Their success now hinges on maintaining the momentum they’ve built in the region, and in bolstering those countries where progress has been slow, including Niger.
As of mid-2018, Niger had reached about 77% of its objective (182,000 new users of modern contraceptives by 2020). But among the partnership countries, its rate of increase in modern contraceptive prevalence is among the slowest.
When I visited this vast West African country during the Ouagadougou Partnership donor caravan in April, I saw a vibrant youth movement. There was also stronger political engagement than we witnessed during the last caravan visit in 2017.
One of the partnership’s strategies is to encourage learning and exchange opportunities—and healthy competition—among the nine countries. And it’s increasing engagement at the highest levels. In Niger, key ministers and the President himself are getting involved and could help Niger meet its ambitious objectives. But first, the country must overcome five key family planning challenges.
1. Service integration
Health service integration, or the practice of intentionally linking multiple health services, makes the best use of resources and increases access to critical care for women and girls. But despite integration’s strong evidence base and its designation as a promising high impact practice, we heard from country officials and implementers that integration is not effective at a national scale in Niger.
A young mother who comes to a health facility for immunizations or nutrition counseling for her child may not have the time or opportunity to make a second visit for family planning. Physical, economic, and sociocultural barriers threaten Nigerien women’s and girls’ access to family planning services, so every opportunity to meet their needs must be treated as critical.
Niger needs health systems and policies that recognize the often-limited opportunities women and girls have to seek health services. The country could capitalize on the intrinsic link between healthy mothers and healthy babies by integrating these health services.
INSPiRE, led by IntraHealth International, is introducing a novel integration model and integration indicators in Niger, Cote d’Ivoire, and Burkina Faso to better track and understand the impact of this approach. A regional integration hub will also provide technical assistance and advice to governments, local organizations, and implementing partners across the nine Ouagadougou Partnership countries.
2. Domestic funding
Niger’s decision-makers at the highest level—including the President, First Lady, Prime Minister, and Minister of Health—made time to meet with the members of the donor caravan. This clear political will and engagement will be critical on Niger’s challenging road ahead.
Historically, a budget line for family planning commodities has existed in the national budget, but only a small percentage of these critical resources are made available to the health workers who need them to stock their facilities.
In response, the Ouagadougou Partnership Coordination Unit (OPCU) is working to increase national-level coordination, particularly by engaging multisectoral, nontraditional health actors—such as ministries of finance, planning, and education—in family planning. And IntraHealth’s Civil Society for Family Planning platform is working with local coalitions of civil society organizations to monitor countries’ progress toward family planning objectives and advocate for the funding to achieve them.
3. Trained health workers
Most health workers in Niger are contract employees, and most are concentrated in the capital city of Niamey. Many do not receive regular and comprehensive training and supervision in family planning.The government and implementing partners must work together to ensure training and capacity-building programs cover the country uniformly and address health workers at all levels. Through city-led projects, the Challenge Initiative is working to do this by scaling up high-impact family planning interventions by engaging facility-based and community health workers in cities.
4. Contraceptive supply chain
Even if health workers are equipped with the knowledge and skills they need to care for the Nigerien population, they can’t provide critical family planning services if their shelves are empty of contraceptives.
During the caravan visit, we heard from government and donor stakeholders about the logistical and resource-related challenges Niger faces in tracking and distributing contraceptives to the last mile. Lack of a fully functioning commodity-tracking system has resulted in a surplus of family planning commodities in urban areas—where only a fifth of the population lives—but a high stock-out rate at the community level.
To meet this challenge, Niger must mobilize domestic resources while seeking new sources of support to rebuild and modernize its supply chain. In Senegal, the Informed Push Model helped to reduce stock-out levels to below 2%, and could see similar success if implemented in Niger.
5. The security situation
Niger shares its borders with politically unstable neighbors, including Burkina Faso and Mali. Over the past decade, the trickle of terrorism and violence across these borders has grown, and as a result, so has the Nigerien national defense budget.
As security concerns and political instability become the norm, these factors must not overshadow the critical role family planning plays in ensuring Niger’s stability and development. Over time, increasing its population’s access to family planning services will enable Niger to reap the benefits of healthier women and girls, greater gender equality, and the economic growth that comes with the demographic dividend.
In Niger’s capital and across the Ouagadougou Partnership countries, the Challenge Initiative is working with mayors and local officials to build a culture of local engagement and investment in family planning as a means to economic growth and stability.
In the countdown to the end of the partnership’s acceleration phase, all eyes will be on these nine countries, particularly those whose targets remain unmet. Niger faces a challenging road ahead but benefits from strong and committed leaders who understand the critical role family planning plays in their country’s development.
In the year ahead, Niger and its partners must align their interventions, resources, and priorities to mitigate these five challenges and increase the population’s access to family planning services. The futures of millions of Nigeriens are on the line.
IntraHealth International hosts the Ouagadougou Partnership Coordination Unit, funded by the Bill & Melinda Gates Foundation and the William and Flora Hewlett Foundation. IntraHealth also leads the Challenge Initiative in West Africa, which is funded by the Bill & Melinda Gates Foundation, the Strengthening Civil Society for Family Planning in West Africa Project, which is funded by the William and Flora Hewlett Foundation and the Dutch Embassy, and the INSPiRE initiative, which is funded by the Bill & Melinda Gates Foundation.
Published on 07-10-2019 in intrahealth