By: Rachel Strodel, Adam Asma, Aboubacar Adakal, and Henry B. Perry
Agents de Santé Communautaire (ASCs) and Relais serve as the backbone of the Niger community health workforce. They provide a breadth of health services, including family planning, health promotion, and distribution of protective equipment like insecticide-treated bed nets. Between 1990 and 2019, their efforts contributed to a 74% decrease in death among children under 5-years-old.
Background
Niger is the least developed country in the world as measured by the Human Development Index. It also has the highest fertility rate in the world (7.1) and the density of its population of 21.5 million is one of the world’s lowest. However, its reduction of under-5 mortality since 1990 has been one of the world’s most dramatic following the introduction of its Community Health Worker (CHW) Program in 2000.
Implementation
There are approximately 2,500 salaried Agents de Santé Communautaire (ASCs) – 1 for every 9,000 or so people – and approximately 5,000 Relais (Relay) Volunteers – 1 for every 4,500 people or so. ASCs work at Health Posts, and Relais Volunteers work out in the community.
Roles/responsibilities
ASCs provide a broad range of Primary Health Care services, from the provision of immunizations and family planning (oral and injectable contraceptives), provision of antenatal care and uncomplicated deliveries, diagnosis and treatment of serious childhood illness, and health promotion. Relais Volunteers support ASCs, support mass campaigns, distribute insecticide-treated bed nets, and visit homes to promote key family practices and identify sick or malnourished children in need of treatment.
Training
ASCs receive 6 months of training, including 6 days of training in Integrated Community Case Management of Childhood Illness (iCCM), which enables them to treat uncomplicated cases of diarrhea, pneumonia, and malaria. Relais Volunteers receive ad hoc trainings, including several days of training in Community-Integrated Management of Childhood Illness (C-IMCI).
Supervision
Each Health Post is linked to a Health Center. A staff member of the Health Center is supposed to supervise ASCs, but this is infrequent and irregular. ASCs supervise Relais Volunteers.
Incentives and remuneration
ASCs receive a salary of US$ 100 per month. Relais Volunteers are supposed to receive a monthly incentive of $20 per month but this is irregular and infrequent. The Relais Volunteers also receive occasional payments for trainings or participation in mass campaigns as well as in-kind support such as gifts of product crops.
Impact
Niger’s mortality among children younger than 5 years of age declined from 328 deaths per 1,000 live births in 1990 to 84 in 2019, a 74% decline. The deployment of ASCs and Relais Volunteers since 2000 has made a major contribution to this dramatic success.
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