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Niger: Niger Health Profile



The health sector has been strongly influenced by the deteriorating state of the economy that has prevailed in Niger up until 2000. This economic deterioration caused a decline in the sanitary conditions amongst the population, and further was responsible for a fall in the funds available for health infrastructure. There began to be a short fall in the number of medicines available in the community clinics, whilst the hospitals had almost lost all of their capacity to administer quality treatment.

It must be said that underlying demographical forces, in a context marked by an insufficient number of medical personnel and financial resources, affect the health sector in Niger. For example, in 2000 Niger only had 226 doctors, 1 128 registered nurses, 334 midwives, 13 pharmacists and 13 dental surgeons, or in other words less medical personnel than is recommended by the World Health Organisation. They recommend a ratio of 1 doctor for every 10 000 inhabitants, and 1 nurse for every 5 000.

The combating measures recommended by the government not only targets the revitalisation of health establishments, but is also trying to ensure an even spread of medical cover throughout the entire country.

This will be done by restoring the creditability of health establishments by giving them the necessary means (medicines and the necessary equipment), but to also improve the ease of access to medical treatment, by increasing the number of medical centres in every region of the country.

To realise these objectives, existing health departments have had to be restructured. The minister entrusted with this task will be empowered with new ways of breaking down each sector. This includes one state secretary, who would be responsible for the fight against epidemic illnesses and hospital reforms. This is an initiative that has started to prove effective, and has subsequently shown results across the country’s hospitals, all of which is due to the successes of business reforms.
Indeed, the National Hospital of Niamey and the Lamordé Hospital are great references for this project, today being exemplary hospitals with a more welcoming atmosphere, better organised services and medical teams that now dispose of ultra modern equipment. As for primary health care, actions have been put in place in order to bring medical centres closer to the rural population. This is done to avoid the death of the rural population of the people of Niger, which would be due to a lack of initial on-site treatments in the event of an evacuation to the hospital.
One hundred new ambulances purchased throughout 2003 with government funding now take care of evacuations.

With 3 regional warehouses and 48 public pharmacies, the Nigerien National Office of Pharmaceutical and Chemical Products (NOPCP) ensures an optimal coverage of pharmaceutical products across the entire country.

Moreover it is within this framework that a special program initiated by the country’s president has been organised to build further health centres. This initiative has allowed the construction of 2 000 health centres in rural Niger. And to ensure the correct running of these centres, 800 community health officers have been trained and sent out to each region. These efforts have meant that the country’s health coverage has increased from 47.6%25 in 2000, to 65%25 in 2003. With the deregulation of the health sector, there are now many private clinics and pharmacies in every city in Niger. These structural improvements have lead to a notable increase in the health of the population.

The development of the national production of pharmaceutical products, and above all, the need to control imports, has meant that the public authorities have created the National Laboratory of Public Health and Expert Appraisal (NLPHEA).

The health policies in place in Niger also include the fight against AIDS, the fight against malaria and other infectious diseases amongst its priorities. Also, a significant effort has been made in vaccinations with the objective to reach and vaccinate a maximum number of the nation’s children in mind. Along with this, the nation’s President, Mamadou Tandja, has made a national, personal commitment during the national vaccination campaign, against poliomyelitis, for which he received the “Champion in the eradication of Polio” prize, presented to him by Rotary International.

Niger’s economy has undergone structural adjustment since 1982. In 2000, the country was eligible for the Heavily Indebted Poor Countries (HIPC) Initiative and in 2002 it adopted the Poverty Reduction Strategy now under review after three years of implementation. In 2004, the outstanding debt amounted to about CFA Francs 1093.2 billion. Niger’s multilateral debt was cancelled in 2005. Weak growth is a major feature of the economy; in 2000-2003, growth accelerated at an average annual rate of 4.2% but its recession in 2004 caused a -0.6 point decline, that is, 3.2% in 2004 against 3.8% in 2003. The health system performance is poor: limited and unequally distributed human resources; structural adjustment impeding recruitment; population/health facilities ratios varying between 8950 and 30 680 and dysfunctional referral and counter referral systems. Only one third of the population has access to health services, with the vast majority relying on traditional medicine. Under five mortality is high (259 per 1000), and varies significantly between rural and urban settings. The main causes are acute respiratory infections, malaria, diarrhoea, and injuries and burns.d Poliomyelitis and neonatal and maternal tetanus are also major public health concerns.
Maternal mortality rates remain high (1600 per 100 000 live births): only 5% of obstetrical care is covered and access to antenatal is 40%. Malaria is the leading cause of morbidity and mortality with an average of 850 000 cases per year, children under five and pregnant women being most vulnerable. Only 15.3% of patients seek care and two thirds of the severely hospitalized forms of malaria are inadequately managed. Only 11% of pregnant women and 15% of under-five children
use insecticide treated nets (Centers for Disease Control and Prevention (CDC) Survey, February 2006). Low prevalence of HIV/AIDS infection is indicated by the 2002 seroprevalence survey, with 0.87% positivity in the adult (15-49 years old) population, 25.6% among sex workers and 3.6% among the military. The survey also confirms vulnerability of women to HIV, with a seroprevalence rate of 3.8% versus 2% among men in the uneducated segments of the population. There is therefore a significant risk of rapid expansion of the epidemic.Tuberculosis is a major public health problem, with an incidence of 1.5 per 1 000 and an annual infection risk of about 2 to 3%. Effective control is impeded by low rates of screening (58%), cure (57%), high drop-out rates (16%), and erratic supply of drugs and reagents.Diseases with high epidemic potential occur frequently, such as meningococcal meningitis, as well as cholera which threatens about 83% of the population. The first shigellosis epidemic outbreak occurred in 2000 and the number of cases is increasing. Over the past two years, there has been a major decline in the incidence of measles due to improved immunization coverage.
Malnutrition is the main aggravating factor of all these diseases. The nutritional survey carried out by the Government of Niger, UNICEF and CDC at the end of 2005 reveals a 15.3% acute malnutrition rate among Niger’s children aged 6 to 59 months, ranging from 9% in the Niamey region to 28% in the Taoua region. In 2005, public health facilities and nongovernmental organizations (NGOs) reported 274 959 malnutrition cases, of which 73 080 were acute and 201 879 moderate malnutrition cases. The health system is mainly funded through external resources. Between 1994 and 2004, the Government allocated an average 6% of its budget to the health sector while foreign aid accounted for 27.48% of overall health expenditure (around US$ 26 million, i.e. 71% of Government health funding (interim report of the 2004 National Health Accounts, Plan de Développement Sanitaire - PDS 2005-2009). In terms of expenditure per inhabitant, investments remain low at US$ 7.82 in 2004. Several bottlenecks impede community participation, namely, insufficient information and training, poor management transparency and lack of care and provision to the poorest segments of the population. Mutual health organizations are only beginning to develop and private health insurance schemes cover less than 1% of the population.

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