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Niger’s Child Survival Success: Contributing Factors to Health System Resilience and Challenges to Sustainability

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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.

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