Social Accountability and Women’s Health in Niger

January 5, 2021

This blog is part of a series of articles written by University of Dayton students, published as part of Counterpart’s Next Generation in Thought Leadership initiative. The opinions expressed in this article are the author’s and do not express the views or opinions of Counterpart International.

Based on Counterpart International’s Inclusive Social Accountability (ISA) approach, we evaluated if Counterpart has been effective in implementing sustainable women’s engagement and leadership in their access to healthcare in Niger. We examined what effect Counterpart’s social accountability and feedback mechanisms had on women’s inclusivity in community dialogue and in the sustainability of the programming in Niger implemented by Counterpart International.

The healthcare system in Niger is underfunded and understaffed, making the challenge of access to quality healthcare a common problem. The low availability of staff leads to higher prices for general care, further restricting access to medical care. Due to the inadequacy of healthcare, women are at a crucial disadvantage by the time they have their first child. Additionally, Niger has a total fertility rate (TFR) of almost seven children for every woman, which is the highest TFR in the world. This high fertility rate combined with a maternal mortality ratio of 555 per 100,000 births results in an extremely challenging environment to ensure the safety and wellbeing of both mother and child. The common practice of child marriages in Niger also contributes to this mortality rate, as many babies are born to very young mothers who may not survive childbirth.

Counterpart International in Niger

Counterpart uses the ISA framework, which works to strengthen accountable systems in a community that ensure broad social inclusion. The ISA serves as a deliberate system of principles to guide decisions regarding productive and sustainable programming. It also aligns with good practices in social accountability in that it integrates both tactical and strategic approaches. Tactical approaches include the use of technical and non-technical tools by citizen stakeholders to communicate their needs to the government. Strategic approaches include the appointment of local stakeholders, leaders, and public institutions into positions that facilitate collective action for accountability and coordination of citizen voice initiatives through reforms that improve public sector responsiveness.

The ISA underpins the Participatory, Responsive Governance – Principal Activity (PRG-PA) project, funded by USAID, which seeks to improve governance of health, education, and security services in Niger. PRG-PA aids in the participation of multi-stakeholder forums to identify citizen priorities and recommendations for improved health care services. These forums provide the foundational feedback that help to formulate the micro plans and policies of health communes in various regions and districts of Niger.

As it relates to healthcare, Counterpart has been working with the Ministry of Public Health to bring about public finance reforms and budgeting of health policies. They have also been working on establishing universal health coverage with the oversight of a multi-stakeholder committee established by the Ministry of Public Health. PRG-PA aligns with good practices in social accountability by taking both a tactical approach and a strategic approach, using various tools to address and achieve a successful social accountability network of healthcare in Niger.

We evaluated Counterpart’s methodology of creating sustainable programming in Niger by comparing it with a program of similar mission and initiative being implemented by CARE International in Niger. CARE is an international humanitarian organization fighting global poverty and world hunger by working alongside women and girls. Like Counterpart, CARE used the strength of collective action by organizing constituencies of citizens. CARE’s research and evaluation of the characteristics of a successful social movement provide insights for Counterpart in regard to its ongoing efforts to ensure women’s participation in health services in Niger. This framework consists of seven characteristics that together embody a well-rounded and inclusive approach to community action and development.

We found that Counterpart is successful in integrating five of the seven characteristics including having a strong, sustained, and diverse grassroots base; diverse leadership that includes next-generation leaders;  a collective political agenda; successful use of multiple strategies that are mutually reinforcing; and a strong supportive infrastructure, including strong anchor organizations and effective decision-making structures and communication systems. We noted that there are no women rights groups being purposely or specifically involved in Counterpart’s programs. Using CARE’s approach, we conclude that Counterpart could improve their collaboration with women’s rights groups and other social justice groups and their collective capacities of women human rights defenders and their organizations to ensure women’s safety and security. This would prove influential in bolstering political will and support for programs to address issues that overwhelmingly impact women and girls in Niger. These issues include access to maternal and reproductive healthcare, and the targeting of child marriage practices, spousal abuse, and domestic violence.

Citizen feedback of health services is at the heart of Counterpart’s initiatives. However, there is an observable gender discrepancy in the representation at the health forums. Counterpart reports 15.11% of the participants in the forums and committees were women. This is a very low proportion of women compared to the total population of Niger, showing that there is room for improvement in regard to representation. Increased women’s participation can only help healthcare committees, whose main concerns are key issues for women and girls, such as population, fertility, and average life expectancy. Stronger initiatives could be made to ensure not only the inclusion of women, but also the active participation of women at community forums. To do so, the promise of security for women is important. Without efforts to ensure a secure environment, ensuring the representation of women and their voices in the feedback mechanism that is needed in these communities will be difficult.

In order to fill the gaps of health policy in Niger concerning women, there must be more women involved in community assemblies regarding health care so that there can be accurate representation of the population and more advocacy for the much needed maternal and reproductive services and resources.

Counterpart International has been an influential organization in the facilitation of community-led progress in healthcare services in Niger. PRG-PA offers opportunities for individuals to bring about change as leaders within their communities, with Counterpart acting in a training and advisory capacity, helping to establish independent civil society organizations and community-based organizations. They have been successful thus far in establishing sustainable programs that will last after Counterpart’s program ends. However, we recommend that in relation to women’s participation in social accountability for improved health care services in Niger, Counterpart strengthen its initiatives to include more women’s representation, bolster its collaboration with women’s rights groups, and enable security so that women’s voices can be heard in health care policy feedback mechanisms. This should allow for increased policies to address women and girl’s specific health care concerns and issues, including access to quality maternal and reproductive health care, as well as targeting the decrease of child marriage practices, spousal abuse, and domestic violence.


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