Equity Case Study: Niger - Developing safety nets for equitable access to social services
© UNICEF Niger/2010/P.Holtz|
Niger is a land-locked Sahelian country marked by chronic poverty and cyclical food insecurity.
By Abhijit Shanker
30 July 2012 - Even though access to basic services such as health and education is improving steadily in Niger, people living in rural settings and in poor and landlocked regions remain particularly vulnerable. To ensure equitable access to basic social services, UNICEF and its partners have been creating and implementing specific strategies targeting these groups. These efforts have been accelerated since 2010, in the context of the UNICEF equity agenda.
Taking into consideration the growing vulnerability of marginalized populations and the under-performance of social protection interventions, UNICEF has been supporting the implementation of a free health care system for all children under five and pregnant women, the development of social safety nets (special measures targeting women and children in the context of emergencies), and a community-based approach to reach populations in remote, rural areas. The UNICEF Niger has also conducted evidence-based advocacy to promote a comprehensive social protection approach.
These strategies have already shown promising results: pilot community-based interventions have proved successful at the local level and will be scaled-up; special interventions targeting women and children in the context of emergencies, such as cash transfer operations, have been recognized as an efficient new tool to protect vulnerable groups; and the National Social Protection Policy was adopted in August 2011. In the future, developing the capacity of social services in the country and defining methodologies to better identify vulnerable populations will be essential to ensure successful equity-based interventions.
Niger is a land-locked Sahelian country marked by chronic poverty and cyclical food insecurity. Almost two-thirds of the population still lives below the poverty line, and 63 per cent of the poor live in rural areas. The country is facing major challenges to ensuring access to quality basic social services, and economic growth remains too low and erratic to satisfy the swelling social needs of the rapidly growing population.
Even though significant progress has been made as far as child mortality and access to primary education are concerned, some groups are still quite vulnerable. The incidence of poverty affects women and children especially. Child survival remains a major challenge in regions such as Agadez, Maradi, Tahoua and Zinder, where under-five mortality rates are over 200 per thousand live births. In times of chronic food insecurity, the health of pregnant and lactating women and under-five children is particularly threatened.
In this context, and based on its renewed focus on equity, UNICEF has designed its interventions to target the most vulnerable populations in the most isolated regions. In emergency situations, UNICEF provides support to all women and children in areas identified as at-risk. At the national level, UNICEF strives to develop strategic partnerships and promote policy dialogue and evidence-based advocacy to ensure coherent and efficient social protection interventions for vulnerable groups, children in particular.
Strategy & Implementation
Among the equity-based strategies UNICEF Niger has been supporting as part of its Country Programme is the implementation of a national free health care system for children under five and pregnant women. Components of the programme include the procurement of essential medicines, the development of an extensive network of 2,500 health posts, and the creation of an outreach programme that enables community health agents to travel to villages with no direct access to a health post. The strategy therefore promotes access of vulnerable populations to basic health services and contributes to the reduction of child and maternal mortality rates.
In addition, as the leader of the nutrition cluster, UNICEF has efficiently supported the precocious planning and management of the national response to the 2010 food and nutrition crisis. In partnership with the World Food Programme (WFP) and other local and international NGOs, UNICEF implemented large-scale blanket feeding and cash transfer operations targeting young children and lactating women in the most vulnerable households within areas affected by severe food insecurity.
UNICEF has also been a proponent of evidence-based advocacy for a comprehensive approach to social protection of vulnerable groups, and for the inclusion of social protection measures in sectorial policies (health, education, protection, etc.) in collaboration with the Government of Niger and the World Bank.
Finally, UNICEF has supported, in collaboration with the World Food Programme (WFP), the national Early Warning and Emergency Management System (Système d’Alerte Précoce, SAP) and the National Institute of Statistics, the regular production and use of data on vulnerability to food insecurity and on the nutritional status of children, in order to strengthen national planning and monitoring systems notably for responding to emergencies. Documentation of the response to food insecurity in 2010 and evaluation of the cash transfer initiative have generated lessons learned that are benefiting the refinement of efforts to target vulnerable groups and the improvement of social transfers programme performance.
Progress & Results
Improved access of vulnerable children and women to basic health services. To support the full operationalization of free health care for children under five and pregnant women, UNICEF has been providing at the district level, essential drugs for the treatment of malaria, acute respiratory infection, diarrhea and severe acute malnutrition, as well as cesarean kits, thereby ensuring free access for all. This initiative has contributed to significant improvement in several key child survival indicators: in particular, the national under-five mortality rate has decreased from 198 to 131 per thousand live births (34 per cent) between 2006 and 2010. In order to make this system sustainable in the long-run, UNICEF is advocating for the establishment of a Social Fund to support the initiative.
UNICEF has also been implementing community-based approaches for behavioral change, such as the promotion of seven key family practices in rural areas where child survival indicators are the most problematic. These approaches aim at strengthening the commitment and participation of vulnerable communities in adopting life-saving behaviors such as exclusive breastfeeding up to six months, and hand-washing with soap. The Community-led Total Sanitation (CLTS) strategy, adopted in an increasing number of rural villages (65 in 2011) has already shown promising results, by leading in a short time to the abandonment of open defecation in many villages, as a result of eye-opening communications strategies highlighting the importance of public and individual hygiene.
Quality management of children affected by food and nutrition crisis. During the 2010 food and nutrition crisis, UNICEF and its partners successfully implemented an emergency response and managed to avoid a major humanitarian disaster. This effort was successful thanks to efficient targeting of and assistance to the most vulnerable populations.
In 2010, UNICEF contributed to the implementation of a large-scale, blanket feeding operation in partnership with the WFP and international NGOs, targeting 678,000 children under five and 56,652 pregnant and lactating women. The operation was conducted again in 2011 and reached 330,000 children and 64,000 lactating women. In order to safeguard the blanket feeding operation, UNICEF also supported two cash transfer operations in 2010 and 2011, targeting 35,000 households in 2010 and 20,880 in 2011.
The final evaluation of the 2010 cash transfer operation showed that 70 per cent of blanket feeding rations were going to children in areas covered by the operation, against nine per cent in areas where there was no cash transfer. In addition, the operation contributed to improving the wellbeing of beneficiaries in terms of access to food, debt payment as well as land and livestock.
UNICEF has also worked closely with the Government to develop the capacity of the health system to detect and treat malnutrition through training of health officers, strengthen health services (with the development of dedicated infrastructure to host therapeutic feeding centers), and the procurement of medicines and supplies required for the treatment of all cases of severe acute malnutrition (SAM) in Niger. As a result, 330,448 children received quality care for SAM at 822 centers in 2010, and over 230,000 children have already been treated in 2011.
Equity-focused national policies and programs. UNICEF Niger has led evidence-based advocacy efforts targeting the Government to ensure the integration of vulnerable groups’ rights in national policies and programs, focusing in particular on the National Social Protection Policy and the Child Protection Policy.
The National Social Protection Policy was adopted in August 2011 and presents five priority focus areas to guide renewed efforts around social protection: (i) food and nutrition security; (ii) social security, including work and employment of the poorest populations; (iii) basic social services and infrastructure; (iv) specific actions targeting particularly vulnerable groups; and (v) strengthening the legislative framework, incorporating the four critical dimensions of protection, prevention, promotion and transformation.
A National Social Safety Net programme with a cash transfer component was adopted by the Government, with the support of UNICEF and the World Bank, as a first step toward implementing the Social Protection Policy. This initiative targets a total of 40,000 households (or 120,000 people) among the most vulnerable groups and aims to address structural causes of chronic poverty such as cyclical food insecurity.
The specificity of this programme in terms of promoting equity resides in the fact that it uses the adoption of Key Family Practices as a “soft conditionality” for households to receive cash transfers in 1,000 selected villages. It was better able therefore to contribute to addressing major factors of poverty in rural areas.
Reaching the most vulnerable populations is not an easy task in Niger. Population movements resulting from migrations, families fleeing food insecurity, or nomadic traditions also complicate the targeting of vulnerable groups. Insecurity has become a significant constraint, especially in the North, where the Libyan political crisis has led to arms-trafficking activities and an increased threat of terrorism.
The weakness of Niger’s basic services infrastructure is also a major constraint, especially in times of emergency when rapid response is needed. UNICEF has been supporting capacity-building and prevention activities in the field of health and nutrition to manage this constraint, resulting in the integration of 822 treatment centers for malnutrition into the existing health system.
Finally, protecting the rights of children and ensuring access to basic services is a considerable challenge in an environment characterized by limited public funds and high population growth. Recent advancements in oil exploration and development within Niger could change this scenario and deliver valuable new resources to the Government. For its part, UNICEF will continue advocating for the investment of a larger share of public funding in social sectors such as health and education.
Intersectoral approaches have proved to be particularly efficient in reaching vulnerable groups (especially in the context of emergencies) and will be more systematically adopted in the future.
The development of key partnerships with other the World Bank (Safety Nets Programme), the WFP, the Food and Agriculture Organization (FAO) of the United Nations (social transfers), and other UN agencies as well as national and international NGOs has led to accelerated results and will be expanded to support equity-based strategies in the future.
In order to ensure equitable access to basic services in the long-run, UNICEF will keep supporting capacity development of Niger’s health and education systems in general.
Among the various initiatives supported by UNICEF to target vulnerable populations, the emergency cash transfer operations conducted in 2010 (the first large-scale operation conducted in Niger) and in 2011 are the most innovative. The cash transfer operation has been recognized as an efficient new tool to improve emergency response. It has helped strengthen the economic capacities of most vulnerable populations and improve child wellbeing.
This approach has succeeded because UNICEF quickly managed to scale up existing cash projects already implemented by other NGOs and to coordinate a number of partners including the WFP, NGOs and the Government. UNICEF was also able to develop common standards and to harmonize the different approaches to emergency cash distribution.
This initiative was part of an effort to diversify possible interventions in periods of crisis. The cash transfer was introduced as a new alternative to support and strengthen the impact of nutrition interventions.
Niger is preparing to respond to a nutritional and food security crisis in 2012, and UNICEF is already working with partners on a coordinated emergency response. In particular, UNICEF is working with WFP to harmonize their approach to cash transfer operations, which will be used again in 2012 as a complementary means to support nutritional interventions and attain a higher impact.
The cash transfer experience will be capitalized and will inform the national safety nets programme planned to start in 2012, in terms of targeting methods that employ a community-based approach, cash transfer monitoring, and the development of strategic partnerships and synergies to maximize the impact of social transfers for the most vulnerable populations.
UNICEF will dedicate extra effort to fine-tuning the targeting of vulnerable groups, thanks in particular to the DHS-MICS survey (2012) and to the results of evaluations of equity-based interventions.
Community-based approaches appear to be particularly well adapted to a country like Niger and will be further developed and brought to scale in the future. Use of Key Family Practices as soft conditionality in the national social safety net programme will be an opportunity to improve child survival indicators in the most vulnerable areas of the country.
Advocacy initiatives, which have been essential to obtaining Government buy-in and to making sure that the rights and needs of the most vulnerable populations are taken into account, will be pursued, notably in the context of the decentralization process. Resource mobilization to support the implementation of these policies will also be continued.