility rates,
regional political upheaval and a resulting massive influx
of refugees, persisting food insecurity, unpredictable GDP
growth and significant dependence on donor support in the
health sector. The reduction in the under-5 mortality rate in
the last 10 years has contrasted with limited improvement in
the country’s economic and social conditions. Much effort
over the past decade has prioritized increasing coverage
and access to quality health care for pregnant mothers and
children. We undertook a broad analytical assessment of
Niger’s mortality declines, interrogating the potential for
sustaining the gains achieved.
We recalculated health coverage indicators and documented
child survival policies and programmes through analysis of
DHS surveys and a document review. The Lives Saved Tool
(LiST) was used to estimate child lives saved and to identify
which interventions had the largest impact on deaths averted.
We developed estimates of child mortality using the 2012
demographic household survey.
The expansion of health care access to the community
through construction of health posts in 2001, removal of
user-fees since 2006, training and deployment of CHWs since
2008 and creation of a cadre of relais (village volunteers)
have impacted positively on health system responsiveness
and resilience. Improvements in access to maternal and
child health interventions between 2006 and 2012 include
increases in the number of women using ANC and receiving
Fansidar and tetanus toxoid during pregnancy, children
receiving measles and dpt3 vaccinations, early and exclusive
breastfeeding, ORS coverage and an increase in the
proportion of children sleeping under a bed net. Decreases
in stunting and wasting, Hib vaccine and ORS made the
greatest contributions to under-5 lives saved (figure 2).
Care seeking at the community level was responsible for
an estimated 7,800 additional deaths averted in 2012.
Despite the immense gains in health access and mortality
declines, the sustainability of the free health care policy
and service provision is threatened. Niger’s population is
expected to nearly quadruple from 19 million in 2015 to
69 million by 2050, pressurizing the government to expand
services in the face of cyclical droughts, unpredictable GDP
growth and public funds being diverted towards security.
Continued strengthening of the community based platform
will be critical in building a resilient health system in Niger by
raising community awareness and participation, filling critical
human resource gaps, monitoring of population health,
provision of nutritional services including iron and food
supplementation, water and sanitation, early identification
of acutely malnourished children and referral, and diagnosis
and treatment of childhood conditions.