Advancing the MDGs: Niger’s achievement
Completing the unfinished work of the health-related Millennium Development Goals 2015 will continue to be a leadership priority for WHO for the next six years. These goals cover maternal and child mortality and HIV/AIDS, malaria and other diseases.
One country that has made significant progress in child mortality rates is Niger. Although it is one of the poorest countries in the world, with one of the highest fertility rates – 7.1 children per woman – it has been able to achieve some excellent results in reducing child mortality.
In 1990 Niger had the highest child mortality rate in the world; in 1998 the rate of death in children under five years was 274 per 1000 live births. But by 2012, this number had fallen to 127 per thousand, an average annual rate of decline of 6%, well above the threshold of 4.3% needed to achieve MDG 4, with gains that exceeded those of its neighbours. And this decrease was seen across all income levels, in rural and urban areas, for girls as well as boys.
How was this enviable reduction achieved?
The Government took a decision to make health care free of charge for all children and pregnant women.
First, the country decided to concentrate on primary health care for women and children, through the creation of a national policy on the use of the Integrated Management of Childhood Illness (IMCI), an integrated approach that includes both prevention and treatment of illness, especially in outpatient and home settings.
Paid community health workers were trained jointly by WHO and UNICEF in integrated case management in the community. Further, the government took a decision to make health care free of charge for all children and pregnant women: when user fees were abolished, use of services increased dramatically. Care was provided mainly at community health posts that were constructed in rural and remote areas far from existing health facilities.
Second, mass campaigns were initiated for interventions such as measles vaccination and the distribution of insecticide-treated bed nets against malaria. Finally, nutrition became an area of strong public health emphasis.
These three strategies combined are what made the difference, along with a focus on the regular collection of high-quality data. Those data were then used to guide the revision of programmes and policies, in collaboration with many partners.
The overall result is that Niger is on track to achieve the MDG on child mortality by the 2015 deadline, thanks to political will and leadership, and support from donors, but most of all through a determined strengthening of one country’s capacity to improve the health of its people.