Flying into Niamey, the capital of Niger, always feels like coming home. Since starting development work in 1981 it is the country that has the most marked me and where I have traveled the most extensively. We are accompanying a columnist from The New York Times, Nick Kristof, and his annual “Win-A-Trip” participant, Erin Luhmann and their videographer, Ben Solomon during their West Africa visit. They will go on from Niamey to a leprosy hospital further to the East, and then on to Chad. The flight in is at the perfect time of day in the perfect season. The beginning of the rainy season has washed off the dust and the foliage is a brilliant green, contrasting with the red earth. The end-of-day light gives the perfect glow to the landscape. Immigration at the airport is more nervous than usual about having journalists visit – perhaps because of the heightened security concerns. However with a little explanation on several fronts the team is out of the airport and off to their first visit in Niamey.
Niamey has changed even from my last visit in April last year, more road construction, more bustle, more traffic jams. The saddest change however is the very heightened security. Just getting into the hotel requires running a gauntlet of security measures with the vehicle screened, weaving around barriers, checking of luggage and body scans at the door. Even before parking at the national museum the car is screened. In the past one of the great joys of living in Niamey was being able to be able to go on a picnic under the mango trees on the banks of the Niger river after just a 15 minute ride. These days such outings are ill advised as risks of kidnapping and terrorist attacks are foremost on everyone’s mind.
Niger has played a very special role in HKI’s Nutrition and Neglected Tropical Disease programming in Africa, and lessons learned have had an impact throughout sub-Saharan Africa. Niger was one of the first countries to integrate life- and sight-saving vitamin A supplementation into campaigns to eradicate poliomyelitis in 1997 – and many countries followed the example. Niger was the first country in Africa to rise to the challenge of getting the second annual dose of vitamin A to children by organizing national micronutrient days in June 1999. Now, Niger routinely reaches over 3.6 million children 6-59 months old every six months and the Niger experience has become the model for most other countries. HKI started integrating treatment of severe acute malnutrition into ongoing programs to prevent malnutrition in 2005 during a national food and nutrition crisis. The approach we took – of building the capacity of the national health system and communities to implement the treatment has now become standard practice across Niger and across the Sahel region. This year over 300,000 children are being treated for severe acute malnutrition by the Ministry of Health with the support of its partners.
The reach of Neglected Tropical Disease control is equally impressive – the Ministry of Health’s national neglected tropical disease program administered over 28 million treatments in 2012 with support from HKI and other partners.
Driving from our hotel for an audience with the Minister of Health it was with great satisfaction that I passed by the national Nutrition Directorate. Nutrition had been a section, hidden within a division, hidden within a directorate. For readers familiar with government bureaucracies you will understand how little priority used to be given nutrition issues, and how important this systematic upgrading in status is. Perhaps even more impressive is a presidential initiative to improve food and nutrition security – loosely translated as Nigeriens Nourish Nigeriens – “3 N”. Control of neglected tropical diseases has also received greatly increased political support with the creation of a national directorate within the Ministry of Health.
This success is laudable and greatly satisfying. It is also very fragile.
Niger is at the center of a “perfect storm” that is hitting so much of the Sahel region. Agricultural production increasingly at risk because of climate change and more erratic weather patterns. Very rapid population growth creating more demands on agriculture and social systems. High dependence on imports creating great exposure to the impacts of food price increases. The threats of terrorism and insecurity are further exacerbating this “perfect storm” – hitting hard on government budgets and undermining capacity of the government and its partners to implement programs. Despite the political commitments to these programs they remain almost entirely dependent on external funding.
It is recognized that managing the threats of terrorism and insecurity are a question of national sovereignty – and the government is addressing these threats with the utmost seriousness. In our discussions with the Minister of Health we stressed that malnutrition and Neglected Tropical Diseases are equally a question of national sovereignty and national security – as they imperil the survival and the future development of the country’s children.
I leave Niger with a huge sense of satisfaction of how programs that HKI supports have flourished. But also with a sense of the magnitude of the challenges the country continues to face.