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Published on 01/12/2021

Conducting a situational analysis of the Expanded Program on Immunization in the Republic of Niger

Askaan Sante along with teams from the Bill and Melinda Gates Foundation (BMGF), Aliko Dangote Foundation (ADF), Solina Health, and McKinsey Consulting visited Niger from October 4-15, 2021. The objectives of this mission were as follows: 

  • Understand the functioning of the Expanded Programme on Immunization in Niger through interviews and visits with all actors involved in the implementation of activities;
  • Understand the current scope of support provided by partners in the field (UNICEF, WHO, GAVI);
  • Determine how best to structure a memorandum of understanding for strengthening routine immunization to achieve maximum impact

During this same period, our teams worked with the government of the Republic of Niger to conduct a situational analysis.

This analysis was in response to the need to identify the specific challenges Niger faces in achieving its immunization goals and to develop tailored solutions that are context-specific and linked to international best practices.

Niger is one of the largest countries in West Africa, with an area of 1.267 million square kilometers, a total population of approximately 23.5 million, and an average annual population growth rate of 3.9 percent (INS 2021). Although the country has made considerable efforts to accelerate its development, many challenges remain in the areas of health, nutrition, hygiene, sanitation, and access to clean water. 

Niger established its Expanded Program on Immunization in January 1987 as a key mechanism to eradicate vaccine-preventable diseases such as polio, measles, yellow fever, tetanus, and hepatitis. The main objectives of this program were to reduce morbidity and mortality from vaccine-preventable diseases among children aged 0-59 months and women of reproductive age 15-49 years through increased use of immunization services, introduction of new vaccines, and integration of other health interventions with immunization. Over the years, the proportion of children receiving the required vaccines has continued to increase with average coverage rates of 94% according to official reports (DVDMT 2020). 

However, the country has yet to meet several of its key immunization targets. Data from the first half of 2021 show that only three of Niger's eight regions have reached the goal of more than 80 percent immunization coverage in all health districts. With regard to vaccine-preventable disease outbreaks, the country has been facing a vaccine-derived poliovirus type 2 (cVDPV2) outbreak since September 2020 with 9 cases imported from Nigeria, Togo, and Côte d'Ivoire. Epidemiological surveillance data for 2020 also show that 35 of the country's 72 health districts have recorded at least one measles outbreak.

To further support the efforts of the Government of Niger and its partners, the Bill & Melinda Gates Foundation (BMGF) has been in discussions with the government to strengthen routine immunization and improve its performance. The first phase of this support was to conduct a diagnostic analysis of Niger's expanded program on immunization to better understand the gaps and identify strategies that can help improve program performance and accelerate the achievement of immunization coverage goals. 

The first step in this process was a literature review of key reports and official documents on Niger's immunization system and the health sector in general. The information from this review informed the discussions and data collection during the visit to Niger.

Meetings with various stakeholders in the Republic of Niger

The Minister of Health and his Secretary General
The Minister of the Interior
The Research and Planning Department
The National Immunization Team of the Immunization Division

The second stage consisted of a series of meetings and discussions with key officials and resource persons at the national level from the Ministries of Public Health, Population and Social Affairs; Interior, Public Security, Decentralization and Customary and Religious Affairs; and Finance; technical and financial partners such as GAVI, WHO, UNICEF, the World Bank, UNHCR, community associations, civil society, the association of traditional chiefs, and the Regroupement National des ONG et Associations du Secteur de Santé du Niger (ROASSN). The third step was data collection in the Dosso region, the Boboye health district and the Kankandi IHC. This provided an opportunity to meet with health officials at the grassroots level and to observe the situation on the ground.

Meetings with international partners and civil society organizations in the Republic of Niger

The Committee on Health and Social Affairs of the National Assembly
The Association of NGOs of the Republic of Niger
The Association of Traditional Leaders of Niger
The World Health Organization's National Immunization Team

At the end of the mission, the main findings show that Niger is doing well in many areas related to the immunization program. However, some gaps remain to be filled so that the functionality of the routine immunization program in Niger is optimal and immunization coverage can be improved to meet the country's objectives.

Ultimately, Askaan Sante will provide technical assistance to support the Government of Niger in improving routine immunization performance through joint funding from the Bill & Melinda Gates and Aliko Dangote Foundations and will work to develop plans and strategies that will guide the design and implementation of complementary interventions to improve the status of routine immunization in the Republic of Niger.