Maternal, new-born and child health situation in Niger

A vast country located in the Sahel region, Niger is among the developing countries, ranking 189^th on the Human Development Index.[1]^,[2]  For over 20 years, Niger has sought to improve maternal, new-born and child health (MNCH) through national development plans. In the framework of the Millennium Development Goals (MDGs), Niger made substantial progress on Goal 4 by reducing child mortality from 123 per 1000 in 1992 to 52 per 1000 in 2015. [3]  

Nevertheless, considerable efforts are still needed. In 2015, while the MDG 5 aimed to reach 175 maternal deaths per 100 000 live-births in Niger, the country recorded 555 of these.[4] The neonatal mortality rate in 2015 was 27 per 1000 live-births. [5],[6] These indicators constitute major challenges for the health system. These challenges are compounded by the unequal distribution of health services in the country, a non-existent functional referral and counter-referral system (including emergency obstetric and neonatal care), insufficient quantity and quality of health human resources (in particular midwives and obstetricians), inadequate distribution of personnel, and insufficient equipment, health structures and training institutions. Niger also faces a shortage of trained personnel in MNCH specifically, including community outreach workers, socio-cultural barriers with respect to family planning services uptake, as well as an inadequate and uncoordinated health care supervision framework across levels of the health system. As a health priority, MNCH represents a strategic opportunity to strengthen Niger’s public health system.

WHO support to improve maternal and new-born health

Thanks to the mobilization of funds from the Islamic Development Bank (IDB) and the French Muskoka Fund, WHO, in collaboration with other agencies such as UNICEF, UNFPA, UN Women, and the World Bank, is supporting Niger's efforts to improve maternal and child health, thereby contributing to the first pillar of the WHO's Thirteenth Programme of Work (GPW 13) “1 billion more people with universal health coverage”. 

WHO has implemented a comprehensive approach to strengthening the health system and improving maternal, new-born, and child health services by supporting the mobilization of communities to provide health services, building the capacity of health facilities and pre-, in-, and post-service health workers, ensuring adolescents' access to sexual and reproductive health and rights, improving nutrition, and promoting women's empowerment through the implementation of high-impact, intersectoral interventions. Through these efforts, Niger has seen a reduction in maternal mortality in recent years (509 deaths per 100 000 live-births in 2017),[7]  neonatal mortality (24 per 1 000 live-births in 2019), infant mortality (47 per 1 000 live-births in 2019), and under-five mortality (80 per 1,000 live-births in 2019 compared to 94 per 1 000 live-births in 2015)[8].

In order to continue to improve maternal and new-born health services, strengthen monitoring of progress and identify strategies/actions to prevent maternal and new-born deaths, in 2020 WHO supported the revision and provision of tools (partographs, pre- and post-natal consultation cards, as well as maternal and child health diaries) for data collection and monitoring of maternal and new-born health. In additions, WHO built staff capacity by training 86 providers on quality maternal and neonatal care, resulting in improved and patient-centred health care in three regions (those with the lowest levels of service and the highest maternal and neonatal mortality rates). WHO also contributed to improving the quality of care for nearly 5 000 pregnant women requiring caesarean sections and 5 910 new-borns by equipping the Issaka Gazoby Maternity Hospital, a third-level referral maternity hospital in the capital, with four multi-parameter dynamaps, two mobile ultrasound scanners, a mobile labour monitor, two neonatal resuscitation tables, an electric hoover, two paediatric hoovers and two oxygen concentrators.

WHO has also strengthened high-impact interventions including the introduction of the community-based maternal and new-born care strategy and the integration of essential new-born and maternal care in 23 public and private health schools in Niger. Similarly, in order to ensure a comprehensive continuation of sexual and reproductive health for young people by adopting a life course approach, WHO has helped to introduce reproductive health education for adolescents into secondary school curricula in Niger, thereby reducing unwanted pregnancies in schools and contributing to the control of sexually transmitted infections. In addition, WHO supported the mapping of youth and adolescent sexual and reproductive health stakeholders, which led to the development of a roadmap for improving the quality of educational content and delivery of intensive school-based sexuality education.

Opportunities for maternal, new-born and child health post-COVID-19

In 2020, while the COVID-19 pandemic slowed progress on these activities due to movement restrictions, WHO continued discussions and worked virtually with central and regional levels and other partners to provide guidance and other necessary support. WHO took advantage of the slowdown in the implementation of planned activities to produce documents and to prepare for the mobilization of resources allocated at regional and district levels in order to move forward quickly once the restrictions were lifted.

In addition, in order to contribute to the continuity of essential health services in health facilities during the pandemic, WHO supported the training and raising awareness of health workers on infection prevention and control in health facilities, the redefinition of the patient circuit in these health facilities, as well as the provision of protective equipment (gowns, gloves, masks, etc.) and hand-washing materials.

In recent years, WHO has been able to contribute significantly to the improvement of maternal and new-born health in Niger by maximizing exchanges and communications with the government and various partners to advance the maternal health agenda. The engagement of maternal and child health actors has also helped to address the socio-cultural challenges before and during the pandemic. While the majority of women usually tend to use health care only when they get sick instead of attending preventively, the COVID-19 pandemic has raised awareness among the Nigerien population about the importance of accessing health care regularly. Despite the risk of COVID-19, health workers did not stop working and services did not close in 2020. This has strengthened trust and links with communities and represents a strategic opportunity to continue to improve maternal, new-born and child health and to move towards universal health coverage in Niger.

Photo caption: Curative consultation at CSI Yantala.

Photo credit: WHO Niger

Disclaimer: This image was taken during a time of no community transmission of COVID-19. Community transmission is defined as the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories). Preventative measures such as mask wearing and physical distancing should be used to prevent the spread of COVID-19.