Health System Reforms in Niger

Health System Reforms in Niger

Interview with Dr. Ranaou Abaché

Secretary General, Ministry of Public Health, Population and Social Affairs of Niger

Government Focal Point, Global Financing Facility

Dr. Abaché Ranaou, Secretary General of the Ministry of Public Health, Population and Social Affairs and Government Focal Point for the Global Financing Facility (GFF), holds a master’s degree in Public Health, obtained from the Institute of Tropical Medicine of Antwerp (Belgium) in 2001 after having trained in District level Surgery for 10 years. Dr. Abaché Ranaou occupied a variety of positions in the health sector, including Chief Medical Officer, Ouallam Health District; Coordinator of a District Management Training Center for Management Teams in Central Ouallam (Tilabéri Region) from 1994 to 2007; Technical Assistance Expert in DRC (Democratic Republic of Congo), supporting the implementation of the new support strategy for strengthening the Intermediate and Peripheral level health system from 2007 to 2011; Medical Coordinator, Médécins du Monde Bélgique in Bamako, from 2011 to 2012; Director of Epidemiological Surveillance and Epidemic Response at the Ministry of Public Health of Niger from 2013 to 2014; Director of Studies and Programs at the Ministry of Public Health of Niger from 2015 to 2016; Executive Assistant to the Director General of the West African Health Organization of ECOWAS (WAHO) in Bobodiuoulasso, Burkina Faso, from 2016 to 2017; and Secretary General of the Ministry of Public Health of Niger from March 2017 to date.

Overview of Health System Reforms in Niger

The health system in Niger is steered by the Ministry of Public Health, Population and Social Affairs (MPH/P/SA), through a National Health Policy (2016-2035 NHP) that aims to provide universal access to quality health care and services to the entire population.

Maternal and child health is the common thread running through this National Health Policy since maternal and child health services cover a large part of the services that could potentially reduce mortality and morbidity. Within this framework, the monitoring and evaluation indicators of the 2016-2035 NHP primarily include indicators related to maternal and child health (e.g., deliveries, neonatal care, family planning, etc.). It is important to note that other indicators related to disease control, particularly communicable and epidemic diseases, are also used.

In order to move toward Universal Health Coverage, the 2016-2035 NHP is implemented through a Health Development Plan (2017-2021 HDP) that prioritizes a number of interrelated reforms. Among these, the most noteworthy include reform of:

• The Health Management Information System, in order to address the need to base decisions on evidence. This reform is based on the roll-out and use of the DHIS2 platform, which allows for the management of virtually all health information, including information related to funding and human resources. At the same time, Niger is also in the midst of a digitization process, in order to better reach people living in remote areas. This process, which is interlinked with the DHIS2, aims to facilitate the use of telemedicine, the networking of various health institutions, and the digitization of patient records.
• A drug procurement and supply system, to ensure the continuous availability of sufficient quantities of good quality drugs to the last mile. This also includes the other inputs involved in patient care at the level of the Integrated Health Centers (IHC). This reform involves the development and introduction of a central logistics information management tool (SIGL).
• A community health system, to significantly expand access to health care services. This reform is based on the mobilization and gradual integration of community-based actors within the health system. This is part of a dynamic to support the improvement of population health in hard-to-reach areas.
• A health insurance system at the national and departmental levels to increase access to quality services at lower costs, particularly through free health care. This reform is supported by a National Institute of Medical Assistance (INAM), established, and mandated by decree to professionalize the management of free health care and to contribute to safeguarding against the financial risk associated with illness.

These reforms also support the national strategy on reproductive, maternal, neonatal, child, and adolescent health (RMNCAH).  Although its development process has been delayed by the COVID-19 pandemic, an investment case is in the process of completion, and it is intended to serve as a resource mobilization tool for RMNCAH in Niger. The document will soon be submitted for technical and political approval.

Decision-making in the Health Sector in Niger

Niger’s national health policy is a living document. During its development, a situational analysis was conducted through workshops, to identify the specific needs and priorities of the local, departmental, regional, and national levels. This participatory process also allows the National Health Development Plan to be broken down into interdependent annual action plans, in a bottom-up approach. Health planning begins at the village and Integrated Health Center levels. It is then consolidated at the departmental and regional levels, to be budgeted and approved at the national level. Its approval is both technical and political.

The participatory nature of the situational analysis and operational planning ensures stakeholder engagement during the implementation process.

Technical and Financial Partners

Technical and financial partners are an integral part of the situational analysis and planning process. Nevertheless, the predictability of partner funding remains a major challenge, with significant implications as far as planning is concerned. At times, funding is less than the projected amount and the failure to meet financial commitments sometimes leads to the implementation of unplanned interventions.  In some cases, despite the mapping of resources, partners want to maintain “their flag” and focus on a particular aspect.

To mitigate this, Niger has set up a pooled fund (Pooled funding for Health) to provide general funding to the health system and ensure better coordination of financing. Few partners (i.e., six) have joined this fund, and interventions continue to overlap, with little synergy.

Key Advice for Other Countries

It is necessary to obtain a consensus around the issue of health care. All partners need to be involved in the assessment of the health care system. This process needs to be appropriate from the outset so that partners can not only understand the barriers and needs, but also the interventions that need to be put in place and the financing required. Involving them “along the way” can hinder the process, including the questioning of decisions previously made.