Revitalizing the health system in Niger: pilot reform experiences enabling to progress towards strategic purchasing

Niger, a low-income country in Western Africa, faces many challenges on the path to universal health coverage (UHC). On the one hand, the financing system is still much fragmented, reducing efficiency and equity. The targeted free healthcare policy has not improved financial protection in a sustainable way, and has negative consequences on the financial viability of health facilities, with negative consequences notably on the availability of common drugs. On the other hand, coverage of quality health services is still low, especially in remote areas, due to important governance and financing constraints. The health system needs to be strengthened both on the supply side (quality services) and on the demand (population/financial protection) side, while ensuring the best use of the available resources. To do so, the Belgian Development Agency (Enabel) supports the Ministry of Public Health in piloting a number reforms, through an action research approach, from design to scaling up. After a brief presentation of key challenges regarding the health financing system and strategic purchasing function, this session intends to present a number of positive evidence-based experiences that are on their way to scaling up and their integration into the national health policy. Two reforms enabling to improve efficiency and strengthen the primary healthcare system in a sustainable way are studied: digitalisation and strengthening of medical equipment and infrastructure maintenance. Then, financing reforms is discussed, with a case study of how a performance-based financing (PBF) scheme enabled to strengthen the foundations on the path to the setting up of a large-scale health insurance model. Overall, this session draws transversal lessons, relevant both for governments committed to UHC and donor agencies which support them.