Niger has made remarkable progress in cutting under-five mortality over the past decade, and it looks set to meet the Millennium Development Goal (MDG) on reducing child mortality rates by two-thirds by 2015. But high maternal mortality, skyrocketing population growth and low government capacity are still impeding progress, say partners and health practitioners.
Child and infant mortality figures have dropped year-on-year for the past decade. The infant mortality rate - deaths among children under age one per 1,000 live births - dropped from 133 in 1992 to 66 in 2011, according to the latest figures from the UN Children’s Fund (UNICEF).
“This is an exceptional performance. If we compare this to others - like Burkina Faso, Mali, Nigeria - Niger has done much better,” said Isselmou Boukhary, the UNICEF deputy head in Niger.
Part of this progress can be attributed to a government push, since 2006, to provide free healthcare to children under age five. Particular focus was placed on addressing the biggest child killers (malaria, diarrhoea and respiratory diseases), giving women free pre- and post-natal consultations and Caesarean sections, and extending healthcare coverage in rural areas, with some 1,000 rural clinics set up in 2013.
The strategy has also involved efforts to reach at least 88 percent of children with vaccination campaigns targeting measles and other childhood diseases, and to distribute insecticide-treated mosquito nets to families.
Since the 1990s, major partners, including the European Commission’s humanitarian aid department (ECHO), the Office of US Foreign Disaster Assistance (OFDA), the UK Department for International Development (DFID) and UNICEF, have increased their funding to infant health by 77 percent, according to the study Niger: A Countdown to 2015.
UNICEF channelled US$25 million on fighting child mortality in Niger in 2013, said Boukhary.
But while Niger is expected to meet the MDG for child mortality, many challenges remain, he said, notably in women’s health.
Healthcare fails to keep pace
Some 590 women per 100,000 live births die of pregnancy-related causes, and just 18 percent of births are accompanied by a skilled attendant, according to UNICEF's 2013 State of the World's Children report. “Without bringing this figure down, we won’t make enough of a dent on child mortality,” Boukhary told IRIN.
On average Nigerien women each have seven children according to government statistics. Government health structures are unable to keep up with population growth, which, at 3.4 percent according to UNICEF, is one of the world’s highest.
The government built 1,000 new health clinics in rural areas in 2013, but that has failed to keep up with needs, said Oumarou Maigari, head of the doctors’, dentists’ and pharmacists’ union (SYMPHAMED).
Further, while the elimination of healthcare user fees has had a huge impact on infant mortality rates, the system is facing problems, with many clinics in arrears as the state fails to reimburse their costs on time. According to Maigari, health centres are in arrears of $50 million.
After user fees were eradicated for children under age five, health clinics provided drugs and care and then billed the state and awaited reimbursement, either in the form of money or medicines. But inefficient supply chain management creates payment lags. Many of the medicines are subsidized or provided directly by partners such as UNICEF, but even their efforts cannot fill the gap, said Maigari. “The state must re-stock indebted health clinics,” he told IRIN.
The government reallocated $18 million to children’s health in 2014.
According to Issoufi Harouna, the head of the regional hospital in the capital, Niamey, each day the hospital registers about 50 sick children and performs around a dozen C-sections.
Before, the hospital would have charged $45 to register a child, and a Caesarean section would have cost $167. Now, they charge nothing, but they do not recoup this money as quickly as they need to, said doctors.
To further reduce infant mortality, on top of addressing maternal mortality and improving health clinic performance, infant malnutrition prevention must be improved, said Boukhary. Over one million Nigerien children will be malnourished in 2014, predicts the UN Office for the Coordination of Humanitarian Affairs.
Malnutrition prevention efforts are being stepped up by the World Food Programme and others, but effectively preventing malnutrition involves not just eradicating healthcare user fees but also integrating disease prevention into nutrition monitoring and water treatment. Such integrated programmes are only being trialled on a small scale.
Still, with donors shifting their focus from treatment to prevention, malnutrition prevention progammes might soon see a boost.
And the government is finally starting to face up to problems associated with high population growth. It will soon hold a meeting to discuss the issue with UNICEF and the UN Population Fund (UNFPA). “This was a taboo subject before, but there are more and more discussions about this,” Boukhary told IRIN.