The Alliance for International Medical Action (ALIMA) is a humanitarian medical aid organization based in Dakar, Senegal. ALIMA is dedicated to continuous quality improvement in medical care in humanitarian contexts and carries out scientific research to improve innovation in healthcare delivery. Since its creation in 2009, ALIMA has treated over 2 million people, conducted 56 programs in 13 countries, and launched more than 10 research projects.

THE PROBLEM

The first 1,000 days are decisive for a child’s physical health, cognitive development, and life expectancy. Mothers and children in Niger, especially in rural areas, face daunting nutrition and health challenges during these crucial 1,000 days and the country’s health indicators are among the world’s worst. The maternal mortality ratio is estimated at 509 per 100,000 live births, and neonatal and younger than 5 mortality rates are estimated at 25 and 84 per 1,000 live births, respectively. On its current trajectory, Niger will not come close to meeting the Sustainable Development Goals for nutrition or maternal and child mortality.

To address this nutrition and health emergency, in January 2015, ALIMA and its Nigerien medical partner, Bien Être de la Femme et de l’Enfant au Niger (BEFEN) introduced the 1,000 Days Program in the southeastern Zinder region’s rural Mirriah District. The program provided a decentralized, integrated package of maternal and pediatric preventive and curative interventions with the objectives of reducing mortality, preventing malnutrition, and improving maternal and pediatric health. A key component to this package was the routine provision of small-quantity lipid-based nutritional supplements (SQ-LNS) for all children 6 to 23 months.

Although consensus surrounding the benefits of providing an integrated package of preventative–curative maternal–child interventions that include SQ-LNS is strong and growing, there is inadequate evidence to inform efforts to scale up these packages—especially a lack of documentation on the costs associated with implementing such comprehensive programs. Better cost information will be needed for accurate budgeting, developing investment plans to mobilize resources, and studying cost-effectiveness of different intervention strategies.

THE PHAROS SOLUTION

In collaboration with Yale University, ALIMA, and BEFEN, we documented the total costs and average cost per mother–child pair associated with providing the 1,000 days package to 9,000 mother–child pairs in Mirriah, Niger and estimated the incremental investments required to implement the program relative to the prevailing standard of care (SOC) in Niger. Possible sources of cost savings were also explored. The total costs of scaling up the program to the district, regional, and national level were analyzed and compared with current health spending in Niger to assess the affordability of such scale up and the need for mobilizing domestic and international resources.

LOOKING AHEAD

Status: Complete

Team Members Involved: Robert Hecht, Lindsey Hiebert, Claire Young, Grace Chen

For more information, contact Robert Hecht at [email protected].