Financing and implementation
Funding for implementation arrived in October 2007 with the signing
of a co-financing agreement between UNICEF and the Canadian
international development agency as part of the global Catalytic
Initiative, which focused on strengthening health systems to deliver
high-impact and cost-effective interventions at the operational level.
The Canadian agency pledged US$ 10 million for iCCM over 6 years
(2007–13), which was matched and administered in Niger by
UNICEF. A massive training campaign for community health workers
took place in 2008–09 and by 2012 over 3000 health workers
had been trained (MSP/DGSP/DOS 2012). The supply of essential
drugs was provided by UNICEF and delivered to the district level
(NIG-2012-5-24). As a result, the number of operational health huts
increased from 1666 in 2007 to 2501 in 2011, with all districts implementing
iCCM by the end of the period (Oliphant et al. 2011).
Alongside the state’s contributions to iCCM in the form of
Tandja’s network of health huts and payment of health worker salaries,
the provision of external resources to fund specific training
and medicines suggests an interplay between government and external
actors when deciding who pays for what. Just before the arrival
of iCCM, in the 2005–09 Health Development Plan, Ministry staff
recommended formulating the health budget such that reproductive
and child health programs existed as separate entities, rather than
integrating them into regular Ministry functioning (MSP 2005).
‘These [programs] will certainly require specific funding’, the document
states, presumably referring to funding from external sources
and later invoking the supposed availability of UNICEF funding for
IMCI programming over the 2004–07 period. The same year
(2005), Nigerien government expenditure on health per capita was
at a relative low at $4.2, whereas the country was experiencing an
influx of development aid towards maternal, newborn and child
health, which increased by 209% per live birth and 474% per child
between 2003 and 2008 (Amouzou et al. 2012). While only
circumstantial, this suggests Nigerien policymakers may have waited
to see how donors would direct funds before acting themselves,
though no specific evidence of strategizing or negotiating is contained
in our data.