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).
When something goes wrong during childbirth, proximity to care can make all the difference. Danger intensifies when lifesaving care is too far 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 a unique partnership between the Ministry of Health in Niger, local medical NGO Bien Etre de la Femme et de l’Enfant (BEFEN), and international NGO the Alliance for International Medical Action (ALIMA). This partnership is 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, BEFEN and ALIMA in collaboration with the Ministry of Health and Public Hygiene (MSHP) provide 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 newborns. Delivery kits, in addition to supplies for clean delivery, include misoprostol to help prevent severe bleeding after childbirth and azithromycin to reduce the risk of maternal infection.
Between March and August 2026, across Dakoro and Bermo districts in Niger’s Maradi region, more than 33,450 women have already received these kits through the program. In 2027, the program will extend to Aguié District with the aim of reaching more than 82,000 pregnant women each year as the project grows.
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. Community health volunteers and community health workers help identify pregnant women and connect them with kits and information close to home. Husbands also play a key role and there are community discussion groups specifically for them as well. 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 health care 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 densely populated with farmers and merchants. 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, BEFEN and ALIMA can adapt delivery to local realities rather than expecting communities to adapt to the health care system.
From evidence to impact
This ALIMA-led partnership in Niger tackles a challenge that 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?
The work of this partnership 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, and they join an extraordinary group of partners, including The Patchwork Collective, Enlight Foundation, ELMA Philanthropies, and Kirk Humanitarian, that are also supporting the project.
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.