This OZY original series takes you to the doorstep of Developing World Lessons: stories of pathbreaking successes in education and health, technology and environmental protection, from Africa, South America and Asia, that are reshaping those societies and that the West too can learn from.
When then U.N. Secretary-General Kofi Annan visited Niger in July 2005, it was a desperate bid to draw the world’s attention to a deepening crisis. Droughts and locusts had sparked a food shortage threatening 2.4 million Nigeriens, including 800,000 children. Now, 13 years later, Niger is commanding the attention of public health experts again — this time as a beacon of success in saving children against all odds.
As recently as 1996, the landlocked West African nation had the continent’s highest under-5 mortality rate (U5MR) — 266 out of every 1,000 children. Since then, it has battled political instability, food crises like the one in 2005, and terrorism. And yet:
Niger now saves 175 more children out of every 1,000 than it did in 1996 — more additional lives saved than in any other African nation during this period.
Niger remains among the poorest countries in the world — only Malawi and Burundi have lower per capita incomes, according to the World Bank. Nevertheless, it has slashed the mortality rate for children under age 5 by two-thirds since 1996. It still faces a stiff challenge in cutting child mortality rates even further, but none of that takes away from its child-saving success over the past 20 years. “Niger’s achievements are absolutely remarkable, yet it’s a story that gets little attention,” says Shawn Baker, who as head of the nutrition team at the Bill and Melinda Gates Foundation has worked on Niger’s public health sector for years. “That’s a pity, because there’s so much others could learn from this country.”
Behind Niger’s achievements, say experts and researchers, is political resolve that extends across regimes. In 1996, President Mahamane Ousmane, Niger’s first democratically elected head of state, was ousted in a coup led by army officer Ibrahim Baré Maïnassara, who ruled until he was killed in another coup, in 1999. Despite the chaos triggered by the 1996 insurrection, the following year Niger became one of the first African nations to introduce vitamin A supplements into its national immunization program.
They couldn’t piggyback on the polio program, but that didn’t stop Niger.
Shawn Baker, head of nutrition, Bill and Melinda Gates Foundation
This was particularly challenging because the polio immunization drive that was the vehicle for delivering the supplements was held only once a year. But children under age 5 need the supplement twice a year for it to be effective. “They couldn’t piggyback on the polio program, but that didn’t stop Niger,” recalls Baker, who at the time was with Helen Keller International and involved with the vitamin A project. Niger went ahead with a separate immunization program independent of the polio one to meet this vitamin A need.
That initiative set a template Niger has largely followed since. In 2000, it introduced insecticide-treated bed nets to reduce deaths from malaria. By 2011, Niger was showing the results of successfully incorporating zinc into its public health programs as a treatment for diarrhea.
In 2012, researcher Agbessi Amouzou of the Johns Hopkins Bloomberg School of Public Health led an international team that found in 2009 alone Niger saved some 59,000 at-risk children under age 5. When the researchers studied the period from 1998 to 2009, they noted the combination of insecticide-treated bed nets, vitamin A supplements, zinc, improved nutrition and immunization were responsible for these gains. “Coverage increased greatly for most child survival interventions in this period,” they wrote in The Lancet medical journal.
Amid sharpening political divides globally, maligning and undoing the work of predecessors is a growing tendency in countries ranging from the U.S. to India. Yet, through upheaval after upheaval, Niger’s regimes — whether benign dictatorships, military despots or democratic governments — have stood by and strengthened policies to cut child mortality. “This has been the one common thread, and that’s why Niger has gotten as far as it has,” says Baker.
Niger isn’t out of the woods. It’s U5MR of 91 is still more than twice the global rate of child deaths, at 41. As security threats mount, so will the temptation to divert funds from health care to defense, says a concerned Baker. Fears about terrorist attacks — such as the one in October 2017 in which five Nigerien and four American soldiers were killed — could also keep international partners away. And research in 2015 by specialists at the Bloomberg School of Public Health found that improving socioeconomic indicators of the poor and women’s education remain vital for Niger to reduce its child death rate further.
Still, it achieved its Millennium Development Goal of slashing the 1990 U5MR by two-thirds in 2012, three years before the 2015 deadline. Neighboring Nigeria, Africa’s largest economy, hasn’t matched Niger’s success. Its 2016 U5MR was 104. As Nigeria debates a law that nongovernmental organizations say will cripple their work, it could look to its poorer neighbor instead.
Niger’s government has remained open to global research, partnerships with international agencies, donor organizations and nonprofits, while crucially ensuring that it stays in charge of child health programs and gives them direction, says Baker. “Niger has hit the balance well,” he says. And it’s showing.
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