Niger: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is publicly available evidence that Niger does have a national AMR plan in place that addresses the surveillance, detection and reporting of priority AMR pathogens.

The National Action Plan Against Antimicrobial Resistance (2025-2027) is available on the WHO website. The plan covers surveillance, detection and reporting of priority AMR pathogens through a national laboratory network coorindated by the LNR-RAM, the use of standardised systems (WHONET, GLASS and PMP-AMR), multisectoral reporting (via the C-RAM and National Focal Point) and the inclusion of human, animal and environmental components under the One Health framework. ¹

The plan describes an integrated national AMR system encompassing human health (Section 2.1.3, p.8), animal health (Section 2.2, pp.16–17) and environmental (Section 2.3, pp.17–18) surveillance. The plan also outlines national laboratory capacities and infrastructure for AMR pathogen detection through diagnostic testing (Section 2.1.2) and the National Reference Laboratory (Section 2.1.7, p.15). Finally, National coordination and reporting (Section 6.1.1), Global reporting (Section 6.1.2) and Human, animal, and environmental integration (Section 6.1.3, p.30) are part of a tiered reporting system linking local data to global surveillance networks. ²

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

There is publicly available evidence that Niger can test for some priority AMR pathogens, such as mycobacterium tuberculosis, Salmonella spp., Shigella spp., E.coli and S. pneumonia, but not for all 7+1 AMR priority pathogens.

There is publicly available evidence that there is a capability for testing of mycobacterium tuberculosis, Salmonella spp and Shigella spp at the National Hospital of Naimey, E. coli in Niger's Central Livestock Laboratory and S. pneumonia in the Center for Medical and Health Research (CERMES). ³⁴⁵⁶ There is no publicly available evidence that Niger can test for K. pneumonia, S. aureus or N. gonorrhoeae on the websites of the Ministry of Public Health or CERMES. ⁷⁸

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that Niger conducts environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms.

Although Niger's national AMR plan does address environmental detection and surveillance activities related to AMR, such activities are mainly identified as gaps and future actions. There is no systematic monitoring of hospital effluents, abattoir wastewater, or industrial discharges for AMR organisms or residue. Environmental microbiological studies in Niger have mostly focused on fecal bacteria and chemical pollutants, as opposed to systematic AMR detection. While some environmental testing capacity exists (LANSPEX for water, INRAN/universities for soil), AMR-focused monitoring is not institutionalised. Furthermore, the plan explicitly recognises the need to develop regulations, communication, and capacity for AMR environmental surveillance (Section 2.3, p.17). ⁹ The Ministry of Health does not provide any further evidence that Niger conducts environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms. ¹⁰ According to the Joint External Evaluation (JEE) for Niger, conducted in July 2018, there is a need to conduct surveillance activities for antimicrobial residues or AMR organisms at all levels. ¹¹

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is publicly available evidence that Niger has national legislation or regulation in place requiring prescriptions for antibiotic use for humans. However, the same evidence also highlights that there are gaps in enforcement.

The national AMR plan refers to existing legislation (Section 2.1.5, p.14) ¹² that provides legal foundation requiring prescriptions for human antibiotic use in Niger: Law 2022-34 of 11 July 2022 (Public Health & Hygiene Law) establishes rules for prescribing and dispensing List 1 and List 2 medicines, which include antibiotics (Articles 42, 46, 59, 60 and 64, p.p.9, 11) ¹³ and Ordinance 97-002 of 10 January 1997 (Pharmaceutical Legislation, 1997) explicitly requires a medical prescription for dispensing any medicines on List 1, List 2, and narcotics. ¹⁴ The type of antibiotics that require prescriptions is not mentioned.

Despite these laws, the National Action Plan Against Antimicrobial Resistance (2025-2027) makes reference to weak enforcement and an absence of a national antibiotic treatment guideline (Section 2.1.5, p. 14), as well as persistent over-the-counter sales and informal markets for antimicrobials (Section 2.4.2, p. 18). ¹⁵

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is publicly available evidence that Niger has national legislation or regulation in place requiring prescriptions for antibiotic use for humans. However, the same evidence also highlights that there are gaps in enforcement.

The national AMR plan highlights the national strategic plan for the control of veterinary medicines (Plan National Stratégique pour le Contrôle des Médicaments Vétérinaires (PNS-CMMV) 2020–2025). The plan also notes that Niger has a network of veterinary medicine control laboratories (LABOCEL, LANSPEX), but faces challenges with reagents, continuous training, and participation in external quality assurance (Section 2.2, pp.16-17). ¹⁶ Although the national AMR plan does not cite a specific law or ordinance by number, Decree 2011-617 of November 25 2011 stipulates that all antibiotics for animals require prescriptions (Article 27, p.8). ¹⁷ The Joint External Evaluation (JEE) for Niger, carried out in July 2018, also confirms the existence of a law regulating all antibiotic prescriptions and includes animal health. ¹⁸

Despite the existence of a legal framework, the plan acknowledges weak enforcement of veterinary drug regulation (Section 2.4, p.18), irregular supply of veterinary reagents (Section 2.2, pp.16-17), limited data on residues of antimicrobials in animal products (Section 2.2, p.16) and the presence of informal/illegal markets for veterinary medicines (Section 2.4.2, p. 18). ¹⁹

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is publicly available evidence that Niger has national legislation, plans, or equivalent strategy documents for zoonotic disease prioritzation, detection and reporting.

Although Law 2004-048 of 30 June 2004 (Framework Law on Livestock Farming) does not create a national list of priority zoonoses, it creates the legal basis for prioritisation by establishing that the law covers animals, their environment, animal products, and veterinary public health (Articles 1-2, pp.1-2). ²⁰ Rift Valley Fever, Avian influenza, anthrax, brucellosis, and rabies were selected as priorities in 2021 by Niger's ‘One Health’ Committee. ²¹ Law 2004-048 lays out the framework for veterinary inspection and control of animals, slaughterhouses, markets, imports/exports, and foods of animal origin (Article 88, p.32) and provides operational tools for detection and response when disease is suspected (Article 2, p.2). With regard to reporting, the law imposes legal obligations for notification of animal diseases and provides penalties for failure to report (Title IX, pp.34-38). ²²

Niger's May 2013 Strategy for Sustainable Development of Livestock includes sections dedicated to animal health and one of its principal goals is to fight main zoonotic diseases that pose risks to human health (Section 3.5.2, p.47) ²³. The World Organization for Animal Health (OIE), Performance of Veterinary Services (PVS) Gap analysis published in February 2012 states that several programs are in place for zoonotic diseases control, such as the rabies vaccination programme and a program for tuberculosis and brucellosis detection. ²⁴

Neither the August 2024 National Action Plan Against Antimicrobial Resistance (2025-2027) nor the July 2019 Joint External Evaluation (JEE) provide specific, additional evidence that national legislation, plans, or equivalent strategy documents which include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans exist. ²⁵²⁶

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

There is publicly available evidence that Niger has national legislation, plans, or equivalent strategy documents which include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans.

Decree 2011-615 of 25 November 2011 sets out core measures for early detection and spillover risk reduction, such as mandatory notification of suspected contagious animal diseases, sanitary controls, and responsibilities of veterinary authorities (Article 78, p.24). The decree also lists important epidemiological events requiring immediate notification, including the appearance of a disease in the list of notifiable animal diseases, the appearance of a new strain of a listed pathogen, and the appearance of an emerging disease with significant zoonotic potential (Article 77, p.23). ²⁷

Neither the National Action Plan Against Antimicrobial Resistance (2025-2027) nor the 2018 Joint External Evaluation (JEE) provide additional evidence that national legislation, plans, or equivalent strategy documents include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans exist. ²⁸²⁹

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 0

There is insufficient publicly available evidence that national legislation, plans, or guidelines that account for the surveillance and control of multiple zoonotic pathogens of public health concern exist in Niger.

The World Organization for Animal Health (OIE) Performance of Veterinary Services (PVS) Gap Analysis references a previous Livestock Development Program 2011-2013 (PTDE) (p.1) and Programme quinquennal 2012-2016, both of which include objectives for animal health and zoonotic disease surveillance (p.25). Specific priority zoonoses covered include rabies, tuberculosis, and brucellosis, with programs for vaccination, active and passive surveillance, tuberculin testing, and post-mortem inspection (Section III.2.D, pp.52-53). ³⁰ The National Emergency Plan to Prevent and Fight Avian flu in Niger 2007-2010 also provides evidence of a national plan to fight Avian flu. ³¹ There is however no mention of current national legislation, plans or guidelines that account for for the surveillance and control of multiple zoonotic pathogens of public health concern. Neither the National Action Plan Against Antimicrobial Resistance (2025-2027) nor the 2018 Joint External Evaluation (JEE) provide evidence that national legislation, plans, or equivalent strategy documents which include measures for risk identification and reduction for zoonotic disease spillover events from animals to humans exist. ³²³³ There is no further evidence available via the Strategy for Sustainable Development of Livestock 2013–2035 or via the Ministry of Public Health ³⁴³⁵

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

There is publicly availble evidence of a department, agency, or similar unit functioning as a multi-sectoral co-ordinating mechanism dedicated to zoonotic disease that functions across ministries.

Niger has adopted the 'One Health' platform as its national coordinating mechanism, the principal objective of which is to "to coordinate, through a multisectoral and multidisciplinary approach, all health interventions with a view to preventing, detecting, and responding to any event affecting human, animal, and ecosystem health, including zoonoses and antimicrobial resistance" (Sectoin 2.2, p.7). As part of this, an interministerial committee (Comité Interministériel [CI]) "serves as the platform's decision-making body" and comprises multiple ministries, including the ministers in charge of Health, Livestock, Environment and Agriculture (Section 3.3.1, p.10-11). ³⁶

1.2.1e Presence of One Health strategic plan

Score: 0

While there is no evidence of a standalone One Health strategic plan in Niger, the One Health approach has made progress in recent years in the country with the creation of the One Health Committee with a roadmap and efforts to improve multi-sectoral collaboration on risk communication.³⁷

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

There is publicly available evidence that Niger has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency.

An Epidemiological Surveillance Network for Priority Livestock Diseases (RESEPI) has been enacted with support from the Food and Agricultural Organisation of the United Nations (FAO), which involved meeting with livestock owners, private veterinarians and community animal health agents. ³⁸

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no publicly available evidence that Niger has legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners).

Law 2017-28 of 3 May 2017 (Law Relating to the Protection of Personal Data) introduced general data privacy legislation but does not specifically mention the surveillance of owned livestock. ³⁹ Niger's National Action Plan Against Antimicrobial Resistance (2025-2027) describes data flows, focal points, and reporting (national and international) (pp.29–31, 41-43), but makes no reference to privacy, confidentiality, or data protection for owners. ⁴⁰ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, also makes no reference to such legislation and/or regulations. ⁴¹

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is insufficient publicly available evidence that Niger conducts surveillance of zoonotic disease in wildlife (e.g., wild animals, insects, other disease vectors), poultry and livestock.

The National Action Plan Against Antimicrobial Resistance (2025-2027) refers to a framework for national surveillance in cattle and abattoirs (Section 2.2, pp.16-17) and targeted pilot surveillance of Salmonella and E. coli in poultry (Strategic Axis 2, pp. 34–37), but does not include any information about surveillance in wildlife, insects, or other disease vectors. ⁴² The Performance of Veterinary Services (PVS) Assessment for Niger of the World Organization for Animal Health (OIE) reports that surveillance of zoonotic diseases in wildlife appears largely reactive (during rift valley epidemics or avian flu, for example) rather than proactive, ongoing pathogen hunting (Section III.2.B 3, p.13). ⁴³ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, also makes no reference to such legislation and/or regulations. ⁴⁴

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH) in Niger.

The Decree 2011-615 of 25 November 2011 (Decree regulating the policing of domestic animal health) mandates owners to notify the veterinary authority (Article 17, p.7), and orders the authority itself to notify the OIE/WOAH (and ECOWAS, UEMOA) of listed disease events (Article 78, p.24) ⁴⁵. Niger is a listed WOAH member. ⁴⁶ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, also makes reference to an effective system for notifying WHO, FAO, and OIE, in Niger and scored the country 3 (developed capacity) (Section D.3.1, p30). ⁴⁷

1.2.4a Number of veterinarians per 100,000 people

Score: 0

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 0

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is insufficient publicly available evidence that Niger's plans, legislation or regulations include mechanisms for working with the private sector in controlling or responding to zoonoses.

Law 2004-048 of 30 June 2004 (Framework Law on Livestock Farming) makes no reference to cooperating with the private sector, while the May 2013 Strategy for Sustainable Development of Livestock lists the establishment of a sustainable partnership between public and private sectors to control or respond to zoonoses as one of its principal objectives (pp.9,30,46). ⁴⁸⁴⁹ Furthermore, The World Organization for Animal Health (OIE) Performance of Veterinary Services (PVS) Gap analysis recommends the establishment of "active surveillance procedures, involving the private sector more closely, particularly within the framework of the expanded health mandate" (p.19). ⁵⁰ The PVS Assessment of 2019 also confirms that the private sector is not involved in any disease control or response activity. ⁵¹ There is no further evidence of such involvement available through the Ministry of Health. ⁵²

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Niger has facilities in which especially dangerous pathogens and toxins are being tracked, and no evidence of a record with details on inventory management.

Niger has submitted annual Biological Weapons Convention Confidence-Building Measures reports since 2022, but their contents are not publicly available. ⁵³ There is also no additional evidence of such a record through the Ministry of Public Health, and the Verification Research, Training, and Information Centre (VERTIC) Biological Weapons Convention (BWC) National Implementation Measures Database states "no information on biosafety and biosecurity measures was found in publicly available sources". ⁵⁴⁵⁵

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Niger has in place legislation and/or regulations related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed.

Niger presented a National Biosafety Framework in 2005 and adopted Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger), which contains measures aligned with the Cartagena Protocol on Biosafety, but both focus primarily on genetically engineered organisms (GMOs) and Living Modified Organisms (LMOs), respectively, and do not address such requirements. ⁵⁶⁵⁷ According to the Joint External Evaluation (JEE) for Niger, conducted in July 2018, there is no comprehensive biosafety and biosecurity legislation in place, and laboratory biosecurity practices are very limited. ⁵⁸ Niger adopted Law 2017-28 of 3 July 2019 (Law Regarding the Supression of Cybercrime in Niger) which addresses general data protection and online fraud, as opposed to establishing cybersecurity requirements for laboratories or facilities handling dangerous pathogens. ⁵⁹ There is evidence that Niger adopted a National Biosecurity Strategy (Stratégie Nationale en Matière de Biosécurité) in 2020, but this is not publicly available. ⁶⁰⁶¹

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence that an established agency (or agencies) responsible for the enforcement of biosecurity legislation and regulations exists in Niger.

A national biosafety strategy was adopted in June 2020 to coordinate institutional responsibilities and avoid overlapping mandates, while the Convention on Biological Diversity (CBD) National Strategy & Action Plan on Biological Diversity for Niger also refers to biosafety efforts and institutional frameworks. However, neither strategies, or at least the information publicly available, provide evidence of an established agency. ⁶²⁶³ The CBD's 2024 paper "National funding priorities for the period July 2026–June 2030" references a Permanent Secretariat for Biosecurity and a National Biosecurity Laboratory, but both bodies are still yet to be established. ⁶⁴ According to the Joint External Evaluation (JEE) for Niger, conducted in July 2018, there is no evidence of an established agency responsible for the enforcement of biosecurity legislation and regulations in Niger. ⁶⁵ The website of the Ministry of Agriculture and Livestock was under construction at the time of research, while the Ministry of Health does not provide any additional evidence. ⁶⁶⁶⁷

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no public evidence that shows that Niger has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

Niger has submitted reports under UN Security Council Resolution 1540 (including an updated report in July 2020), but the publicly available versions do not describe measures to centralise or minimise the number of laboratories holding high-risk pathogens. ⁶⁸⁶⁹ The Joint External Evaluation (JEE) for Niger, conducted July 2018, reviewed biosafety and biosecurity capacities but did not note any consolidation of pathogen holdings. ⁷⁰

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is insufficient publicly available evidence of capacity to conduct Polymerase Chain Reaction (PCR)–based diagnostic testing for anthrax and/or Ebola, which would preclude culturing a live pathogen in Niger.

Niger's National Ebola Preparedness Plan (2014) makes no mention of PCR-based diagnostics in-country. ⁷¹ According to the “Sampling procedure and sending of blood samples in case of suspected Ebola infection” document (2014) by the Niger Medical and Health Research Centre (CERMES), suspected Ebola samples must be sent to external reference labs (Institut Pasteur Dakar, or Lyon) for confirmation. ⁷² CERMES is also listed as having a “Plateforme PCR” on the Pasteur Network, but its public pages do not document Ebola or anthrax PCR assays. ⁷³

Information available through the Ministry of Health does not reveal any published evidence of PCR assays for Ebola or anthrax in Niger. ⁷⁴ According to the Joint External Evaluation (JEE) for Niger conducted in July 2018, the country has in-country capacity for PCR-based diagnostic testing; however, it is not specified whether this capacity extends to anthrax and/or Ebola. ⁷⁵

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is insufficient publicly available evidence that Niger requires biosecurity training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The Verification Research, Training, and Information Centre (VERTIC) Biological Weapons Convention (BWC) National Implementation Measures Database notes that Niger has criminal laws against biological weapons and regulates transfers, and mentions “training of personnel on biosafety/biosecurity” under its biosecurity/biosafety obligations, but it does not provide evidence that those training obligations are elaborated into a common curriculum. ⁷⁶ Furthermore, Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) focuses mainly on biotechnology/LMOs governance and does not prescribe a standardised laboratory biosecurity training curriculum for high-risk pathogen work. ⁷⁷ The Performance of Veterinary Services (PVS) Assessment for Niger of the World Organization for Animal Health (OIE) confirms that training of veterinary and paraprofessional personnel exists (albeit sporadically for decentralised staff), but concedes there is no national coordination or standardized curriculum and that the curent curricula needs to be revised. Additionally, diseases with pandemic potential like Rift Valley Fever or avian flu are not included in the core curricula at the Institut Pratique de Développement Rural (IPDR). (pp.7,8,49) ⁷⁸ There is no further evidence available via the Ministry of Public Health. ⁷⁹ Lastly, the Joint External Evaluation (JEE), conducted in July 2018, confirms there is no biosecurity training in place for personnel who work in facilities that handle or store highly dangerous pathogens, toxins, or other biological materials with pandemic potential. ⁸⁰

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is insufficient publicly available evidence that Niger has regulations or licensing conditions that specify that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to the following checks: drug testing, background checks, and psychological or mental fitness checks.

Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) does not mention any provisions about screening (background, psychological, or drug) of personnel with access to dangerous pathogens or toxins. ⁸¹ In a June 2020 communiqué from Niger’s Council of Ministers, it was acknowledged that although a National Biosecurity Strategy had recently been established and Law 2019-48 was adopted, there remain “insufficiencies” in the biotechnology/biosafety domain. The National Biosecurity Strategy is, however, not publicly available. ⁸²⁸³

The Joint External Evaluation, conducted in July 2018, confirms that Niger does not have measures in place to enforce personnel reliability screening—such as drug testing, psychological evaluations, or background checks—for individuals working with high-risk pathogens. ⁸⁴ There is no further evidence available via the Ministry of Public Health. ⁸⁵

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is insufficient publicly available evidence that Niger has national regulations on the safe and secure transport of infectious substances (specifically including Categories A and B).

The government has recently promoted the integrated system for transporting biological samples (SITEB) as a "harmonised system for the transport of biological samples, involved in the governance of the sample management system at all levels and communication and management of information". The system aims to "strengthen the national epidemiological surveillance system". ⁸⁶ The August 2024 National Action Plan Against Antimicrobial Resistance (2025-2027) refers to SITEB as "still being set up" (Section 2.1.3, p.14). ⁸⁷ Furthermore, there is no publicly available evidence that SITEB includes a binding, technical A/B rule. Law 2022-34 of 11 July 2022 (Law Determining the Fundamental Principles of Public Health and Hygiene) and the Sanitary Law Compendium of August 2008 are both high-level and do not spell out infectious-substance transport categories. ⁸⁸⁸⁹ Finally, according to the Joint External Evaluation (JEE) for Niger, conducted in July 2018, there is a need to develop guidelines for the safe and secure transport of infectious substances. ⁹⁰

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that there is legislation and/or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential.

Although the United Nations Biological Weapons Convention National Implementation Measures Database states that Niger "regulates the transfer of items that might be relevant for BWC implementation through Article 32 of the Customs Code which provides for measures related to imports and exports of prohibited or restricted goods", it also confirms the absence of "end-user certification requirement for export of controlled items". ⁹¹⁹² Similarly, while Niger’s civil-aviation framework publicly lists national orders on dangerous goods (including providing details on appropriate packaging and sender responsibility) and designates the Niger National Civil Aviation Agency (ANAC Niger) as the competent authority, there is no evidence of end-user screening or that the detailed requirements follow a Niger-specific technical rule, as opposed to the ICAO Technical Instructions. ⁹³⁹⁴ Law 2022-34 of 11 July 2022 (Law Determining the Fundamental Principles of Public Health and Hygiene) and the Sanitary Law Compendium of August 2008 are both high-level and do not spell out cross-border or end-user categories. ⁹⁵⁹⁶ There is no further evidence available via the Ministry of Public Health. ⁹⁷ Finally, the Joint External Evaluation (JEE) for Niger, conducted in July 2018, explicitly states that the country lacks a biosafety/biosecurity legal framework and recommends developing one that includes safe transport of infectious materials. ⁹⁸

1.4.1a Biosafety laws/regulations

Score: 0

There is insufficient publicly available evidence that Niger has in place national biosafety legislation and/or regulations.

Niger enacted Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger), which includes provisions covering notification, decision-making, risk management, labeling, transboundary movement, and public participation, among other elements and is designed to bring Niger into compliance with international obligations under the Cartagena Protocol on Biosafety. ⁹⁹ The law “assures biosafety and ethics in research and development in modern biotechnology, the procedure for transboundary movement, and the commercialization of modified living organisms and/or their derived products.” ¹⁰⁰ However, there is no evidence that the scope of the law extends beyond genetically modified organisms. There is no further evidence of broader biosafety legislation available through the Ministry of Health. ¹⁰¹

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is insufficient publicly available evidence that Niger has an established agency responsible for the enforcement of biosafety legislation and regulations.

The Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) establishes a Competent National Authority (ANC) “responsible for regulation and implementation” of the law at the national level (Articles 16, 32). ¹⁰² In September 2021, the Nigerien government signed a ministerial decree that defines the composition, organization and functioning of the National Technical and Scientific Committee on Biosafety (CTSNB), whose role it is to evaluate authorization requests, validate risk management plans, examine dossiers, and make recommendations to the competent minister (in application of Law 2019-48). ¹⁰³ However, there is no evidence that the scope of Law 2019-48 and therefore of the CTSNB extends beyond genetically modified organisms. There is no further evidence of an established agency responsible for the enforcement of biosafety legislation and regulations available through the Ministry of Health. ¹⁰⁴

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is insufficient public evidence that Niger requires biosafety training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) does not mandate a standardised, required biosafety training program and only applies to genetically modified organisms. ¹⁰⁵ There is no further evidence available through the Ministry of Public Health. ¹⁰⁶

The Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not make reference to biosafety training with a standardized, required approach for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. ¹⁰⁷

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Niger has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

Niger has submitted annual Biological Weapons Convention Confidence-Building Measures reports since 2022, but these are not publicly available. ¹⁰⁸ Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) makes no reference to oversight of especially dangerous pathogens, toxins, or dual-use research. ¹⁰⁹ There is no further evidence available via the Ministry of Public Health. ¹¹⁰ Finally, the Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not provide evidence of ongoing research involving especially dangerous pathogens, toxins, pandemic-potential pathogens, or other dual-use research. ¹¹¹

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research exists in Niger.

Niger has submitted annual Biological Weapons Convention Confidence-Building Measures reports since 2022, but these are not publicly available. ¹¹² Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) makes no reference to such legislation. ¹¹³ The decree defining the composition, organisation and functioning of the National Technical and Scientific Committee on Biosafety (CTSNB) is an implementing instrument which envisages that further implementing decrees and measures will be promulgated by sectors and ministries to operationalise its provisions. The decree does not include any evidence of legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research exists in Niger. ¹¹⁴ There is no further evidence available via the Ministry of Public Health. ¹¹⁵ Finally, the Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not identify a national legal regime for regulating research on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. ¹¹⁶

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is insufficient evidence of an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research in Niger.

In the 2018 draft legislature text and project proposal "Draft law on the Biotechnology Safety Regime", there is mention of a National Biosafety Committee (Comité national de biosécurité), comprising public sector, private, research/academic, and NGO representatives, but this has yet to be established. ¹¹⁷ Niger has submitted annual Biological Weapons Convention Confidence-Building Measures reports since 2022, but these are not publicly available. ¹¹⁸ Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) makes no reference to such an agency. ¹¹⁹ The decree defining the composition, organisation and functioning of the National Technical and Scientific Committee on Biosafety (CTSNB) does not include any evidence of an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. ¹²⁰ There is no further evidence of an operational agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research available via the Ministry of Health or Ministry of Environment. ¹²¹¹²² Finally, the Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not identify an agency with such responsibility. ¹²³

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence of legislation and/or regulation requiring the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold in Niger.

Niger has submitted annual Biological Weapons Convention Confidence-Building Measures reports since 2022, but these are not publicly available. ¹²⁴ Law 2019-48 of 30 October 2019 (Law Establishing the Fundamental Principles of Biological Risk Prevention in Niger) does not address the screening of synthesized DNA. ¹²⁵ The decree defining the composition, organisation and functioning of the National Technical and Scientific Committee on Biosafety (CTSNB) does not include any evidence of such legislation and/or regulation. ¹²⁶ There is no further evidence available via the Ministry of Public Health. ¹²⁷ Finally, the Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not identify a national legal regime for regulating research on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. ¹²⁸

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

There is evidence that official foot-and-mouth disease (FMD) vaccination figures for livestock in Niger are publicly available through the OIE-WAHIS database.¹²⁹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

There is publicly available evidence that Niger has a national immunization strategy/plan, which includes a plan to ensure equitable distribution and a strategy specifically aimed at overcoming socioeconomic inequalities, geography, cultural/linguistic differences and/or gender barriers to vaccination.

Niger implemented a Comprehensive Multi-Year Vaccination Plan (PPAC) for 2016-2020, which serves as its national strategic plan for vaccination. The PPAC 2016-2020 states that its goal is to improve access and equity for all to vaccination services (Section 2.2, p.22), although the depth of how equitable distribution is operationalised is not clearly documented. The PPAC includes a Contractualisation Strategy and a commitment to engage civil society organisations (OSC) in community mobilisation and follow-up to vaccination (pp.115,118-119). Promotion of communication via community radios, debates, public shows, theater, religious preaches populations is also documented, however there is no evidence that the plan is still operational, or that a renewed plan has been conceived or implemented. ¹³⁰ The 2024 "Vaccination Horizon 2030" statement refers to "innovative vaccination strategies focused on equity" including in desert, nomadic and insecure zones, as well as in peri-urban areas" (p.3), but does not provide any evidence of a specific plan being in place. ¹³¹ There is no publicly available evidence via the Ministry of Health of a national immunization strategy/plan, which includes a plan to ensure equitable distribution and a strategy specifically aimed at overcoming socioeconomic inequalities, geography, cultural/linguistic differences and/or gender barriers to vaccination. ¹³²

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Niger's national immunization strategy/plan does not include measures to address vaccine hesitancy and build public trust in vaccines.

Niger's Comprehensive Multi-Year Vaccination Plan (PPAC) for 2016-2020 does include measures to address vaccine hesitancy and build public trust in vaccines, but there is no publicly available evidence of an updated plan containing such measures via the websites of the Minsitry of Public Health and the Ministry of Environment, and Sanitation. ¹³³¹³⁴ The Plan contains details trust building measures through community dialogue ("a trimesterly community dialogue session at the level of low-performing health facilities to identify the causes of non-use of services and propose local solutions") (p.115) and engagement with local and trusted messengers, such as religious and traditional leaders through "sermons, commercials, public broadcasts, debates" to understand and resolve barriers (p.115). "Designing and multiplying visual communication media" is also detailed in the PPAC, with the aim of normalising vaccination behaviour (p.115). Within the Plan, an anthropological study on perception and acceptability conducted in advance of the introduction of the HPV vaccine (p.115) indicates an awareness of cultural hesitancy or beliefs. ¹³⁵

1.6.1e National advisory group for immunization strategy/plan

Score: 100

There is a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government in Niger.

Niger has a Technical Consultative Group for Vaccination (GTCV-Niger), which, for example, has issued a recommendation on how to introduce the RTS,S malaria vaccine into the routine immunisation schedule. ¹³⁶ The GTCV is housed within the immunisation division of the Ministry of Health, as evidenced by the minutes from the group's first meeting in January 2020. ¹³⁷ Moreover, Niger self reported having a NITAG to the WHO. ¹³⁸

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no evidence that Niger has an immunization programme for influenza.

The World Health Organisation's Introduction of Seasonal Influenza Vaccine data shows that Niger’s status is “No”. ¹³⁹ The Comprehensive Multi-Year Vaccination Plan (PPAC) for 2016-2020 does not include an immunisation programme for influenza. ¹⁴⁰ The 2025 study by Lagare et al. "The National Burden of Influenza-Associated Respiratory Illness Among Children Aged <5 Years in Niger, 2015–2018" states that currently "Niger has no recommendations for seasonal influenza vaccination". ¹⁴¹ Finally, in 2024 the Gavi Alliance documented recent vaccine introductions in Niger, but influenza was not included. ¹⁴²

1.7.1a Strategy/plan for resilience of health system

Score: 100

There is publicly available evidence that Niger has a strategy or plan to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose, that includes the threat of infectious diseases.

In 2022 Niger introduced the National Climate Change Adaptation Plan, which includes a dedicated Health section with concrete, costed programs for 2022–2026 that targets climate-sensitive diseases and system resilience. The plan aims to "improve availability/quality of care for climate-sensitive diseases and develop an emergency preparedness and response plan" (Section 9.3.16, p.191), "increase financing for climate-sensitive health projects and build capacity in climate finance for the health sector" (Section 9.3.17, p.192), and "strengthen health information and research and create a surveillance and information system that integrates climate data" (Section 9.3.18, p.193). The plan also details how Niger’s climate hazards, such as heat, floods and dust storms drive outbreaks of, for example, malaria, cholera and measles (Section 9.3.16, p.191). ¹⁴³

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

There is publicly available evidence that the Nigerien national laboratory system has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

The Centre for Medical and Health Research (CERMES) in Niamey functions as the national reference laboratory coordinating Niger’s lab network. ¹⁴⁴ The Labo2S project works to strengthen diagnostic and monitoring services for HIV and tuberculosis. ¹⁴⁵. The World Health Organisation's 2024 Niger Annual Report refers to serological testing as part of national programs for prevention of HIV (Section 1.3, pp.7-8,11-12). ¹⁴⁶ There is further evidence that the national laboratory system can perform the above tests, as well as the rapid diagnostic testing for Plasmodium spp. (malaria), polymerase chain reaction (PCR) testing for influenza virus, viral culture for poliovirus (polio), and bacterial culture for Salmonella enteritidis serotype Typhi (typhoid). ^147148149

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no publicly available evidence that Niger has a national plan, strategy or similar document for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.

Although there are disease-specific national preparation and response plans for Covid-19, Ebola and influenza, they do not inlude considerations for testing for novel pathogens, scaling capacity, and defining goals for testing during emergencies. ^150151152 Furthermore, there is no additional evidence available through the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ¹⁵³¹⁵⁴ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not provide any evidence of a national plan, strategy or similar document for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing. ¹⁵⁵ Niger's One Health Platform Governance Manual references the National Action Plan for Health Security (PANSS), describing it as "a comprehensive, multisectoral, collaborative, and time-limited strategic plan" which "aims to strengthen the country's health system and improve its emergency response to public health threats at the human-animal-environment interface" (Section I, p.5). However, the plan itself is not publicly available. The same manual highlights "strengthening the national capacity for rapid detection and confirmation of health events and emergencies" as a One Health objective (Section 2.3, p.7), and states "all areas of monitoring (epidemiological and microbiological, environmental) in terms of human, animal, and environmental health" should be dealt with by a Technical Work Group (GTT) (Section 3.3.4, p.17). The manual does not, however, provide evidence of a specific plan strategy or similar document for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing. ¹⁵⁶

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

There is publicly available evidence that Niger has a national laboratory that serves as a reference facility which is accredited (e.g., International Organization for Standardization [ISO] 15189:2003, U.S. Clinical Laboratory Improvement Amendments [CLIA]).

Niger's Centre for Medical and Health Research (CERMES) has received ISO 15189:2022 accreditation from the West African Accreditation System (SOAC/WAAS). The certificate is valid from 2 Aug 2025 to 1 Aug 2027 and covers molecular biology testing. ¹⁵⁷

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is publicly available evidence that Niger has a national laboratory that serves as a reference facility which is subject to external quality assurance review.

Niger is a member of RESAOLAB, a regional laboratory network, through which its reference laboratory, the Centre for Medical and Health Research (CERMES), participates in laboratory supervision, quality assurance, and external quality assessment initiatives. ¹⁵⁸ The National Action Plan Against Antimicrobial Resistance (2025-2027) states that CERMES conducts external quality assurance by sending cerebrospinal fluid samples and bacterial strains to CDC-Atlanta for external quality control (Section 2.1.7,p.14). ¹⁵⁹ the Joint External Evaluation (JEE) for Niger, conducted in July 2018, states that for programmes such as meningitis, cholera, gastroenteritis, influenza, HIV, and tuberculosis, reference laboratories participate in an external quality assessment programme through the World Health Organisation. ¹⁶⁰

2.2.1a Nationwide specimen transport system

Score: 100

There is publicly available evidence that a nationwide specimen transport system exists in Niger.

Niger's 2024 IHR States Parties Self-Assessment Annual Report (SPAR) scored C.5.1 Specimen referral and transport system 80%. ¹⁶¹ An operational plan for the Integrated System for the Transport of Biological Specimens (SITEB) has been announced, covering 2024-2026, but there is no evidence to confirm that the system has come into effect. ¹⁶² In April 2022, Niger announced the System for Tracking Epidemiological Data and Laboratory Specimens (STELab) to track fluid specimens used in meningitis surveillance and outbreak response. The system uses barcodes to allow tracing of specimens during transport across regions in Niger, but is limited to meningitis. ¹⁶³ Similarly, the Labo2S project, which works to strengthen laboratory diagnostic capacity and the transport of samples of HIV and tuberculosis, is restricted to the aforementioned infectious diseases and “struggles to integrate all the necessary components” (including infrastrcture) to ensure continuity of laboratory services. ¹⁶⁴

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is insufficient publicly available evidence that Niger has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

There is no mention of such a plan in any of Niger's preparation and reponse plans for Covid-19, Ebola or influenza. ^165166167 There is no such evidence via the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ¹⁶⁸¹⁶⁹ Finally, the Joint External Evaluation (JEE) for Niger, conducted in July 2018, doesn’t describe any emergency fast-track authorisation pathway. ¹⁷⁰ The National Action Plan for Health Security (PANSS) is referenced in the World Health Organisation's Cooperation Strategy 2023-2027 (Section 2.4.5), as well as the Health and Social Development Plan for the period 2020-2023 (p.21,49) ¹⁷¹¹⁷² Niger's One Health Platform Governance Manual provides additional information and describes the plan as "a comprehensive, multisectoral, collaborative, and time-limited strategic plan" which "aims to strengthen the country's health system and improve its emergency response to public health threats at the human-animal-environment interface" (Section I, p.5). ¹⁷³ However, the plan itself is not publicly available and therefore does not provide any evidence of rapid authorisation or licensing of laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There publicly available evidence of ongoing event-based and indicator-based surveillance in Niger, but no evidence that the data are being analysed on a daily basis.

Niger employs national, digital health tools such as a Community Health Toolkit, Integrated Supportive Supervision and a Health Management Information System (HNIS), all of which are listed as “systems with functionality or ability to monitor patterns indicative of infectious disease epidemic outbreak, detect and document cases of emerging disease threats, investigate those threats, identify cases, and manage the response”. ¹⁷⁴ Event-based surveillance systems have also been documented as being in place as part of Niger's integrated disease surveillance and response (IDSR) frameworks. ¹⁷⁵ The HeRAMS Niger 2023 baseline report explicitly lists event-based surveillance among the expected services that a health facility should provide (p.20). ¹⁷⁶ High-performing surveillance of acute flaccid paralysis (as part of poliomyelitis monitoring) and notification of meningitis cases (and their performance) have also been documented. ¹⁷⁷¹⁷⁸ The World Health Organisation, however, notes that "strengthening surveillance systems, laboratory capacity, and health facility readiness is critical to enabling early detection, rapid response, and effective case management during health emergencies". ¹⁷⁹ Niger submits surveillance data to the West African Health Organisation. The Situation Summary by Period tables for cholera and ebola, for example, highlight weekly monitoring, but there is no evidence of daily analysis. ¹⁸⁰

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline in Niger.

The establishment of a National IHR Focal Point as a "multisectoral coordination body" and strengthening of communication between the focal point and the World Health Organisation was confirmed at the 76th World Health Assembly (May 2023). ¹⁸¹ Niger’s official State Party Annual Reports (SPAR) submitted to WHO for 2022, 2023 and 2024 show scores for “C2: IHR Coordination and NFP functions,” indicating an operational National IHR Focal Point. The Average Capacities Score was 67% in 2022 and 2023, and 73% in 2024. ^182183184

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

There is publicly available evidence that the Nigerien government operates an electronic reporting surveillance system at both national and sub-national levels.

The World Health Organisation's Team to strengthen preparedness for Ebola December 2014 Niger visit report confirms that the surveillance system integrated into National Health Information System, in turn built on DHIS2, is fed with data from different units, such as the rapid intervention teams, which can quickly intervene in case of an emergency; the Directorate for Surveillance and Response to Epidemics, which is responsible for the preparation and response to epidemics and other health events; and the epidemiological surveillance centres at the district level (pp.7,24). ¹⁸⁵¹⁸⁶ Niger has recently been working on interoperability frameworks and consolidating multiple health digital platforms to feed into a unified data flow. ¹⁸⁷

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 100

There is publicly available evidence that a real-time electronic reporting surveillance system is in place in Niger and data can be disaggregated.

Niger uses DHIS2—configurable to analyse data by age, sex, and geography—for public-health surveillance and has integrated it with STELab. Since it integrates DHIS2, STELab can provide real-time, disaggregable case and specimen data and the success of its integration into DHIS was highlighted during Niger’s 2024–25 meningitis response. ¹⁸⁸¹⁸⁹

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within Niger. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 16 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.¹⁹⁰

A published study focused on AMR surveillance from wastewater by leveraging wastewater sample collection routinely conducted by the national polio surveillance program.¹⁹¹

According to research, Niger began ES in Africa in 2014.¹⁹² In 2016, under the Polio Environmental Surveillance Expansion Plan (PESEP), the GPEI began initiating ES implementation in six new countries (Burkina Faso, Cameroon, Chad, Guinea, Madagascar and Niger).¹⁹³

That being said, in 2024, the WHO and GPEI reported that Niger has engaged in ad-hoc ES, notably in 2020, 2022, 2023 and 2024. The report states that "while there has been substantial expansion of the environmental surveillance network, there are still gaps in site quality, including in areas with high transnational populations. Focused action is needed to address gaps and ensure high quality surveillance at all levels."¹⁹⁴

2.4.1a Common usage of electronic health records

Score: 50

There is publicly available evidence that electronic health records are in use in Niger. However, there is no publicly available evidence that their use is common.

Niamey’s Hôpital Général de Référence, the largest hospital in Niger, adopted a modernisation policy which includes digitising patient files, but such an initiative is isolated and does not extend beyond this hospital-level example. Details on the timeframe of the implementation of the modernisation policy are not available through the Hospital's website. ¹⁹⁵¹⁹⁶ A country portfolio for Niger (2022-2026) published by the Belgian Development Agency ('Enabel'), an organization that implements Belgium’s governmental international cooperation, includes targets where electronic patient records are functional in targeted sites (p.138), indicating project-bounded electronic health record capability rather than nationwide scale. ¹⁹⁷ Niger’s National e-Health Strategy (2019–2023) documents ambitions for digital health, but does not evidence implementation of national electronic health records. ¹⁹⁸ Health information systems for data reporting and program-specific digital health tools are more predominant in Niger, as opposed to patient-level electronic health records. ¹⁹⁹²⁰⁰

2.4.1b Public health system access to individual electronic health records

Score: 0

The national public health system in Niger does not have access to electronic health records of individuals in the country.

Niger’s National e-Health Strategy (2019–2023) states there is no national electronic health record project, only limited pilots in Gaya et Gothèye (p.41). ²⁰¹ Niger's Medical and Health Research Centre (CERMES) and Ministry of Public Health do not provide any additional evidence of electronic records of individuals in the country being accessible to the public health system, nor do the preparation and reponse plans for Covid-19, Ebola or influenza. ^{202203204205206}

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no publicly available evidence that Niger has data standards to ensure data is comparable since electronic health records are not commonly in use.

Niger’s National e-Health Strategy (2019–2023) states there is no national electronic health record project, only limited pilots in Gaya et Gothèye (p.41). ²⁰⁷ Niger's Medical and Health Research Centre (CERMES) and Ministry of Public Health do not provide any additional evidence of electronic health records, nor do the preparation and reponse plans for Covid-19, Ebola or influenza. ^{208209210211212}

2.4.2a Data sharing mechanisms

Score: 100

There is publicly available evidence of established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance in Niger to share data (e.g., through mosquito surveillance, brucellosis surveillance).

Since 2022, Niger has a formal One Health Platform with an Inter-ministerial Committee, a Technical Committee, a multisectoral secretariat, and dedicated working groups, including 'Surveillance'. The Technical Committee’s mandate explicitly includes disseminating health alerts and producing standardised quarterly reports circulated to all participating ministries (Section 3.3.2, p12). The platform's governance manual lists the Director of Fauna (from the Ministry of Environment) among the Technical Committee rapporteurs and participants (Section 3.3.2, p13). ²¹³ Furthermore, the Ministry of Agriculture and Livestock’s veterinary services issue monthly Epidemiological Surveillance Network of the Livestock Sector (RESEPI) bulletins that track priority zoonoses, including brucellosis. The June 2024 RESEPI bulletin notes a regional One Health team collaborating on an avian-influenza investigation (p.3). ²¹⁴

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

There is publicly available evidence that Niger makes de-identified health surveillance data on infectious diseases publicly available via reports (or other format) on government websites.

The Ministry of Agriculture and Livestock’s veterinary services issue monthly Epidemiological Surveillance Network of the Livestock Sector (RESEPI) bulletins through the PRAPS II website that track priority zoonoses and provide aggregate case counts, lab results and trends. The monthly publications are available from July 2023. ²¹⁵²¹⁶ The Ministry of Health publishes the Niger Health Statistics Directory, which compiles data from all levels and includes surveillance data (Section 4.11), but these are retrospective and aggregated. ²¹⁷ The Ministry of Health's National Malaria Control Program has worked to consolidate malaria data into a National Malaria Data Repository (NMDR) to streamline malaria data, but there is insufficient evidence that the platform is publicly available. ²¹⁸ Additionally, Niger submits data to the West African Health Organization for publication on its "Outbreak Dashboard". ²¹⁹

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is publicly available evidence that Niger has legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities.

Niger has general personal-data protection legislation (Law 2022-59 of 16 December 2022) that applies to public authorities and private entities processing identifiable information, which states that "the processing of personal data is confidential" (Article 81, p.38) ²²⁰ Health data is included as personal data and defined as "any personal data relating to the physical or mental health of a person, including the provision of health care services that reveals information about the past, present, and future health status of that person" (Article 1, p3). ²²¹

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no publicly available evidence that legislation and/or regulations safeguarding the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, include mention of protections from cyber attacks (e.g., ransomware).

Niger has a general personal-data law (Law 2022-59, as amended by Law 2023-31) that covers all personal data and treats health data as sensitive, but protections from cyber-attacks (e.g., ransomware) are not mentioned. ²²²²²³ Ordinance 2024-28 of 7 June 2024 (Ordinance amending Law 2019-33 of July 3 2019 on the suppression of cybercrime in Niger) criminalises cybercrime and addresses unlawful acts, but is not health-specific. ²²⁴ There is no additional evidence available via the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ²²⁵²²⁶

2.4.5a Cooperative commitments or agreements within regions

Score: 50

There is publicly available evidence that the Nigerien government has made a commitment via public statements, legislation and/or a cooperative agreement to share surveillance data with other countries for only one disease during a public health emergency.

At the 76th World Health Assembly, Niger delivered an official statement regarding its commitment to the International Health Regulations (2005). ²²⁷ The country is therefore required to notify the World Health Organisation of events that may constitute a Public Health Emergency of International Concern and to share relevant information internationally (Article 6,p.12). ²²⁸ This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries.

Within the Lake Chad Basin, the 2024 plan for polio eradication calls for “regular sharing of vaccination and disease surveillance data between all partners and neighboring countries” (p.2) and sets up coordination channels between neighbouring health authorities (p.11). ²²⁹

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no publicly available evidence that Niger has a national system in place to provide support at the sub-national level (e.g. training, metrics standardization and/or financial resources) to conduct contact tracing in the event of a public health emergency.

Niger has mobilised ad-hoc mechanisms during emergencies, such as "strengthening contact tracing of travellers during COVID-19" and using a community-based surveillance network adapted from the polio program, but such measures are reactive and event-specific, as opposed to a standing national system. ²³⁰²³¹ The World Health Organisation has previously sent surge teams to support Niger during cholera epidemics, who "facilitated contract tracing and health information exchange across borders". Such support would be available in future epidemics, but again is reactive rather than a standing national system. ²³² There is no further evidence of such a system in Niger's One Health Governance Manual or Health and Social Development Plan (PDSS) 2022-2026, or through the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ^233234235236 The preparation and reponse plans for Covid-19, Ebola or influenza also do not provide any evidence of a national system in place to provide support to conduct contact tracing. ^237238239

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is insufficient publicly available evidence that Niger provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support (paycheck, job security) and medical attention.

In response exclusively to Covid-19 the government declared that diagnostic testing and care for COVID-19 patients would be free of charge, waived water and electricity bills for vulnerable households, and instituted an emergency cash transfer program, targeting around 500,000 beneficiaries across eight regions, intended to help households cope with economic shocks from COVID-19. ²⁴⁰²⁴¹ However, there is no evidence that specific wraparound services are in place to enable infected people and their contacts to self-isolate or quarantine in the Covid-19 Preparation and Response Plan, through the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ^242243244

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is insufficient publicly available evidence of a joint plan or cooperative agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency.

In Niger's Covid-19 Preparation and Response Plan, "strengthening of surveillance at points of entry" and "monitoring of isolated and confined contacts" are detailed in Section 5.2. ²⁴⁵ However, Niger’s official State Party Annual Report (SPAR) submitted to the World Health Organisation in 2024 shows limited, developing capacity at points of entry, scoring "C.11.2 Effective public health response at points of entry" 40%. ²⁴⁶ The Ministry of Public Health and Centre for Medical and Health Research (CERMES) do not provide any evidence of an agreement to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency. ²⁴⁷²⁴⁸ The Ministry of Interior also does not provide evidence of such an agreement or plan. ²⁴⁹

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

There is publicly available evidence that an applied epidemiology training program (such as FETP) is available in Niger, but not that resources are provided by the government to send citizens to another country to participate in applied epidemiology training programs (such as FETP).

In 2014, Niger established a Field Epidemiology and Laboratory Training Program (FELTP) with frontline cohorts. The Ministry of Health was a founding partner. ²⁵⁰ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, states that "a multidisciplinary Nigerien team has already benefited from advanced FETP training in Burkina Faso (four epidemiologist doctors, one medical biologist, and one veterinarian) with the support of the West African Health Organisation (OOAS) (Section D4.2., p.32). ²⁵¹ In 2010, an FETP program was established in Burkina Faso, which provides an opportunity for Nigeriens to participate at Ouagadougou University. The program was still active in 2023 ²⁵². However, the Ministry of Public Health and Centre for Medical and Health Research (CERMES) do not provide any evidence that resources are provided by the government to send citizens abroad to participate in such programs. ²⁵³²⁵⁴

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is publicly available evidence that the available field epidemiology training programs are explicitly inclusive of animal health professionals and there is a specific animal health field epidemiology training program offered (such as FETPV) in Niger.

A 2023 African Field Epidemiology Network's (AFENET) publication on Niger’s fourth FETP cohort explicitly states that "three officials from the Ministry of Agriculture and Livestock have received their training completion certificate" (p.2). ²⁵⁵ Furthermore, animal-health professionals in Niger could in 2024 apply with the In-Service Applied Veterinary Epidemiology Training (ISAVET) program. ²⁵⁶

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is no publicly available evidence that Niger has at least 1 trained field epidemiologist per 200,000 people.

The Joint External Evaluation (JEE) for Niger, conducted in July 2018, reports that only six Nigeriens had completed advanced-level FETP (four physician-epidemiologists, one medical biologist, one veterinarian) (p.31). ²⁵⁷ Based on Niger's 2025 population, to achieve 1 field epidemiologist per 200,000 citizens, 131 people would be required to complete FETP. There is no publicly available evidence via the Ministry of Public Health that this threshold has been met. ²⁵⁸²⁵⁹

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 0

There is no publicly available evidence that Niger has an overarching or disease-specific national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential.

The National Action Plan for Health Security (PANSS) is referenced in the World Health Organisation's Cooperation Strategy 2023-2027 (Section 2.4.5), as well as the Health and Social Development Plan for the period 2020-2023 (p.21,49) ²⁶⁰²⁶¹ Niger's 2022 One Health Platform Governance Manual provides additional information and describes the plan as "a comprehensive, multisectoral, collaborative, and time-limited strategic plan" which "aims to strengthen the country's health system and improve its emergency response to public health threats at the human-animal-environment interface" (Section I, p.5). ²⁶² However, the plan itself is not publicly available, and there is no evidence of a publicly available response plan in the World Health Organisation's list of countries that have published such a plan. ^263264265266 The Centre for Medical and Health Research (CERMES) or the Ministry of Public Health also do not provide any further evidence of the plan, or whether it is still being adhered to. ²⁶⁷²⁶⁸ There is evidence of disease-specific national preparation and response plans for Covid-19, Ebola and influenza, but these are no longer in place. ^269270271

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

There is no evidence that Niger has an overarching national public health emergency response plan in place which addresses planning for multiple communicable diseases with epidemic or pandemic potential that has been updated in the last three years.

The National Action Plan for Health Security (PANSS) is referenced in the World Health Organisation's Cooperation Strategy 2023-2027 (Section 2.4.5), as well as the Health and Social Development Plan for the period 2020-2023 (p.21,49) ²⁷²²⁷³ Niger's One Health Platform Governance Manual provides additional information and describes the plan as "a comprehensive, multisectoral, collaborative, and time-limited strategic plan" which "aims to strengthen the country's health system and improve its emergency response to public health threats at the human-animal-environment interface" (Section I, p.5). ²⁷⁴ However, the plan itself is not publicly available, and there is no evidence of a publicly available response plan in the World Health Organisation's list of countries that have published such a plan. ^275276277278 The Centre for Medical and Health Research (CERMES) or the Ministry of Public Health also do not provide any further evidence of the plan, whether it is still being adhered to, or whether it has been updated in the last three years. ²⁷⁹²⁸⁰

3.1.1c One health principles by covering multiple threat types

Score: 0

There is no evidence that Niger has an overarching national public health emergency response plan in place and, therefore, no evidence of a plan that follows one health principles by covering multiple threat types, e.g. antimicrobial resistance, zoonotic disease spillover, biological accidents or deliberate acts.

The National Action Plan for Health Security (PANSS) is referenced in the World Health Organisation's Cooperation Strategy 2023-2027 (Section 2.4.5), as well as the Health and Social Development Plan for the period 2020-2023 (p.21,49) ²⁸¹²⁸² Niger's One Health Platform Governance Manual provides additional information and describes the plan as "a comprehensive, multisectoral, collaborative, and time-limited strategic plan" which "aims to strengthen the country's health system and improve its emergency response to public health threats at the human-animal-environment interface" (Section I, p.5). ²⁸³ However, the plan itself is not publicly available, and there is no evidence of a publicly available response plan in the World Health Organisation's list of countries that have published such a plan. ^284285286287 The Centre for Medical and Health Research (CERMES) or the Ministry of Public Health also do not provide any further evidence of the plan, whether it is still being adhered to, or whether it covers multiple threat types. ²⁸⁸²⁸⁹

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

There is no evidence that Niger has an overarching national public health emergency response plan in place and, therefore, no evidence of a plan that includes consideration of the impact of health equity and/or mechanisms for identifying and considering the needs of vulnerable populations (e.g. lower socioeconomic status, age, minority ethnic groups, etc).

The National Action Plan for Health Security (PANSS) is referenced in the World Health Organisation's Cooperation Strategy 2023-2027 (Section 2.4.5), as well as the Health and Social Development Plan for the period 2020-2023 (p.21,49) ²⁹⁰²⁹¹ Niger's One Health Platform Governance Manual provides additional information and describes the plan as "a comprehensive, multisectoral, collaborative, and time-limited strategic plan" which "aims to strengthen the country's health system and improve its emergency response to public health threats at the human-animal-environment interface" (Section I, p.5). ²⁹² However, the plan itself is not publicly available, and there is no evidence of a publicly available response plan in the World Health Organisation's list of countries that have published such a plan. ^293294295296 The Centre for Medical and Health Research (CERMES) or the Ministry of Public Health also do not provide any further evidence of the plan, whether it is still being adhered to, or whether includes consideratoin of the imapct of health equity and/or mechanisms for identifying and considering the needs of vulnerable populations. ²⁹⁷²⁹⁸

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is no publicly available evidence that Niger has a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response.

Niger’s Health and Social Development Plan (PDSS) 2022–2026 recognises that the private health sector should be engaged more systematically and explicitly mentions "enhancing collaboration with private health structures" as a means of strengthening accountability and partnership with the private health sector. The plan also refers to the establishment of an institutional framework for the identification, planning, and implementation of projects involving public service and private actors in the health sector. (pp.101-102). The plan does not refer to a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response. ²⁹⁹ Epidemic preparedness and response coordination in Niger is organised through the Public Health Emergency Operational Centre (PHEOC), which draws actors from multiple ministries. However, there is no evidence of a formal role for the private sector. ³⁰⁰ There is no further evidence of such a mechanism via the Centre for Medical and Health Research (CERMES), Ministry of Public Health or the national preparation and response plan for Covid-19. ^301302303

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is insufficient publicly available evidence that Niger has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

Niger's national preparation and response plan for Covid-19 referred to social distancing, hand hygiene, cancellation of mass gatherings, and the closure of schools, for example. However, there is no evidence that the plan was applicable to other diseases or has been integrated into a national policy ³⁰⁴. There is no further evidence of a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic at a national level via the the Centre for Medical and Health Research (CERMES), Ministry of Public Health. ³⁰⁵³⁰⁶

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is no evidence that Niger has activated their national emergency response plan for an infectious disease outbreak or completed a national-level biological threat-focused exercise (either with WHO or separately) in the past year.

In September 2025 a nationwide response to diphtheria was launched, but there is no evidence that explicitly states that Niger formally activated its national emergency response plan. ³⁰⁷³⁰⁸ There is no evidence of a national-level biological threat-focused exercise being carried out since that for Ebola in 2015 via Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ^309310311 There is publicly available evidence that Niger conducted a simulation exercise activity in 2023, but the same source does not include any more recent exercises. ³¹²

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no publicly available evidence that Niger in the past year has identified a list of gaps and best practices in response (either through an infectious disease response, after action review or a biological-threat focused exercise) and developed a plan to improve response capabilities.

The World Health Organisation currently lists after action review activities for Niger as 'Planned', with no year specified. ³¹³ There is no evidence that a biological-threat focused exercise has taken place since that for Ebola in 2015, either via the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ^314315316 CERMES and the Ministry of Public Health do not provide any evidence that a plan to improve response capabilities has been developed. ³¹⁷³¹⁸

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no publicly available evidence that Niger in the past year has undergone a national-level biological threat-focused exercise that has included private sector representatives.

There is no evidence that a biological-threat focused exercise has taken place (with or without private sector representatives) since that for Ebola in 2015, either via the Centre for Medical and Health Research (CERMES) or the Ministry of Public Health. ^319320321

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is publicly available evidence that Niger has in place an Emergency Operations Center (EOC).

Niger established a Public Health Emergency Operations Center (PHEOC) (Centre des Opérations d’Urgences en Santé Publique [COUSP]) in 2022. ³²²³²³ The World Health Organisation's Cooperation Strategy 2023-2027 includes reinforcing preparedness, prevention, and response to health emergencies and provides evidence that the PHEOC has been activated (Section 2.4.5). ³²⁴

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is insufficient publicly available evidence that Niger's Emergency Operations Center (EOC) is required to conduct a drill for a public health emergency scenario at least once per year or that they conduct a drill at least once per year.

The World Health Organisation's Cooperation Strategy 2023-2027 references Niger's Public Health Emergency Operations Center (COUSP), but does not document its requirements. ³²⁵ There is also no evidence of a requirement conduct a drill for a public health emergency scenario at least once per year or that it that they conduct a drill at least once per year in Niger's Health and Social Development Plan 2022-2026 or via the Ministry of Health. ³²⁶³²⁷ There is no evidence on the websites of the Ministry of Public Health and the Ministry of Interior that Niger conducts a drill at least once per year. ³²⁸³²⁹ A World Health Organisation Niger country Facebook page mentioned a Plan for Operational Standards Procedures and Strategy (SoPS; plan stratégique et des Procédures Opératoires Standards (SoPs)) in a post on 8 December 2022, however this plan is not publicly available through the websites of Niger's Ministry of Public Health or the World Health Organisation. ^330331332

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no publicly available evidence to show that Niger's Emergency Operations Center (EOC) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario.

The World Health Organisation's Cooperation Strategy 2023-2027 references Niger's Public Health Emergency Operations Center (COUSP), but does not contain any information about whether a coordinated emergency response or emergency response exercise has been conducted within the last year. ³³³ There is also no such evidence in Niger's Health and Social Development Plan 2022-2026 or via the Ministry of Health. ³³⁴³³⁵ A March 2022 United Nations SURGE team scoping mission report discusses "strengthening existing infrastructures such as the recently inaugurated COUSP for a diligent and effective response to emergencies at the regional, national and subnational levels", but does not confirm plans for emergency reponse exercises. ³³⁶

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is insufficient publicly available evidence that public health, animal health, the private sector and national security authorities have carried out an exercise to respond to a potential deliberate biological event (i.e., bioterrorism attack). There is also insufficient publicly available evidence of standard operating procedures, guidelines, memorandums of understanding (MOUs), or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event (i.e., bioterrorism attack).

In 2019 Niger participated in a regional tabletop exercise specifically on responding to the deliberate use of biological weapons, but there is no evidence that the public health, animal health, private sector and national security authorities were represented in the delegation. ³³⁷³³⁸ Niger's One Health Platform Governance Manual sets out structures and procedures for multi-sector coordination and explicitly includes the Ministry of Defence and the Ministry of Interior alongside health, animal health, environment, and the private sector. While the manual covers multi-sector emergency health threats and assigns roles to security ministries and the private sector, it does not represent a standard operating procedures, guidelines, memorandums of understanding (MOUs). The manual does outline "organising simulation exercises to test procedures" as a responsibility of the Technical Work Group (GTT) (Section 3.3.4, p.19), but there does not confirm that a exercise has already been carried out. ³³⁹ The World Health Organisation's Cooperation Strategy 2023-2027 references Niger's Public Health Emergency Operations Center (COUSP), but does not contain any information about an exercise or guidelines to respond to a potential deliberate biological event. ³⁴⁰ The Ministry of Public Health does not provide any such evidence. ³⁴¹ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, references collaboration between public health and national security authorities during public health emergencies, but does not mention standard operating procedures, guidelines, memorandums of understanding or other agreements (Section D.2.1, p.27). ³⁴²

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

There is insufficient publicly available evidence that Niger has in place a risk communication plan that is specifically intended for use during a public health emergency.

Niger’s Ministry of Public Health adopted a strategic communication plan in June 2015 “to support prevention and management of health emergencies,” validated at a national workshop in Niamey. ³⁴³³⁴⁴ Niger's national preparation and response plan for Covid-19 also confirms the presence of an "expert in risk communication and community engagement" and states that there is "a platform for risk communication with a functional integrated communication plan" (pp.8-9). ³⁴⁵ Niger’s official State Party Annual Report (SPAR) submitted to the World Health Organisation in 2024 reports strong capacity for emergency risk communications (score 80 under C.10.1), indicating such a plan is in place within the national emergency framework. ³⁴⁶ Despite this, there is no additional evidence of such a plan being operational and no further details about its scope. The World Health Organisation's Cooperation Strategy 2023-2027 references Niger's Public Health Emergency Operations Center (COUSP), but does not contain any information about a risk communication plan that is specifically intended for use during a public health emergency. ³⁴⁷ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, states there is no risk communication plan specifically intended for use during a public health emergency and explicitly recommends developing and validating one as a priority action under the risk communication capacity area. ³⁴⁸

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

There is insufficient publicly available evidence that Niger's risk communication plan (or other legislation, regulation or strategy document used to guide national public health response) outlines how messages will reach populations and sectors with different communications needs (eg different languages, location within the country, media reach, vulnerable groups and hard-to-reach groups).

While such a plan is referenced in Niger's Integrated Strategic Communication Plan 2011—the implementation of which was confirmed in June 2015—and the country's national preparation and response plan for Covid-19, there is no evidence that a national risk communication plan is currently operational, no further details about its scope and therefore no evidence that it outlines how messages will reach populations and sectors with different communication needs. ^349350351 While the Joint External Evaluation (JEE) for Niger, conducted in July 2018, confirms that the country has the capacity to disseminate information in local languages, it also states that there is no risk communication plan specifically intended for use during a public health emergency and explicitly recommends developing and validating one as a priority action under the risk communication capacity area. ³⁵²

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is insufficient publicly available evidence that Niger's risk communication plan (or other legislation, regulation or strategy document used to guide national public health response) designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.

While such a plan is referenced in Niger's Integrated Strategic Communication Plan 2011—the implementation of which was confirmed in June 2015—and the country's national preparation and response plan for Covid-19, there is no evidence that a national risk communication plan is currently operational, no further details about its scope and therefore no evidence that it designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency. The Covid-19 plan assigns public messaging to the "Cellule gouvernementale de communication" and the 'Commission Communication' under the multisectoral crisis committee, which serves as the government’s public communication interface, but does not designate one specific official as the lead spokesperson and is disease-specific (Section 4, p13.) ^353354355 The Joint External Evaluation (JEE) for Niger, conducted in July 2018, states that there is no risk communication plan specifically intended for use during a public health emergency and explicitly recommends developing and validating one as a priority action under the risk communication capacity area. ³⁵⁶

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is publicly available evidence that in the past year, Niger's public health system has actively shared messages on a regular basis via online media platforms (e.g. social media, website) to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation.

Information regarding a variety of public health matters has regularly been shared online in the last twelve months: outbreak communications and calls to action during Niger’s 2025 diphtheria response; routine and preventive campaigns in relation to measles and yellow fever; warnings against medicines of dubious origin. ^357358359360 State outlet Agence Nigérienne de Presse updates its Facebook page daily, posting regularly about public health matters. ³⁶¹

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicy available evidence that Niger's senior leaders (president or ministers) have shared misinformation or disinformation on infectious diseases in the past two years.

There is no evidence of sharing of misinformation or disinformation by Niger's senior leaders in the past two years via Niger's state outlet Agence Nigérienne de Presse, other main outlets such as the Office national d'édition et de presse, niamey.com, Niger Inter or the Ministry of Health. ^{362363364365366}

3.6.1a Percentage of households with Internet

Score: 50.49

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 35.55

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 33.33

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 75

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that in the past year, Niger has implemented restrictions on export/import of medical goods (e.g. medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak.

Relating to the cholera outbreak which extended to Niger in September 2024, the World Health Organisation "does not recommend travel or trade restrictions to and from the cholera outbreak-affected countries". ³⁶⁷³⁶⁸ There is no evidence of such restrictions via the Ministry of Health, Ministry of Trade and Industry, Ministry of Economy and Finance's quarterly newsletter from June 2025 or Niger's state and main outlets. ^{369370371372373374375}

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is insufficient publicly available evidence that in the past year, Niger has implemented restrictions on export/import of non-medical goods (e.g. food, textiles, etc) due to an infectious disease outbreak.

Although regional authorities imposed a "strict prohibition of all movement of poultry and poultry products" in response to the February 2025 avian influenza outbreak and in line with the World Organisation for Animal Health's policy recommendations, such measures were contained to the affected zone and not cross-border. ³⁷⁶³⁷⁷ There is no evidence of such restrictions via the Ministry of Health, Ministry of Trade and Industry, Ministry of Economy and Finance's quarterly newsletter from June 2025 or Niger's state and main outlets. ^{378379380381382383384}

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that in the past year, Niger has implemented inbound or outbound travel restrictions due to an infectious disease outbreak.

There is no evidence of such restrictions via the Ministry of Health, Ministry of Trade and Industry, Ministry of Economy and Finance's quarterly newsletter from June 2025 or Niger's state and main outlets. ^{385386387388389390391}

3.7.2b Risk-based approach to international travel-related measures

Score: 100

There is sufficient publicly available evidence that Niger uses a risk-based approach to international travel-related measures.

During the Covid-19 pandemic, Niger did employ "classic public health control measures such as […] travelling ban". ³⁹² The Covid-19 national preparation and response plan strongly encourages citizens to "avoid travelling to countries where the epidemic is spreading" (Annexes, p1) and anyone entering from an affected country was "confined to their home or any other suitable location for 14 days". ³⁹³³⁹⁴ Niger also requires proof of vaccination against yellow fever for travellers arriving from any country. ³⁹⁵

4.1.1a Doctors per 100,000 people

Score: 0

4.1.1b Nurses and midwives per 100,000 people

Score: 1.26

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

There is insufficient publicly available evidence that Niger has a health workforce strategy in place (which has been updated in the past five years) to identify fields where there is an insufficient workforce and strategies to address these shortcomings.

The most recent health workforce strategy was the Human Resources Health Plan 2011-2020. ³⁹⁶ Niger's Health and Social Development Plan 2022-2026 diagnoses insufficient numbers and maldistribution of health workers and highlights measures to address shortages, but does not represent a standalone health workforce strategy, itself stating that the 2011-2020 plan "will need to be renewed" (Section 4.2.4, p.60). ³⁹⁷ Furthermore, the World Health Organisation's Cooperation Strategy 2023-2027 lists promoting "the development and implementation of a new human resources development plan" (Section 5.2.1) as a priority. ³⁹⁸ The Ministry of Health does not provide any additional evidence that a health workforce strategy is in place, or that the 2011-2020 has been updated. ³⁹⁹

4.1.1d Health system capacity for essential health services

Score: 0

There is no publicly available evidence of sufficient capacity within the health system to deliver essential health services.

The Joint External Evaluation of IHR core capacities scores the country 1 on this measure and highlights the lack of a plan defining the procedures and decision-making processes related to the dispatch and receipt of medical personnel during a public health emergency as a core obstacle.⁴⁰⁰

The Universal Health Coverage (UHC) service coverage index, which is used to track "reproductive, maternal and newborn and child health; infectious diseases; non-communicable diseases and service capacity and access" scored Niger 35/100 in 2021, highlighting that essential services are not reaching large parts of the population. ⁴⁰¹⁴⁰² Furthermore, the World Health Organisation's 2024-2025 Niger country profile reports that "only 56.66% of the population have access to a health centre within 5 km and less than 38% coverage of essential services". ⁴⁰³ As of April 2025, the density of of physicians and nursing and midwifery personnel in Niger (per 10 000 population) is 0.4 and 4.2, respectively, far below the world (17.2 and 37.7) and African averages (2.6 and 11.3). ⁴⁰⁴⁴⁰⁵

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no publicly available evidence of a plan to ensure continuity of essential health services during a public health emergency in Niger.

In the context of Covid-19, Niger formulated a Family Planning Service Continuity Plan, with strategies to "identify measures/strategies to ensure continuity of family planning services" (p.3). However, the plan is limited to the Covid-19 pandemic and family services. ⁴⁰⁶ The World Health Organisation's Health Cluster reports in 2025 that it "supports the Government of Niger in […] ensuring the continuity of essential health services" during crises, however there is no further information about how this objective will be achieved or whether there exists a dedicated government plan. ⁴⁰⁷

The World Health Organisation's Cooperation Strategy 2023-2027 includes "continuity of essential services during humanitarian crises and health emergencies, including reproductive health and maternal" as a priority to strengthen "capacities for prevention, preparedness, and response to health emergencies" (Section 5.2.2), yet acknowledges a "lack of continuity of essential health services during emergencies" (Section 2.4.5). ⁴⁰⁸ The Ministry of Health also does not provide evidence of a comprehensive plan to ensure continuity of essential health services during a public health emergency in Niger. ⁴⁰⁹

4.1.2a Hospital beds per 100,000 people

Score: 2.02

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

There is insufficient evidence that Niger has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation room/unit located within the country.

During the Covid-19 pandemic, Niger was reported as having "an absence of isolation zones in health facilities", while 39.3% of cases as of 4 July 2020 were "isolated and treated at home". Furthermore, isolation zones were described as "non-existent in healthcare facilties" in Niamey. ^410411412 The Joint External Evaluation (JEE) for Niger, conducted in July 2018, makes reference to two isolation units in the Hôpital Général de Référence in Niamey and a centre for the management of possible Ebola cases in Lazaret, but does not provide any information about their capacity. ⁴¹³ There is no additional evidence of a permanent biocontainment patient care unit and/or patient isolation room/unit via the Centre for Medical and Health Research (CERMES) or the Ministry of Health. Neither source provides any further information on the Lazaret centre. ⁴¹⁴⁴¹⁵

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 100

There is publicly available evidence that Niger has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years.

During the 2024 cholera outbreak, Niger’s health authorities—supported by the World Health Organisation—identified, set up, and operated cholera treatment centres. ⁴¹⁶ Cholera treatment centres are designed to "isolate and treat patients with cholera" (Section 6, p.39). ⁴¹⁷

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

There is publicly available evidence of a national procurement protocol or contract framework in place which can be utilized by the Ministries of Health and Agriculture for the acquisition of laboratory supplies (e.g. equipment, reagents and media) and medical supplies (e.g. equipment, PPE) for routine needs.

Niger's Public Procurement Code, introduced by Decree 2022-743 of 29 September 2022, governs how ministries buy goods and services and includes framework agreements, call-off/indefinite delivery and purchase orders. The decree also includes a derogation for "markets aimed at acquiring, in the event of stock shortages, medicines and essential products used in emergency medicine or during an epidemic" (p.1864). ⁴¹⁸ The National Office for Pharmaceutical and Chemical Products (ONPPC), whose mission it is to "acquire generic essential medicines, medical consumables, small medical equipment, laboratory reagents and strategic health inputs at the best conditions", represents another channel of procurement for the Ministries of Health and Agriculture. ⁴¹⁹ Its website shows that this channel has in 2025 been used for the "purchase of laboratory products and consumables". ⁴²⁰

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 33.33

There is publicly available evidence of a stockpile of medical supplies (e.g. MCMs, medicines, vaccines, medical equipment, PPE) for national use during a public health emergency in Niger.

The Joint External Evaluation (JEE) for Niger, carried out in July 2018, confirms existence of such a stockpile for national use during an emergency response (p.33). ⁴²¹ The National Office for Pharmaceutical and Chemical Products also provides "distribution of high-quality medicines to the last kilometer of the national territory through a network of three depots and forty-three popular pharmacies". ⁴²²

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There insufficient publicly available evidence that Niger has a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency.

The Joint External Evaluation (JEE) for Niger, carried out in July 2018, makes no reference to stockpiles of laboratory supplies. ⁴²³ There is no evidence of such a stockpile via the Ministry of Health. ⁴²⁴ Furthermore, a Labo2S project document reports "prolonged shortages of laboratory reagents" for HIV and tuberculosis. ⁴²⁵ The websites of the Directorate for Surveillance and Response to Epidemics, the National Office of Pharmaceutical and Chemical Products of Niger and the Ministry for Humanitarian Action and Crises Management were all unavailable at the time of research.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is insufficient publicly available evidence that Niger conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency.

The Joint External Evaluation (JEE) for Niger, carried out in July 2018, makes no reference to an annual review of the national stockpile. ⁴²⁶ There is no evidence of such a stockpile via the Ministry of Health. ⁴²⁷ The websites of the Directorate for Surveillance and Response to Epidemics, the National Office of Pharmaceutical and Chemical Products of Niger and the Ministry for Humanitarian Action and Crises Management were all unavailable at the time of research.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is no publicly available evidence that Niger, for national use during a public health emergency, has a plan/agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce medical supplies, a plan/mechanism to procure medical supplies, or a plan/mechanism to expedite medical supplies through points of entry.

The Joint External Evaluation (JEE) for Niger, conducted in July 2018, confirms that there is neither a legal framework for sending and receiving medical supplies nor agreements with manufacturers or distributors for access to medical means during public health emergencies (Section R.3.1., p.39). ⁴²⁸

Niger's National Preparation and Response Plan for Covid-19 acknowledges that there is a need to obtain more medical supplies (p.41), however, there is no evidence of a plan/agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce, procure or expedite through points of entry medical supplies during a public health emergency. The plan also refers to "developing a management plan for public health emergencies at the point of entry" (p.28), but again does not mention a plan/mechanism to expedite medical supplies through points of entry. ⁴²⁹ The National Office of Pharmaceutical and Chemical Products of Niger, Ministry of Health or Medical and Health Research Centre (CERMES) do not provide evidence of any such plans. ^430431432 The websites of the Directorate for Surveillance and Response to Epidemics and the Ministry for Humanitarian Action and Crises Management were both unavailable at the time of research. ⁴³³⁴³⁴

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no publicly available evidence that Niger, for national use during a public health emergency, has a plan/agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce laboratory supplies, a plan/mechanism to procure laboratory supplies, or a plan/mechanism to expedite laboratory supplies through points of entry.

Niger's National Preparation and Response Plan for Covid-19 acknowledges that there is a need to obtain more laboratory supplies (p.41), however, there is no evidence of a plan/agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce, procure or expedite through points of entry laboratory supplies during a public health emergency. The plan also refers to "developing a management plan for public health emergencies at the point of entry" (p.28), but again does not mention a plan/mechanism to expedite laboratory supplies through points of entry. ⁴³⁵ The National Office of Pharmaceutical and Chemical Products of Niger, Ministry of Health or Medical and Health Research Centre (CERMES) do not provide evidence of any such plans. ^436437438 The Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not provide any additional evidence. ⁴³⁹ The websites of the Directorate for Surveillance and Response to Epidemics and the Ministry for Humanitarian Action and Crises Management were both unavailable at the time of research. ⁴⁴⁰⁴⁴¹

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

There is insufficient publicly available evidence that Niger has a system or mechanism for national and subnational levels for emergency logistics and supply chain management.

Law 2017-006 of 31 March 2017 (Law establishing the fundamental principles of civil protection organisation) provides the "fundamental principles of the organisation of civil protection” and assigns roles for prevention, alerting, mobilisation of resources and coordination of relief operations. The law also mandates a relief organisation (ORSEC) plan at departmental and lower levels, intended to organise and coordinate the mobilisation of resources in emergencies, as well as coordination of national resources through relevant ministries. ⁴⁴² However, the law does not provide any evidence of a system or mechanism for emergency logistics or supply chain management. Niger's National Procurement Code does not provide any additional evidence of such a system or mechanism in during emergencies. ⁴⁴³ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, notes gaps in "emergency logistical and supply chain management". ⁴⁴⁴ The websites of the Directorate for Surveillance and Response to Epidemics and the Ministry for Humanitarian Action and Crises Management were both unavailable at the time of research. ⁴⁴⁵⁴⁴⁶ There is no evidence of such a system or mechanism available through UNICEF Niger's January – December Sectoral and Thematic Report. ⁴⁴⁷

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is insufficient publicly available evidence that Niger has a plan, program, or guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency (i.e., antibiotics, vaccines, therapeutics and diagnostics).

The National Office for Pharmaceutical and Chemical Products (ONPPC) describes a national network of depots and pharmacies to make "strategic health inputs available to the last kilometre", but dispensation of medical countermeasures for national use during a public health emergency is not mentioned. ⁴⁴⁸ There is no further evidence of such a plan, program, or guidelines available via the Ministry of Health or the General Directorate of Civil Protection. ⁴⁴⁹⁴⁵⁰ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, acknowledges the absence of a plan that defines procedures and decision-making for sending/receiving medical countermeasures during a public health emergency and lists the establishment of such a framework as a priority. The JEE does make reference to existing elements, such as some vaccine/medicine reserves and ONPPC, but emphasizes that these do not amount to a national MCM dispensing framework (pp.39-40). ⁴⁵¹ The websites of the Directorate for Surveillance and Response to Epidemics and the Ministry for Humanitarian Action and Crises Management were all unavailable at the time of research. ⁴⁵²⁴⁵³

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

There is sufficient publicly available evidence of a plan in place to facilitate workforce surge in an emergency in Niger.

Law 2017-006 of 31 March 2017 (Law establishing the fundamental principles of civil protection organisation) mandates a relief organisation (ORSEC) plan, which organises "the mobilisation, implementation and coordination of actions of all public or private persons contributing to the general protection of populations and the environment". ⁴⁵⁴⁴⁵⁵ Furthermore, Niger has implemented a program to strengthen emergency preparedness and response via a Rapid Response Team (RRT) mechanism, which has been "deployed in four regions of the country, six districts as part of the response to six public health events". ⁴⁵⁶ Niger has also been a WHO SURGE country since 2022. ⁴⁵⁷

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence of a plan in place to receive health personnel from other countries to respond to a public health emergency in Niger.

Niger was a member state of the Economic Community of West African States (ECOWAS); under this agreement, one of the West African Health Organisation's main objectives was "protection of health of the peoples in the sub-region through the harmonisation of the policies of the Member States, pooling of resources, and cooperation with one another and with others for a collective and strategic combat against the health problems of the sub-region" ⁴⁵⁸. Despite this, there is insufficient publicly available evidence that Niger sent or received health personnel to and from other countries during an emergency. Additionally, Niger withdrew ECOWAS in January 2024. ⁴⁵⁹

There is no further evidence of a plan to receive health personnel from other countries available via the Ministry of Health or the General Directorate of Civil Protection. ⁴⁶⁰⁴⁶¹ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, confirms that there is no plan in place to receive health personnel from other countries to respond to a public health emergency in Niger. ⁴⁶²

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is insufficient publicly available evidence of a public plan in place to redeploy—geographically or role-based—existing health personnel within the country.

Niger's Health and Social Development Plan 2022-2026 does discuss human resources for health, but does not provide an explicit description of a systematic internal redeployment mechanism. ⁴⁶³ The National Health Policy of 2015 references a "strategy for the regionalisation of budgetary positions and the participation of local authorities in resource management" (Axis 3, p.12), but again does not provide evidence of a public plan for redeployment. ⁴⁶⁴ The 2012 National Integrated Strategic Plan for Prevention and Control of Chronic Noncommunicable Diseases notes maldistribution and redistribution of resources as a planning challenge by acknowledging that "80% of healthcare workers are located in urban areas". ⁴⁶⁵ The Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not refer to any public plan or formal mechanism for redeploying existing health personnel within the country. ⁴⁶⁶ There is no further evidence of such a plan available via the Ministry of Health. ⁴⁶⁷

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

There is publicly available evidence that the Nigerien constitution explicitly guarantees citizens’ right to medical care. However, there is insufficient publicly available evidence that citizens' right to medical care is guaranteed as free.

Article 12 of the Nigerien constitution recognises a "right to health", while Article 13 states that everyone has the right to "enjoy the best state of physical and moral health" and that the State "sees to the creation of the proper conditions to assure to all, medical services and medical assistance in the case of illness". However, Article 13 also stipulates that "The law determines the modalities for implementing this provision", leaving details such as coverage, cost and eligibility to legislation. ⁴⁶⁸ There is publicly available evidence that free medical care is guaranteed for pregnant women and children up to five years old (p.3). ⁴⁶⁹ The Ministry of Health and the Ministry of Employment and Social Protection does not provide any evidence of guaranteed free healthcare for any other groups. ⁴⁷⁰⁴⁷¹

4.4.1b Access to skilled birth attendants (% of population)

Score: 17.65

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 97.09

4.4.1d Coverage of essential health services through universal health coverage

Score: 16.67

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 75.73

4.4.1f Rate of mortality amenable to health care

Score: 81.33

4.4.2a Guaranteed paid sick leave

Score: 66.67

There is publicly available evidence that workers in Niger are guaranteed paid sick leave, but insufficient publicly available evidence that sick leave is available for mental as well as physical health problems.

In Article 70 of Law 2012-45 of 25 September 2012 (Law establishing the Labour Code of the Republic of Niger) states an employment contract may be suspended "for the duration of the employee's absence in the event of illness duly certified by an approved doctor, limited to six months" (p.12). Article 71 of the same law confirms that the employer is obligated to pay during the period of sickness. The law does not distinguish between physical and mental health problems and therefore does not provide sufficient evidence that sick leave in the case of mental health. ⁴⁷² The Ministry of Health and the Ministry of Employment and Social Protection does not provide any additional evidence that sick leave is available for mental health problems. ⁴⁷³⁴⁷⁴

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is insufficient publicly available evidence that the Nigerien government has issued legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

Law 2012-45 of 25 September 2012 (Law establishing the Labour Code of the Republic of Niger) does not include any information about a commitment to providing healthcare services. ⁴⁷⁵ The preparation and reponse plans for Covid-19, Ebola or influenza also do not provide any evidence of legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency. ^476477478 The Ministry of Health and the Joint External Evaluation (JEE) for Niger, conducted in July 2018, do not reference any such legislation, policy or public statement. ⁴⁷⁹⁴⁸⁰ There is no evidence of such a commitment via Niger's state and main outlets. ^481482483484

4.5.1a Existence of system for communication during a public health emergency

Score: 100

There is publicly available evidence that Niger has a system in place for public health officials and healthcare workers to communicate during a public health emergency.

In its January 2023 Strategic plan for strengthening Public Health Emergency Operations Centres in Member States of Africa and Eastern Mediterranean Region (2023–2027) report, the World Health Organisation African Region recommended the region's Public Health Emergency Operations Centers (PHEOC; Centre des Opérations d’Urgences en Santé Publique [COUSP] in Niger) to adopt "integrated information management systems" to enable "informed interventions and effective response" and reinforce "capability to receive, analyse, display, and monitor incident information (incident-related, operational, and contextual information" (Section 4.3, pp.20-21). ⁴⁸⁵ In an article the following year, it was confirmed that the composition of Niger's response team is "organized around an incident management system housed within the COUSP, enabling it to have effective operational capabilities and to better coordinate response activities with other partners" (Section 3.3, p.114), providing evidence that a system for public health officials and healthcare workers to communicate during a public health emergency had been implemented. ⁴⁸⁶ The United Nations' March 2020 Inter-agency contingency plan for preparation and response to the coronavirus pandemic COVID-19 stipulates that COUSP's incident management system should "strengthen multisectoral coordination with all stakeholders, strengthen risk communication and community engagement and advocate for the mobilisation of additional resources to meet emerging needs" (p.13). ⁴⁸⁷

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is insufficient publicly available evidence that the system for public health officials and healthcare workers to communicate during an emergency encompasses healthcare workers in both the public and private sector.

A World Health Organisation Surge team has previously provided communication support during the 2022 cholera outbreak but there is insufficient evidence that they had access to Niger's integrated information management system. ⁴⁸⁸ The Ministry of Health website and Niger's preparation and reponse plan for Covid-19 do not contain any information about a system for public health officials and healthcare workers to communicate during an emergency that encompasses healthcare workers in both the public and private sector. ⁴⁸⁹⁴⁹⁰. The Joint External Evaluation (JEE) for Niger, conducted in July 2018, does not provide any evidence of such a system. ⁴⁹¹ The United Nations' March 2020 Inter-agency contingency plan for preparation and response to the coronavirus pandemic COVID-19 stipulates the missions of COUSP's incident management system, but does not confirm whether they incorporate both the public and private sector (p.13). ⁴⁹²

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is insufficient publicly available evidence that the Nigerien national public health system is monitoring for and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities.

While the National Strategic Plan to Improve Access to Water, Hygiene, and Sanitation Services in Healthcare Facilities 2022–2026 refers to the risk posed by healthcare associated infections that take place in healthcare facilities, it does not mention a system for monitoring or tracking cases. ⁴⁹³ There is no evidence of such a system via the World Health Organisation's Mid-Term Results Report 2024-2025 or the Joint External Evaluation (JEE) for Niger, conducted in July 2018, which confirms "weak capacity of healthcare facilities to combat nosocomial infections" (Section P.3.3, p.13). ⁴⁹⁴ There is no further evidence available via the National Medical and Health Research Centre or the Ministry of Health. ⁴⁹⁵⁴⁹⁶

4.6.1b Infection prevention and control programme

Score: 0

There is evidence of an infection prevention and control programme in place nationally in Niger, but it is not publicly available.

The World Health Organisation annual reports for Niger for 2023 and 2024 mention the "development of a sustainable infection prevention and control programme plan" (Section 3, p.35) and the "finalization of the National Strategic Plan for the Sustainable IPC Program in Niger for 2024-2028" (Section 2.6, p.41), respectively. ⁴⁹⁷⁴⁹⁸ Although the 2024 annual report identifies "insufficient resources for the implementation of sustainable infection prevention and control strategies in accordance with Niger's 2024-2028 sustainable IPC strategic plan" as a specific challenge (Section 2.7, p.44) and the plan is not yet publicly available, it was confirmed to have been launched in February 2024. ⁴⁹⁹⁵⁰⁰ Niger's Ministry of Public Health has also adopted a National Strategic Plan to Improve Access to Water, Hygiene, and Sanitation Services in Healthcare Facilities 2022–2026, with actions including strengthening infection prevention and control within facilities. ⁵⁰¹ However, the plan does not provide a general infection prevention and control programme beyond health facilities.

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

There is publicly available evidence of a plan to ensure a safe environment in health facilities nationally in Niger.

Niger's Ministry of Public Health has adopted a National Strategic Plan to Improve Access to Water, Hygiene, and Sanitation Services in Healthcare Facilities 2022–2026, with actions including strengthening infection prevention and control within facilities. ⁵⁰²

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is publicly available evidence of a national requirement for ethical review (e.g., from an ethics committee or via Institutional Review Board approval) before beginning a clinical trial.

Niger has a national ethics body called the National Ethics Committee for Health Research (Comité National Ethique pour la Recherche en Santé [CNERS]), which must approve clinical trials before they are performed. ⁵⁰³⁵⁰⁴ The National Ethics Committee for Health Research was established by Decree 2016-644/PRN/MSP (Decree establishing the creation, missions, composition, and functioning of the National Ethics Committee for Health Research). ⁵⁰⁵ News outlets have reported on CNERS activity in 2022, providing evidence that it is operational. ⁵⁰⁶

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no publicly available evidence of an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics in Niger.

There is no information regarding such a process via Niger's pharmaceutical regulator (ANRP), or the National Ethics Committee for Health Research (CNERS). ^507508509 The Ministry of Health and Joint External Evaluation (JEE) for Niger, conducted in July 2018, do not provide any additional evidence. ⁵¹⁰⁵¹¹

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is publicly available evidence of a government agency responsible for approving new medical countermeasures (MCM) for humans.

Decree 2022-915 of 30 November 2022 (Decree approving the statutes of the Nigerien Agency for the Regulation of the Pharmaceutical Sector [ANRP]), replaced the previous Directorate of Pharmacies, Laboratories and Traditional Medicine (DPHL/MT) with the newer Agency for the Regulation of the Parmaceutical Sector (ANRP). ^512513514 The ANRP was introduced to cover "the entire pharmaceutical sector". ⁵¹⁵ Arrêté 315/MSP/P/AS/MF of 29 March 2023 (Arrêté setting the amounts due for fees and other services provided by the Nigerien Agency for Regulation of the Pharmaceutical Sector [ANRP]) confirms "market authorisation" and "clinical trial authorisation" as some of ANRP's responsibilities (Article 2), and includes fees for "the approval of health products for human use" (Article 8). First authorisations, variations, and renewals of medicine and medical devices are also listed as part of ANRP'S costs in the Arrêté's annex. ⁵¹⁶

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is insufficient publicly available evidence of an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public health emergencies in Niger.

There is no mention of an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public health emergencies on the Nigerien Agency for the Regulation of the Parmaceutical Sector (ANRP) wesbite, or in the decree confirming its adoption. ⁵¹⁷⁵¹⁸ There is no additional evidence available through the Ministry of Health. ⁵¹⁹ The West African Economic and Monetary Union's (UEMOA) Regulation 04/2020/CM/UEMOA states "a national authority may rely on another member’s assessment when granting marketing authorisation" (Article 13) and it also allows a “special import authorision […] for public health reasons” (Article 14), but there is no evidence that Niger applies this regulation. ⁵²⁰

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Niger has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁵²¹

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

There is publicly available evidence that epidemics and pandemics are integrated into Niger's national risk reduction strategy.

Niger treats epidemics and pandemics within its multi-hazard National Strategy for Disaster Risk Reduction, which explicitly lists epidemics as a hazard (Section 1.2, p.1) and lists them as an area of application (Section 5.4, p.24). With reference to the cholera and meningitis epidemics of 2013 and 2014, the strategy acknowledges that there were "shortcomings that need to be addressed to better prevent disasters and manage them effectively when they occur" (Section 2, p.2). ⁵²² The World Health Organisation's 2023-2027 Cooperation Strategy for Niger also confirms the creation of the National Strategy for Disaster Risk Reduction (Section 2.1). ⁵²³

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 0

There is insufficient publicly available evidence that Niger has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to public health emergencies.

Niger was previously a part of the Regional Disease Surveillance Systems Enhancement (REDISSE) Project for West Africa, which provided "immediate and effective response in case of emergency". However, the project's website confirms an end date of September 2022. ⁵²⁴ Niger is also no longer a member state of the Economic Community of West African States (ECOWAS); under this agreement, one of the West African Health Organisation's main objectives was "protection of health of the peoples in the sub-region through the harmonisation of the policies of the Member States, pooling of resources, and cooperation with one another and with others for a collective and strategic combat against the health problems of the sub-region". ⁵²⁵⁵²⁶ Furthermore, according to the Joint External Evaluation (JEE) for Niger, conducted in July 2018, Niger is also a "participant in a collaboration agreement among the G5 Sahel countries (Niger, Mali, Mauritania, Chad, and Burkina Faso) for the diagnosis and identification of highly pathogenic agents in case of suspected or declared outbreaks" (Section R.3.1, p.39). However, there is publicly available evidence that Niger has withdrawn from the G5. ^527528529 The Cross-border coordination plan for polio eradication efforts 2024-2025: Chad Basin and Sahel countries calls for “regular sharing of vaccination and disease surveillance data between all partners and neighboring countries” (p.2) and sets up coordination channels between neighbouring health authorities (p.11). However, this does not represent an agreement, protocol or MOU with regards to a public health emergency. ⁵³⁰ There is further evidence available through the Ministry of Health. ⁵³¹

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

There is no publicly available evidence of cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to animal health emergencies in Niger.

The Joint External Evaluation (JEE) for Niger, conducted in July 2018, states that Niger is also a "participant in a collaboration agreement among the G5 Sahel countries (Niger, Mali, Mauritania, Chad, and Burkina Faso) for the diagnosis and identification of highly pathogenic agents in case of suspected or declared outbreaks" (Section R.3.1, p.39). However, it is not specified whether the agreement concerns animal health emergencies and there is publicly available evidence that Niger has withdrawn from the G5. ^532533534 According to the OIE PVS Assessment of 2019, at international level, veterinary services "participate sporadically in meetings or activities" (p.107). The assessment also reports "inexistent cross-border collaboration except in the area of pastoralism (for example agreements between Maradi and Katsina in Nigeria and response/vaccination against anthrax)" (p.75). ⁵³⁵ There is no further evidence available via the Ministry of Agriculture and Livestock or the Ministry of Health. ⁵³⁶⁵³⁷

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

There is publicly available evidence that Niger has signatory and ratification status to the Biological Weapons Convention.

Niger deposited its instrument of ratification on 23 June 1972, with the Biological Weapons Convention entering into force on 26 March 1975. ⁵³⁸

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

There is publicly available evidence that Niger has submitted confidence building measures for the Biological Weapons Convention in the past three years.

Niger has submitted annual Biological Weapons Convention Confidence-Building Measures reports since 2022. ⁵³⁹

5.3.1c Submission of UNSCR 1540 reports

Score: 100

There is publicly available evidence that Niger has provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee).

On the United Nations 1540 Committee National Reports webpage, Niger is listed as having submitted (UNSCR) 1540 reports to the Security Council Committee established pursuant to resolution 1540 (1540 Committee) in 2008 (by note verbale) and 2020. ^540541542

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

There is no evidence that Niger is a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), the Australia Group (AG) or the Proliferation Security Initiative (PSI).

Niger is not listed as a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP) or the Australia Group (AG) on their respective websites. ⁵⁴³⁵⁴⁴ Niger is not listed as a participant of the Proliferation Security Initiative (PSI) on the United States Department of State website. ⁵⁴⁵

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

There is insufficient publicly available evidence that Niger has completed a Joint External Evaluation (JEE) or precursor external evaluation (e.g., GHSA pilot external assessment) and published a full public report in the last five years.

The most recent Joint External Evaluation (JEE) for Niger available on the World Health Organisation website is from 2018. ⁵⁴⁶

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

There is insufficient publicly available evidence that Niger has completed and published a Performance of Veterinary Services (PVS) assessment in the last five years.

The most recent World Organisation for Animal Health (WOAH) Performance of Veterinary Services (PVS) Evaluation (Follow-Up) was published in 2019. ⁵⁴⁷ This is confirmed on the WOAH website. ⁵⁴⁸

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

There is insufficient publicly available evidence that Niger has completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years.

The most recent World Organisation for Animal Health Performance of Veterinary Services (PVS) gap analysis was completed in 2012. ⁵⁴⁹ This is confirmed on the WOAH website. ⁵⁵⁰

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

There is publicly available evidence that Niger has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

In 2023, in response to the gaps highlighted by their neglected tropical diseases (NTDs) scorecard, the Nigerien government established a dedicated budget line for such diseases and contributed $291,000 to cover "operational costs, capacity-building initiatives, certain NTD-related interventions, including supervision and surveillance, and the purchase of essential medicines and supplies" (p.11). In 2024, the Nigerien government "allocated $524,000 in national resources to neglected tropical disease programs" (p.11). A Speak Up Africa report from October 2024 confirms that "the State's Social and Health Development Plan for the period 2022-2026, which aims to ensure that 'the population has universal access to quality social and health services that meet their needs' now takes NTDs into account" (p.11). ⁵⁵¹ The plan itself confirms that "Niger has targeted 10 NTDs" (Section 3.1.8, p.27). ⁵⁵²

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

Neither the Joint External Evaluation (JEE) report nor the National Action Plan for Health Security (NAPHS) allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. Niger does not have a national GHSA roadmap.

According to the Joint External Evaluation (JEE) for Niger, conducted in July 2018, there is "Presence of a budget line for the financing of health security, epidemic, and disaster management activities" (Section P.1.1, p.7). However, the JEE also lists "making national financial resources available for public health emergencies" as a priority. (Section R.1.2, p.35). ⁵⁵³ There is publicly available evidence that Niger's National Action Plan for Health Security was no longer in operation as of 31 December 2023. ⁵⁵⁴ Niger is not listed as a member of the Global Health Security Agenda. ⁵⁵⁵

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no publicly available evidence that the Performance of Veterinary Services (PVS) gap analysis and/or PVS assessment allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps.

Neither the 2019 Performance of Veterinary Services (PVS) Evaluation (Follow-Up) nor the 2012 Performance of Veterinary Services (PVS) gap analysis, conducted by the World Organisation for Animal Health (WOAH) allocated or describe specific funding from the national budget covering a time-period either in the future or within the past five years to address the identified gaps. The 2019 PVS Evaluation (Follow-Up) proposes a technical and financial plan for 2021–2030 "to strengthen veterinary services" (Section I.2, p.8), however this is detailed as a future proposal rather than an approved or budgeted plan. The 2012 PVS gap analysis describes a "five-year investment program for Niger's veterinary services" but this is for the period from 2012 to 2017 (p.5). ⁵⁵⁶⁵⁵⁷

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is publicly available evidence of a publicly identified special emergency public financing mechanism and funds which the country can access in the face of a public health emergency (such as through a dedicated national reserve fund, an established agreement with the World Bank pandemic financing facility/other multilateral emergency funding mechanism, or other pathway identified through a public health or state of emergency act).

Niger is listed as an International Development Association (IDA) borrowing country and is therefore eligible for financial support through the IDA'S Crisis Response Window, which notes that "resources may be used to address public health emergencies". ⁵⁵⁸⁵⁵⁹

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is publicly available evidence that senior leaders in Niger, in the past three years, have made a public commitment improve the country’s domestic capacity to address pandemic or epidemic threats by requesting support to improve capacity.

On 23 October 2024, Niger's Ministry of Health made a formal appeal to the World Health Organisation representative in Niamey for "increased support for pandemic response funds" and confirmed that they had requested resources from the Pandemic Fund for "better prevention, improved preparedness activities and an adequate response to pandemics" (p.1). ⁵⁶⁰

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is publicly available evidence that Niger has, in the past three years, provided other countries with financing or technical support to improve capacity to address epidemic threats. Additionally, there is publicly available evidence that Niger has, in the past three years, requested financing or technical support from donors to improve the country’s domestic capacity to address epidemic threats.

The World Health Organisation's 2023-2027 Cooperation Strategy for Niger confirms the country has provided "support to other countries in the Region through its network of national experts and its national public health and expertise laboratory" (Section 4.2). ⁵⁶¹

There is publicly available evidence that Niger requested oral cholera vaccine from the International Coordinating Group (ICG) in 2024. ⁵⁶² Furthermore, to increase capacity for disease surveillance and epidemic preparedness, UNOPS is also procuring and delivering six equipped mobile laboratories and three equipped veterinary mobile laboratories for the Ministry of Public Health and the Ministry of Hydraulics and the Environment. ⁵⁶³

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 0

There is no publicly available evidence that Niger has fulfilled its full contribution to the WHO within the past two years.

In the World Health Organisation's April 2025 Status of collection of assessed contributions document, Niger is listed as having an outstanding balance of $11,542 from 2024 (Annex 1, p.9). ⁵⁶⁴ The World Health Organisation does not provide any further evidence that those arrears have been paid since the publication of the report. ⁵⁶⁵

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available evidence that Niger has a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organizations and/or other countries that goes beyond influenza.

The Joint External Evaluation (JEE) for Niger, conducted in July 2018, states that "formalised mechanisms for transferring samples to reference laboratories outside the country are limited" and that sample transfer has "not yet been formalised by written procedures" (p.23). ⁵⁶⁶ Niger's Preparation and Reponse to Covid-19 Plan states "Laboratory supplies will be provided through the regional laboratories", while "Quality control of the samples will be ensured by the CERMES Laboratory, Dakar (Pasteur Institute) or other international laboratories" (p.13). However, the plan does not provide evidence of a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials). ⁵⁶⁷ The Pasteur Institue International Network, of which the Niger Medical and Health Research Centre (CERMES) is a member, recently encouraged members "to share data and biological samples within the Network and with external research and public health institutions" (Article 5, p.2), however this does not represent a general policy or legal framework. ⁵⁶⁸ No further evidence is available through the Ministry of Public Health or Centre for Medical and Health Research (CERMES). ⁵⁶⁹⁵⁷⁰

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no publicly available evidence that Niger has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years.

The World Health Organisation has designated the Medical and Health Research Centre (CERMES) a National Influenza Centre (NIC). NICs are "the backbone of the WHO's Global Influenza Surveillance and Response System (GISRS)", the network that implements virus sharing for PIP. ^571572573 Influenza sequence records from 6 October 2025 attributed to Niger appear on GISAID, indicating active surveillance and data sharing, albeit not through PIP. ⁵⁷⁴ CERMES publicly reports trainings on sentinel influenza surveillance, including sampling and transport procedures for specimens, and notes that it houses the national influenza reference lab, consistent with ongoing participation rather than non-sharing. ⁵⁷⁵ There is no further publicly available evidence that Niger has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years via the Ministry of Health, the Medical and Health Research Centre (CERMES) or Niger's state and main outlets. ^{576577578579580581}

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no publicly available evidence that Niger has not shared pandemic pathogen samples during an outbreak in the past two years.

There is no publicly available evidence that Niger has not shared pandemic pathogen samples during an outbreak in the past two years via the Ministry of Health, the Centre for Medical and Health Research (CERMES) or Niger's state and main outlets. ^{582583584585586587} There is however publicly available evidence that Niger has shared such samples, for example during the 2023 polio outbreak, where it sent samples to Ghana, albeit delayed due to the political climate. ⁵⁸⁸

6.1.1a Policy formation

Score: 0

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 34

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 25

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 25

6.1.4a Risk of terrorism

Score: 0

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 25

6.1.5a Presence or risk of armed conflict

Score: 0

6.1.6a Government territorial control

Score: 0

6.1.7a International tensions

Score: 0

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 37.46

6.2.2a UNDP Gender Inequality Index score

Score: 19.59

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 42.7

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 67.1

6.3.1a Adequacy of road network

Score: 0

6.3.2a Adequacy of airports

Score: 25

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 97.28

6.4.2a Change in forest area (percentage points)

Score: 75.17

6.4.3a Natural disaster risk

Score: 0

6.5.1a Total life expectancy (years)

Score: 30.49

6.5.1b NCD mortality rate

Score: 73.12

6.5.1c Population aged 65+

Score: 94.41

6.5.1d Tobacco use (% of adults)

Score: 71.48

6.5.1e Level of adult obesity (%)

Score: 97.66

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 92.13

6.5.2a Access to potable water

Score: 52.93

6.5.2b Access to at least basic sanitation facilities

Score: 15.88

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 22.92

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 1.84

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 0