More than 55% of deliveries in Niger take place outside a healthcare facility. In some remote health districts, that figure rises as high as 74% (source).
Giving birth outside a health facility is not necessarily dangerous in theory. But in practice, danger emerges when something goes wrong, and lifesaving care is too far away to reach in time.
For women in remote parts of Niger, a health center may be kilometers away from home. Flooding, insecurity, lack of transportation, and other barriers can make that distance perilous to cross, especially in the middle of a medical emergency.
Delivery is part of the innovation
The global health sector has produced strong data and evidence about interventions that can improve maternal health, but knowing what works is only part of the challenge. Any intervention can only save lives if it reaches the people who need it, when they need it.
Which means delivery must be part of the innovation.
Enter the Alliance for International Medical Action (ALIMA). In Niger, ALIMA and its partners are putting this principle into practice by designing maternal health care around how women experience pregnancy and childbirth in their communities.
Bringing proven tools closer
With support from Gates Philanthropy Partners, ALIMA provides pregnancy and delivery kits that address several important risks during pregnancy and childbirth.
Pregnancy kits include multiple micronutrient supplements (MMS) to support maternal nutrition and healthier pregnancies. Delivery kits include misoprostol to help prevent severe bleeding after childbirth and azithromycin to reduce the risk of infection. As of 2025, across Dakoro, Bermo, and Aguié in Niger’s Maradi region more than 69,000 women have already received these kits through the program.
But supplying the medicines is only one part of the model. Getting them to women requires a delivery system that extends beyond health facilities.
ALIMA works through Niger’s existing health system and the community networks connected to it. Traditional birth attendants, community health volunteers, and community health workers help identify pregnant women and connect them with kits and information close to home. The kits stay with women as childbirth approaches, so they have them wherever they ultimately give birth.
Trained community workers can also recognize warning signs of complications and help connect women to higher levels of care. The result is a model designed not around healthcare facilities, but around women.
Adapting to how communities live
Reaching women also means recognizing that access can look very different from one community to another.
Bermo, for example, includes a significant nomadic population, while Aguié is predominantly sedentary. A single approach to reaching pregnant women would not necessarily work equally well in both places.
Community “listening spaces” give women and families opportunities to ask questions and provide feedback, helping the program respond to these different contexts. By pairing proven interventions with people who understand how to reach women in their own communities, ALIMA can adapt delivery to local realities rather than expecting communities to adapt to the healthcare system.
From evidence to impact
The challenge ALIMA is addressing in Niger reflects a broader pattern in global health.
Innovation often begins with a scientific advancement: a new medicine, vaccine, diagnostic, or other tool. But its potential becomes real only when it moves from evidence into everyday use.
That requires answering practical questions alongside scientific ones. How does a medicine travel the last mile from a health facility to a woman at home? Who can reach her early in pregnancy and explain how to use it safely? And how does she stay connected to skilled care when she needs it?
ALIMA’s work offers one approach: start with proven interventions, understand the barriers that shape access, and build delivery around the people and systems already serving communities.
The role of philanthropy
As philanthropic donors, we have an opportunity to help bridge the gap between the science that works and getting strong solutions to the people who need them.
Through Gates Philanthropy Partners, donors support organizations like ALIMA that are putting proven health interventions into practice while building the systems needed to deliver them effectively.
Scientific progress gives us more tools to improve health, but tools cannot create impact if they don’t reach the people who need them. Designing for delivery is essential.