Submitted by crinadmin on
MARADI, 29 August (IRIN) - Experts are applauding government-led solutions to deal with Niger's chronic health problems but say funding shortfalls are holding up progress. Niger's health threats are typical of West Africa, with malaria, tuberculosis and diarrhoea as the biggest killers. But these problems are compounded by malnutrition, which a staggering 50 percent of the population suffers from each year. Diseases such as polio, measles, cholera and sleeping sickness that nearly have been stamped out in many other sub-Saharan countries remain endemic in parts of Niger. According to the United Nations annual Human Development Index, there are just three doctors per 100,000 people in Niger. A trained midwife tends to only 16 percent of the 600,000 Nigeriens born every year. Twenty percent of those children will die before their fifth birthday, half of them from malaria. In the same report, Niger falls at the bottom of 177 countries surveyed in every category, making it the poorest country in the world. SYSTEMS STALLED In April, the Nigerien government passed a law that would make healthcare free for pregnant women and children under five. Although the law was trumpeted at the time, "the system to get things up and running is not there yet," said a public sector expert at the UN in the Nigerien capital, Niamey. The government is also working to set up a social fund to finance the free healthcare plan, but there is no system in place for that either, the expert said. For a consultation and treatment, Nigeriens must still pay CFA 500 (US $1) for a child and CFA 1,000 (US $2) for an adult. This is a fortune in villages where someone who earns CFA 200,000 (US $400) in a year is considered to be rich. The government of Niger has drawn up guidelines on the treatment of malnutrition, which according to government figures affects over 50 percent of the country's population annually. "Before, the problem was seen just as a problem of food shortages," said one aid agency official. "Now they clearly recognise there is a nutritional issue as well, that there needs to be quality and diversity, not just quantity." But on implementation, the state is again lacking, aid agencies say. Local doctors said they were desperately short of medicines, expertise and general staff. In government-run health facilities IRIN visited throughout the southwest and southeast of the country, most of the staff dealing with malnutrition were provided for and funded by foreign NGOs. "We have never seen any sign of the government here," said the head of one NGO's nutritional centre, set up within the grounds of a health centre near Maradi. BRIDGING THE GAP Matching rhetoric with reality requires funds and time, according to economists. The government is already spending $5 per person on healthcare, according to the World Health Organisation (WHO). Although that is a fraction of the accepted need of US $35 for poor countries to spend, it amounts to about 12 percent of Niger's GDP, making the country one of the biggest spenders per person on healthcare in West Africa. "The challenge is how to increase government revenues so they can spend more on the poorest," said the International Monetary Fund's (IMF) representative in Niger, Pierre Laporte. "Unless more revenue comes in there is always going to be a limit on what they can spend." Tax revenue in Niger is the lowest in the region, according to the Central Bank of West Africa (BCEAO). Under an IMF-led plan, Laporte said Niger's government has boosted tax revenues by 25 percent in the first two quarters of 2006 compared to the same period in 2005. "This reflects tightening of controls and a serious war against people not paying tax," Laporte said. The government is also "doing well" on controlling non-priority spending and focusing revenues on education and health, he said. But the government has faced serious obstacles to imposing value-added tax on basic foodstuffs. The country's powerful unions have blocked tax hikes by mobilising "dead city" strikes in Niamey several times this year. For the other 50 percent of the budget that is largely made up of foreign assistance and grants, aid and donor officials regularly complain that the link between government coffers and projects is often slow, unwieldy and sometimes riddled with corruption. In June 2006, a US $100 million education fund was frozen after a report by the auditing firm Deloitte and Touche found that about US $8 million had gone missing. A government official assured foreign diplomats last week that guilty officials "at every level" would be held accountable. Still, medical experts are satisfied that the country's chronic health problems are at least featuring on the political agenda. "We are far from the situation where you can say that the problem is solved, but at least the political will is there," said the head of a foreign medical NGO that works in Niger, speaking specifically about malnutrition-related illnesses. "We have had some very encouraging discussions with the health authorities. They are pushing to find a solution, accepting that emergency measures are needed for now, but that they also need a long-term fix," he said.