Niger’s Health Common Fund: A Strategic Evaluation by AFD

The Health Common Fund in Niger, established in 2006, has mobilized over €91 million to bolster the country’s healthcare policies. A recent evaluation, featured in the Africa section of the French Development Agency’s (AFD) assessment report, highlights the fund’s effectiveness and identifies key areas for enhancement.

In a nation where the healthcare sector faces chronic underfunding, the Health Common Fund emerged as a collaborative initiative led by the Ministry of Public Health, with initial support from AFD and the World Bank. Today, the fund unites six donors and has channeled €91 million between 2015 and 2019.

Objectives and Operational Framework

The fund aims to enhance the health and well-being of Niger’s population, particularly women and children, by aligning with the National Health Development Plan (PDS). Its core mission is to strengthen the government’s capacity to deliver healthcare services nationwide through pooled resources from international partners.

Participatory Evaluation Approach

The evaluation of the fund’s operations and outcomes adopted a participatory methodology, engaging central and decentralized ministry officials alongside all partner organizations. Insights from this evaluation directly influenced the design of AFD’s fourth phase of support for the fund.

Findings revealed that the fund’s relevance has grown over time. It successfully adapted to partner preferences for targeted funding of priority PDS activities while adhering to aid alignment principles. Additionally, the fund fostered strategic dialogue between the Ministry and its partners, though coordination among partners still requires improvement.

Efficiency and Financial Management

The fund is recognized for its exceptional efficiency in financial management, with budgets tripling in 2018-2019 compared to previous periods. Clear and universally accepted procedures were established, enhancing the Ministry’s financial management capabilities. The fund also serves as a reliable and predictable funding source for regional health departments, enabling them to finance annual activity plans.

However, the evaluation identified significant weaknesses in tracking expenditures, achievements, and outcomes. This gap hinders the ability to measure the effectiveness of targeted interventions. The report further emphasizes recurring issues with the top-down planning of the PDS and the inadequacy of its monitoring and evaluation framework.

Key Insights from the Ministry of Public Health

Dr. Abaché Ranaou, Secretary General of the Ministry of Public Health and Strategic Coordinator of the Health Common Fund, shared his perspective on the evaluation’s outcomes:

“To ensure coordinated implementation of successive National Health Development Plans and promote the well-being of the Nigerien population, the Ministry of Public Health, in collaboration with technical and financial partners, established a common donor fund in 2005, operational by 2006. This initiative aims to align partner actions with national priorities, harmonize their interventions, and enhance the predictability and stability of international aid.”

The AFD-led evaluation revealed overwhelmingly positive results. These findings strengthen the confidence of technical and financial partners in the Ministry of Public Health and encourage renewed commitment to the fund, which stands as a national pride benefiting our people.”

While tangible results have been achieved, the evaluation underscores areas needing further refinement. The Health Common Fund must prioritize improvements in communication, programmatic aspects, monitoring, and evaluation. To engage partners and stakeholders effectively, it is crucial to enhance the visibility of actions and highlight the results achieved relative to the resources invested.”