Paper short abstract:

The feasibility of free public health policies in Niger - mainly thanks to the intervention of several NGOs - tends to favour the emergence of new temporal and geographical inequalities, especially with regard to access to maternal and child healthcare.

Paper long abstract:

In Niger, since 2006, it has been enshrined in law that maternal (namely prenatal) and child healthcare (for children under five years) are free of cost. However, in reality, this regime of free care derives more from the [Nigerien] state's concern with international pressures than from real health promotion for the population health's, especially for women and children. Indeed, since this regime of exemption was put in place state administration has never been able to ensure the allocation of funds which are necessary for its accomplishment. Consequently, at the local level, many health facilities must deal daily with budget problems which affect the quality of services provided to the population, particularly due to the constant lack of medicines and others consumables. In some areas where health facilities are supported by some NGO's - which help to bypass the financial difficulties, particularly through the donation of medicines or the hiring of health workers - the system of free maternal and child healthcare seems to work more effectively. Therefore, the transfer of funds through NGOs involved with the Nigerien health sector has contributed to the emergence of new forms of inequality both temporal (during the time in which health development projects are running) and geographic (not necessarily in the center versus periphery), especially with regard to women and children's access to health care. A case study highlighting these inequalities will be presented.