management, health system strengthening and a ‘community’ component
to strengthen links between health facilities and the communities
they served.
IMCI was designed to improve child survival rates; however, its
implementation in Niger was mainly limited to health facilities and
thus failed to reach a large portion of Niger’s children, who lacked
access to these facilities for economic, geographic and social reasons.
And though political stability returned to Niger with the advent of
the Fifth Republic in 1999, creating a more favourable environment
to pursue policy enterprises, implementation of ‘community’ IMCI
remained stalled, even following a national orientation workshop in
August 2002 and initial training sessions in 2003–04 in Madarounfa
and Matame`ye. By 2007, only 10 of 42 health districts had initiated
any activities on the community component (Hamsatou 2008):
At that time there were no funds, there was nothing for IMCI. Much
later we got funds from UNICEF and WHO to conduct the first
activities. (NIG-2012-7-12-2, IMCI officer, government sector)
Not only were funds missing to train personnel and carry out
activities, community IMCI was meant to be operated out of a new
type of health structure, the case de sante´ (‘health hut’), created by
ministerial decree in 1999. However, few health huts had been built
by the time community IMCI stalled as a policy in the early 2000s.