Twenty years ago, Niger suffered from the world's highest death rates for children under the age of five. Today it ranks as one of the world's top 20 performing countries in reducing child mortality. This turnaround is one of the most remarkable public health success stories of our time.
The under-five mortality rate in Niger declined by more than 60 percent between 1990 and 2011, U.N. estimates show. The infant mortality rate was almost halved in the same period.
Between 1998 and 2009, under-five mortality in the country fell by an annual average of 5.1 percent per year, a staggering rate of progress that would exceed the rate needed to meet United Nations Millennium Development Goal 4 of reducing child mortality by two-thirds between 1990 and 2015, according to research, including UNICEF, published in The Lancet.
In 2009 alone, nearly 60,000 children's lives were saved. Nutrition interventions including the treatment and prevention of severe acute malnutrition, providing extra micronutrients such as Vitamin A and reducing stunting -- the outcome of chronic nutritional deficiency during the first critical phase of a child's life -- contributed to one-third of the lives that were saved.
Three factors are largely behind these achievements: government action to support universal access to primary health care; effective and equitable health service delivery targeting the main child killers -- malaria, pneumonia, diarrhoea and measles; and concerted efforts to tackle malnutrition.
Frontline health centres equipped with essential drugs and staffed by trained community health workers are now providing effective care. Financial barriers were reduced by making care free for expectant mothers and children. All these efforts and more translated into impressive results -- saving children -- no matter where they live and who their parents are.
The government's commitment to making preventive and curative health care available in all rural communities, including the hardest to reach and the most vulnerable is commendable.
Financial assistance to support such national health programmes came from a substantial increase in development assistance in the late 1990s, donor support targeted to maternal and child health and increased government spending on public health. The government's expenditure on health per capital rose from U.S. $5.30 per person in 1990 to U.S. $9.10 in 2008.
Niger also benefitted from the Enhanced Heavily Indebted Poor Countries Initiative to provide debt relief and contribute to growth in the poorest, most heavily indebted countries.
Niger however is still one of the world's poorest nations with a subsistence economy and recurrent droughts. The Gross Domestic Product hasn't grown considerably over the last decade. Poverty remains high and chronic malnutrition is a severe threat. But its example shows what can be achieved when effective policies, partnership and political will combine.
The striking success for child survival in Niger adds impetus to a call for global action made in June on under-5 mortality under the banner of A Promised Renewed, a movement to build on the progress of the last 20 years and achieve even sharper reductions in preventable child deaths.
Much more still needs to be done for children, even in Niger. One in two children in the country suffers from stunted growth, causing irreversible damage to bodies and brains. Improvements in reducing death among infants in the first month of life have been slow.
Recurrent droughts and food crises drain the resilience of rural communities. This year more than 6 million people struggled with the impact of climate change and a food and nutrition crisis in Niger. More than 250,000 children were treated for severe acute malnutrition in 2012.
Investments in health care and nutrition have saved hundreds of thousands of lives. But overcoming the root causes of child deaths is not only about health interventions. Access to improved water and sanitation, exclusive breastfeeding and better nutrition for mothers and babies are crucial if we want to give every child the opportunity to survive in good health.
Low-cost, evidence-based solutions are within reach, such as providing micronutrients, including vitamin A, iodine, iron and zinc during the first two years of a child's life to ensure physical and intellectual development of a child. Promoting good practices to improve child health, nutrition and hygiene make families more able to withstand unexpected shocks.
Improving the status of women is equally vital. Whether it is increasing women's education or ensuring expectant mothers receive proper neonatal and prenatal care, the benefits for mothers, babies and families are enormous. Educated women are more likely to have smaller and healthier families with children protected from malnutrition and killer diseases.
The government and its partners have built a foundation in recent years to break the vicious cycle of malnutrition and child death and overcome structural causes of vulnerability. We must seize this opportunity globally to give every child the best possible chance to survive and thrive.