Part of MSF's response to Niger's nutritional crisis is to strengthen the local health system. What led to this action?

© Johannes Arlt Click for full view "In just 10 days, we admitted 58 children to our center in Dan Issa and in one week, we admitted 22 to the center in Aguié. These are primarily cases of severe malaria, acute respiratory infections and acute diarrhea. With the recent arrival of the rainy season, the malaria cases have increased sharply."

"There is no free health care in Niger today. As a result of this cost recovery system, many children do not have access to care. We know that this is one of the primary causes of the current crisis, so MSF decided to provide free care for children under 5 years of age in the areas where we are working.

"For three weeks, we have been providing free medicine and are paying a stipend to employees in seven Integrated Health Centers in those areas.

"In addition, during the admission screening for our nutritional programs, we encounter many children who are not malnourished but are in urgent need of hospitalization. However, apart from the already overflowing Maradi hospital, there are no facilities in the region to meet this flood of patients, so we opened two pediatric units in the Maradi region. They serve as referral points for emergency cases that require hospitalization.

"In just 10 days, we admitted 58 children to our center in Dan Issa and in one week, we admitted 22 to the center in Aguié. These are primarily cases of severe malaria, acute respiratory infections and acute diarrhea. With the recent arrival of the rainy season, the malaria cases have increased sharply."

Why do you believe that the lack of access to care is partially responsible for the current nutritional crisis?

"In the rural areas, most families cannot afford to go to the health center when their children are ill. When they have malaria or diarrhea, they usually remain at home and the families turn first to traditional medicine.

"When, two or three weeks later, the children arrive at our therapeutic nutritional programs, they have become severely malnourished as a result of their illness. If the children were treated sooner, we could prevent many cases of severe malnutrition. The lack of access to care is one of the primary causes of this crisis."

© Johannes Arlt Click for full view "Severely malnourished patients can be treated relatively easily without having to be hospitalized."

Do the health centers have the ability to detect and treat malnutrition?

"Nigerien health workers are trained to detect malnutrition. The method they use, more focused on detecting moderate malnutrition, differs from ours, but is efficient.

"According to Ministry of Health statistics, the number of cases of moderate malnutrition in the region is quite high. However, they do not yet have the resources to treat malnutrition. There is a therapeutic food in Niger similar to the Plumpy'nut that we use, but it is not widely available in health centers.

"The Ministry recently set up a protocol and this product should be distributed in all the centers soon. Teams composed of representatives from the Ministry and Unicef have been formed and are visiting our projects. This is important because they will be able to see that with these therapeutic foods, severely malnourished patients can be treated relatively easily without having to be hospitalized."

The crisis is far from over, but given that malnutrition is a chronic problem in the region, can we draw any lessons for the future from this experience?

"Local health authorities have visited our projects and understand that it is not difficult to treat severe malnutrition on an outpatient basis. They must quickly incorporate therapeutic foods and medicine into the health system.

"Furthermore, while it is obviously important to carry out development policies in the area of food security, the system must also be able to function on an emergency basis when a food crisis arises. The system did not function at either level here.

"We have not seen either development or the ability to address the crisis. What we have seen is that selling food at moderate prices did not work. That was not the appropriate response. In a crisis, you've got to distribute massive quantities of free food and make sure that health care is free.

"Finally, we can continue to treat severe malnutrition year after year, but if we really want to address malnutrition, we've got to attack it at the source. We've got to treat people with moderate malnutrition before it becomes severe and make sure that people are treated for illnesses that are often the cause of malnutrition, like malaria and diarrhea."