Health care system
Niger ranks among one of the lowest public health countries in the world, whose public health expenditure per person is $27 per year and infant mortality rate is 248 per 1,000 people, the world's highest. The public health system is limited due to lack of facilities and staff. It consists of 3 levels- National hospital in Niambey, regional hospitals and major health facilities, and primary health care centers. Fourty-six pharmacies and several private hospitals also exist but mostly concentrated in the capital city, Niambey. In 2004, there were only 377 doctors in Niger, a ratio of 0.03 per 10,000 population.

Improving the quality and accessibility of health services is the main target of the government's Poverty Reduction Strategy because Niger lacks most of the basic health provisions and facilities. Cold chain capacity to store vaccines is needed in order to control widespread meningitis incidence, but most of the public health centers cannot use refrigerator due to limited electricity supply. Refrigerators using compressed gas are sometimes used but hardly maintainable because of the high cost. These drawbacks make the supply of vaccines in Niger harder, even with several years of foreign aid.

An unbalanced public health system between rural and urban areas is another limitation in strengthening surveillance system and response against meningitis in Niger. The highest proportion of the population with access to acceptable sanitation and acceptable drinking water is concentrated in the urban areas, 91 percent and 27 percent in urban areas, and 32 percent and 3 percent in rural area, respectively. Unregulated dumping of waste facilitates proliferation of vectors of meningococcal meningitis.

The health system in Niger is in chaos during meningitis epidemics. Routine services such as immunizations at the health center level cease during these periods and special programs such as poliomyelitis or yellow fever immunization campaigns are delayed. Responding to a meningitis epidemic supersedes all other health-related activities because populations are frightened and demand a response immediately. Managing the clinical needs of actual or suspected meningitis cases and educating the public consume all of the health staff's available time. Furthermore most of the reactive immunization campaigns with polysaccharide vaccines are done when the epidemic wave has already passed. Therefore, such campaigns have little to no public health impact, and they are a financial drain on the health systems and economies in Niger.

Reference:
By Jeff Green CNN (2006-05-10). "U.S. has second worst newborn death rate in modern world, report says - May 10, 2006". CNN.com. Retrieved 2010-05-03.

J. Robbins et al, A rebuttal: epidemic and endemic meningococcal meningitis in sub-Saharan Africa can be prevented now by routine immunization with group A meningococcal capsular polysaccharide vaccine. Pediatric Infectious Disease Journal, 2000, 19(10): pp 945-953

M. Laforce et al, The Meningitis Vaccine Project. Vaccine, 2007, 25 Supple 1: A 97-100