Health centres bracing for malnutrition surge

Most government health centres in Niger are ill-equipped to absorb the expected influx of malnourished children, according to the Ministry of Health.



The government estimates at least 200,000 more children may require treatment for severe malnutrition following a bad harvest which has put some two million people at immediate risk of severe hunger.



After the country’s last agriculture crisis in late 2004, international NGOs helped care for wasting children dying of hunger.



In response, the government developed plans in 2006 to take over that medical care, but a shortage of qualified health workers, medicine and therapeutic food have stalled the handover.



“The physical integration of malnutrition treatment [into state health centres] has happened at various levels [since 2008],” the Health Ministry’s deputy director of nutrition, Aboubacar Mahamadou, told IRIN. But the reality is that “few centres can really provide the care, in terms of quality and quantity,” he added.



Bad



More than half the population (7.8 million) have used up almost their entire food reserves from the most recent harvest, and are still half a year from the next harvest, according to the government.



As of 2010, of the 812 health structures caring for malnourished children, 382 are supported by international and local NGOs.



Health centres without NGO support for malnutrition care - including transportation to get patients to the centres - treat few, if any, malnourished children, according to the director of the Médecins Sans Frontières Zinder office, Kalil Hamadoun Touré. “If these centres had more support from [malnutrition care] partners, we could avoid the worst [of the food crisis].”



In 2008, there were 7,376 health workers for a population of about 14 million.





















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Almost 90 percent of workers were in cities - leaving rural areas with 885 workers, according to 2008 Health Ministry data. Forty percent of all health workers were in the capital, Niamey, and 900km east in the city of Zinder.



Even with relatively more health workers than other parts of the country, the head of Zinder Region’s public health division, Amadou Harouna, told IRIN there are not enough government-paid medical staff to offer nutrition care.



“It is a real obstacle,” Harouna told IRIN. Even though 90 percent of the region’s health facilities have been trained in malnutrition medical care and are “capable”, half of the region’s 637 health facilities have only “one health worker who is expected to do everything. You really need at a minimum two health workers [to do the job well],” he said.



“You have to weigh, measure, diagnose, treat, educate… You spend much longer with each patient [than with other illnesses] and the health worker must still see the regular patient load [such as] prenatal visits, vaccinations,” Harouna explained.



“And they are asked to produce immaculate statistics on top of all this,” he added, in reference to the Health Ministry’s identification of poor data as a challenge in nutrition services.



Some 15.4 percent of surveyed children in Zinder Region in June 2009 were underweight for their height (acute malnutrition), which placed Zinder over the World Health Organization’s emergency threshold for malnutrition. The same survey recorded 17.4 percent acute malnutrition in Niger’s most eastern region, Diffa.



Worse



WHO recommends severely malnourished children who do not have medical complications receive a medical evaluation, presumptive treatment for diarrhoea, pneumonia and malaria, and nutrient-packed ready-to-use therapeutic food. After initial enrolment, children should return once a week for follow-up and more therapeutic food until they are cleared of danger.














Photo: Anne Isabelle Leclercq/IRIN
Therapeutic feeding centres like this one in Magaria, southern Niger are seeing more children than before

As of 19 March at least 55 children had died from malnutrition since the beginning of the year - out of a registered 45,525 children under five treated for malnutrition, according to the junta that recently took power.



Partly due to a change in international guidelines on malnutrition, and partly due to the insufficient harvest, malnutrition treatment centres have seen their numbers increase by on average 50 percent. (Malnutrition is not only caused by lack of food, but also poor feeding practices).



Marie David, head of the Red Cross delegation in Zinder, told IRIN the increase in children being treated for moderate malnutrition in Zinder “is too great not to be significant,” even after factoring in the expected increase due to new treatment guidelines.



Financing



The junta that overthrew the president on 18 February has launched an international appeal for US$35 million to fund the prevention and treatment of malnutrition.



But even beyond the thus-far anaemic spending on nutrition services in Niger, overall health spending has been insufficient, according to a March 2009 government nutrition working paper.



The government spent 9 percent of its annual budget on health care in 2007, which worked out at about US$7 in health expenses per resident that year.



The government has had problems financing a 2007 law to provide under-five children and pregnant women with no-fee health care; in Zinder alone, the government owes health centres more than $1 million for no-fee services they were legally required to provide, according to regional health officials.  



As of March, the UN has estimated the cost of responding to the unfolding food crisis in Niger at $158.6 million in its Humanitarian Action Plan.



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