Niger’s Service Delivery Transformation: From Medicine Shortages to Reliable Health and Education Outcomes

In Dan Gaourou, a village in Niger’s Maradi region about 600 kilometers from the capital Niamey, Salamatou Hassan remembers when sick children had nowhere to turn. “In the past, our children suffered from many diseases whose causes we often did not know,” she recalls. “We tried to see the doctor at the health center, but sometimes the center had no staff or medicines. Our children stayed unwell, and sadness filled our homes.”

A mother of three who farms and raises livestock, Salamatou represents most families in her community whose wellbeing depends on reliable access to basic services. For years, that reliability was absent: health centers ran out of essential medicines, schools opened without exercise books or textbooks, and teachers and health workers were in short supply, often reluctant to be posted in remote areas far from the capital.

The immediate impact is severe: when essential medicines are out of stock, seeking treatment becomes extremely difficult, especially in areas with too few health workers. In education, overcrowded classrooms and limited learning materials mean children share what they can, and teachers work with fewer tools than they need.

“When the health center has what our children need, we can focus on our work—and our children can recover faster and return to school,” Salamatou says.

To address these challenges, the Government of Niger, with support from the World Bank, launched the Public Sector Management for Resilience and Service Delivery Program in 2022. Using a Program-for-Results approach, the program ties funding to concrete, verifiable achievements rather than simply directing funds toward inputs.

Budget releases to the Ministries of Health and Education now translate into real purchasing of supplies, staffing where needed, and clearer visibility for local offices. Over three years, results have been striking: average stockout days for essential medicines in health centers fell from 16 days in 2022 to just 5 days in 2025. School supplies procured rose from 839 tons in 2023 to 2,031 tons in 2025—a 142% increase.

Since 2022, the program has mobilized an estimated 5,958 temporary workers across Niger for procurement, transport, and delivery duties, increasing from 1,248 in 2022 to 1,770 in 2025. In the Maradi region alone, an estimated 340 people were mobilized in 2025 for unloading medicines and vaccines. These temporary surge-support roles demonstrate how strengthening public systems can create immediate local employment while improving essential service reliability.

“When the health center has what our children need, we can focus on our work—and our children can recover faster and return to school,” Salamatou says.

The program also supports better management of staff deployment, including clearer and more transparent mobility criteria for teachers, ensuring underserved areas are not left behind.

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