Niger Faces Five Key Family Planning Challenges

By Molly Rosett,
Program Officer, IntraHealth International
President Mahamadou Issoufou shakes hands with Mariama Abdou Gado, president of the Niger youth ambassador network. Photo by EtriLabs.

President Mahamadou Issoufou shakes hands with Mariama Abdou Gado, president of the Niger youth ambassador network. Photo by EtriLabs.

July 10, 2019
The Ouagadougou Partnership is nearing the end of its 2015-2020 acceleration phase. This alliance of nine West African countries set an ambitious goal to reach 2.2 million new women and girls with modern contraceptives during those five years. So far, they’ve reached over 1.8 million.
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.