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levels of literacy and education, and the size and landlocked nature of the country, which
obstruct the provision of essential goods and services to the population.
In addition, Niger is confronted with recurrent crises. For many years, the country has suffered
from chronic food insecurity, and faced food and nutrition crises in 2010 and 2012. It also
regularly experiences epidemics, including cholera, as well as floods. Moreover, instability in
the Sahel region has in recent years led to insecurity and population displacement, especially
in the eastern part of the country affected by the armed conflict with Boko Haram and in the
western areas bordering with Mali.
The growth rate in Niger has experienced significant fluctuations in recent years and dropped
from 3.5% in 2015 to 5.2% in 2017. Niger relies strongly on external support provided by
technical and financial partners, such as non-refundable aid, budget support, and loans.
Except for the education sector, budgetary allocations to social sectors remain far below
international recommendations or national commitments. Allocations to the education sector
were 15-20% in recent years, compared with a national commitment to increase the education
budget to at least 25% of the national budget by 2020. However, the share of health in the
national budget was 7% on average between 2010 and 2017, while the World Health
Organization recommends at least 13%.
Niger's health sector
Over the past 20 year, the under-five mortality rate decreased substantially, allowing Niger to
be one of the countries that reached Millennium Development Goal 4 related to the reduction
of under-five mortality. The maternal mortality rate slightly declined and went from 535 per
100,000 live births in 2012 to 520 per 100,000 live births, according to the most recent statics
of 2015. However, many challenges impeded the health sector efforts to maintain
achievements, including the low national health coverage at 48.4%, as well as the fragile
governance and limited leadership of the sector.
A study on the multidimensional deprivation of children in Niger conducted in 2016 indicates
that deprivation in health affects 68% of children under 2 years, of which 76% live in rural
areas. The incidence of the number of multidimensional deprivations is 2.74 times greater in
rural areas than in urban areas in the age group of 2 to 4 years old. Three main challenges
could explain such a situation: i) the rapid growth of the population in link with child marriage
and the high fertility rate (7.6 children per woman), ii) the poverty level: the number of people
in need of humanitarian assistance represents more than 10% of the population in Niger iii)
the weak level of education.
In 2018, the country continued its modernization efforts, with wide-ranging initiatives to
address systemic issues, particularly in the health sector. The reform of the national
procurement and supply management system is moving forward with strategic planning for
strengthening governance, distribution, and storage capacity, with a focus on the "last mile"
(for example, the distribution of medical supplies up to the last sites of health service such as
health huts), which is critical for delivering quality services to the most vulnerable children.
The health information system also kept evolving with the introduction and gradual scale-up
of the District Health Information System platform (DHIS-2). However, in 2018 Niger was still
confronted with data quality issues which pose a challenge to achieving results for children in
Niger, with serious consequences on national policy planning and decision-making. The 2017
Demographic and Health Survey could not be published in 2018 due to severe quality issues,
resulting in the lack of updated baseline data to monitor progress in the implementation of the
country national and international development commitments.
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