Reducing Health Care Inequality: Adequate primary care for rural communities in Niger

‘In Niger many women bleed to death during or after giving birth because they cannot reach the health services. That is why the Belgium development agency partnered with the government of Niger to ensure that health services can reach mothers and children where they live.‘


It is nine in the morning and the sun is high up in the sky above Boulkagou, a village some 120 kilometres from Niamey. At the health centre a group of forty women is waiting for the midwife to arrive. Things have changed in Boulkagou. Until four months ago these women had to go to Gothèye, some 35 kilometres away, to obtain care from mobile health agents who travel on motorbikes in this desert region and they had to purchase medication on the streets.

With the re-opening of the health centre, which had been in poor shape for many years, they now can access quality health care. The building has been completely redone and the working conditions have much improved. Better still, in addition of the rehabilitation, this village health centre has been equipped and benefits of a motorbike. ‘We did not even have a consultation table or bed to give birth. We lacked prenatal or baby consultation equipment. Now, the Belgian development agency has provided us with all of this,’ witnesses Issaka Tahirou, a nurse at the health centre.

In addition to the equipment, the small pharmacy of the health centre obtained essential pharmaceuticals. Thanks to the new working conditions, more people come to the health centre. ‘This past quarter, we registered no less than 4,004 consultations,’ confirms Issaka. ‘This figure shows how relevant such an initiative is.‘


Equipped health centres are indeed much needed in areas like Boulkagou. In the layered health system of Niger, health centres constitute the basic structure providing village communities with primary health care. They function as dispensaries and ensure primary health care with a minimum of equipment: curative consultations, vaccination and family planning, pre-natal consultation and delivery.

Fifteen rehabilitated entities, supported and equipped by the Belgian development agency under the support project for strengthening the health system in Niger (PARSS), considerably improve access to quality health care for the more than 90,000 inhabitants of the Maradi, Zinder and Tillabéri regions, in particular in terms of maternal and infant health.


‘Giving birth in Niger often implies much suffering. Having lost eight children, I suffered a lot in the past. When I gave birth to my twins, I came here. Without the intervention of the doctor, I would not have survived. Without this health centre, I would have had to go 45 kilometres down the road to get the care that I needed. Even if I had borrowed my neighbour’s cart, such a trip would have been hard. Now, at least, we have everything right here and health care is of good quality,' says Mariama (35), while waiting in line for postnatal care.

‘Boulkagou is in a very poor region,’ explains Issaka, ‘and poverty impacts maternal health very much. Many women experience reproductive difficulties. We notice there are many obstetrical emergencies, because the women live so far away, and, in case of emergency, bringing them here is a challenge.‘


‘In Niger, like in many other countries in Africa, women are responsible for their family. They take care of the children, feed the family and ensure the family is healthy,’ confirms Dr Soumana Adamou Hamma, the head of the PARSS project.

‘Most people in Niger live in rural areas where we lack adequate health infrastructure and consequently women must cover large distances to access health services. And that is even worse when they are pregnant. Too often they give birth at home, attended only by a midwife, a mother-in-law or a neighbour. So, in case of complications, they do not know what to do and the mother risks dying,’ he adds. ‘We focus on regular consultation and especially on care for pregnant women and children under age five.‘

The primary cause of maternal mortality in Niger is haemorrhage. ‘Niger has the highest fertility rate in the world (seven children per woman on average). Obviously, often complications occur. Women bleed to death during or after giving birth because they cannot reach the health services. Yet, giving birth at a medical centre is fundamental to mother and infant health,’ says Dr Hama.  ‘That is why we have partnered with the government of Niger to ensure that the health services can reach mothers and children where they live.‘.


The support project for strengthening the health system in Niger (PARSS) of the Belgian development cooperation assists Niger’s health entities with investments in infrastructure and equipment. Four district hospitals are built, fifteen health centres are transformed and mobile consultations are organised to reach populations in remote regions.