In Niger, traditional medicine plays an important role in healthcare as only one third of the population has access to modern health services. Traditional healers include bone setters, blacksmiths, and wanzam or barbers who perform surgeries. Spirit possession rituals conducted by zimas are also an important part of the culture and religion. The health system is underfunded and dependent on foreign aid, with limited resources and poor health outcomes overall.

1. MODERN AND TRADITIONAL HEALTH
NIGER

2. •Population: 14 million
•UNDP Development Index: In 2006 Niger was
ranked 177 out of 177 countries
•Environment:
•Sahel: Semi-desert region with unpredictable
seasonal rains
•In 2005, the population faced a severe food crisis
following a 12 percent decline in agricultural
production due to the 2004 drought.
•Vital Statistics:
•infant mortality rate of 81 per 1,000 live births
• life expectancy of 49 years
•literacy rate of 28.7 percent
•gross primary school enrollment of 54 percent
•Economy: Rain-red agriculture
•46.7 percent of GDP in 2005
•livestock production accounts for about a third
of the value added in the sector
•average per capita income $280
COUNTRY PROFILE

3. •The health system performance is poor:
•limited and unequally distributed human resources
•structural adjustment impeding recruitment
•population/health facilities ratios varying between 8950 and 30 680
•dysfunctional referral and counter referral systems
• only one third of the population has access to health services, with the vast
majority relying on traditional medicine
•Development aid is focused on investments. Overall, it accounts for more than half the
total annual Government expenditure in health, with the Government covering basic
operating expenses
PUBLIC HEALTH
INFRASTRUCTURE

4. •Health system highly dependent on external funding
• National priorities not taken into account by some partners
• Weaknesses in current coordination mechanisms
• Weak capacity for aid absorption.
PUBLIC HEALTH
INFRASTRUCTURE

5. The health system is mainly funded through
external resources
•Between 1994 and 2004, the Government allocated an average 6% of its budget to the health
sector while foreign aid accounted for 27.48% of overall health expenditure (around US$ 26 million,
i.e. 71% of Government health In terms of expenditure per inhabitant, investments remain low at
US$ 7.82 in 2004.
•Several bottlenecks impede community participation:
•insufficient information and training, poor management
•transparency and lack of care and provision to
the poorest segments of the population.
•Mutual health organizations are only
beginning to develop and private health
insurance schemes cover less than 1% of the population.
PUBLIC HEALTH
INFRASTRUCTURE

6. •In Niger, candidates for the license to practice traditional medicine are
assigned to the National Hospital in Niamey, where they practice under the
supervision of the Chief Physician
• Once satisfied with the skills of the traditional medicine practitioner, the Chief
Physician then recommends that the Ministry of Public Health and Social
Affairs issue a license.
LICENSING
TRADITIONAL MEDICINE

7. 1. Hausa 53%
2. Djerma (Zarma) 21%
3. Fulani 7%
4. Tuareg 11%
5. Beri Beri (Kanuri) 6%
6. Arab, Toubou, Gourmantche 2%
ETHNIC GROUPS

8. “Among the Tuareg people in the Air Mountain region of Niger, women are sometimes
possessed by spirits called ‘the people of solitude’. The evening curing rituals of the
possessed, featuring drumming and song, take place before an audience of young men
and women, who joke and flirt as the ritual unfolds.”
•Nomadic Group
•“White” & “Black” Toureg peoples
•Slavery, caste-system, or misconception?
•Often missed by government and non-government health & education programs
•Leads to sporadic bouts of violence and protest in the North
•One of the reasons for Niger’s recent governmental decentralization
TOUREG RITUAL

9. “Some of the essays in Modernity and Its Malcontents address familiar anthropological
issues—like witchcraft, myth, and the politics of reproduction—but treat them in
fresh ways, situating them amidst the polyphonies of contemporary Africa. Others
explore distinctly nontraditional subjects—among them the Nigerian popular
press and soul-eating in Niger—in such a way as to confront the conceptual limits of
Western social science. Together they demonstrate how ritual may be powerfully
mobilized in the making of history, present, and future. .”
•Sedentary Group
•Ethnic Majority
•Located in Eastern Niger
•Zinder was the capital of the ancient Damagaram empire,
the country moved the capital to the Western Zarma city of
Niamey due to water shortage
•This move is cause for significant Zarma-Hausa
tension
HAUSA RITUAL

10. “While Rain Dances are persistent rites in the ecologically fragile environment of the
Sahel, their success depends upon the absence of dissension within and among the
World of the Spirits and the Social World. This linkage is dramatically exposed during
the efforts to end the terrible drought of 1984. As intrusive values and changed social
conditions alter the ancient relationship between the community and the
ancestors, Songhay attribute such catastrophes to the failure to honor that
relationship.”
•Sedentary Group
•The Zarma people are descendents of the historically powerful
Songhay Empire (having traveled East from Mali)
•The French chosen “Bouguoise” under-class
•Located in Western Niger
ZARMA RITUAL

11. “The Zarma designation of malaria is Heemar-ize. Heemar-ize means product or
child of the harvest period or rainy season, during which people fell ill with malaria.”
MALARIA

12. MALARIA

13. “Weyno is inherent in the person, congenital. As one tradipractitioner stated, ‘everyone
has weyno’. Weyno is said to originate in the lower stomach. When provoked, due to for
instance a change in food habits, weyno ‘rises’ and causes the person trouble such as
loss of appetite, fatigue and headaches. Consequently, as one interviewee pointed out,
one is never cured of weyno, it is only ‘calmed’, ‘the illness lies down’.”
WEYNO

14. Tootosi: Zarma for Bilharzia
• The designation of bilharzia as tootosi is recent. In the past tootosi designated
primarily urinary problems, pain and urinating blood, seen as a manifestation of
weyno
BILHARZIA

15. Street Vendors
•One of the most common sources of medication
•Unregulated
•Sold on the street and in markets by petty traders
•Often the cause of death and morbidity
•Many drugs fabricated in Nigeria
•In Nigeria and neighboring countries the traffic
of imitation drugs and medicine sold beyond their
expiry date accounts for as much as 70% of the
market
•Unregulated
•Directions in English (unreadable even to
fluent English speakers)
•Old
‘PHARMACIE PAR TERRE’

16. “The Zima is the priest of the cult of the holey, a spirit possession cult that lies at the
heart of Songhay-Zarma religion. In his seminal work on Songhay religion and magic
Rouch describes the cult of the holey as the most important manifestation of Songhay
religion. The spirit possession cult with its public rituals and wide geographical reach has
replaced older private and localised ancestor worship cults. External influences, such as
neighboring cults and Islam, have been incorporated into the cult of the holey. The
spirits (the holey) control the forces of nature and are the masters of the human world.”
ZIMA

17. “The Marabout can have many different religious, social and therapeutic functions.
Wall, in his study of health and illness among the Hausa in Nigeria, points to the
multiple functions of the marabout as a counsellor, diviner, astrologer, fortune-teller,
spiritual adviser, pharmacist and physician. The marabout, through his ability to read the
Koran, has access to the realm of Islamic thought and to its secrets and spiritual power.
Rouch points to the perception in Songhay-Zarma
country of marabouts as learned men with magical
powers . The marabout is consulted in quite diverse
matters and he is called upon in all human activities,
such as illness, harvest, war, glory, travel and wealth.”
MARABOUT

18. GRIS GRIS

19. GRIS GRIS

20. GRIS GRIS

21. GRIS GRIS

22. WANZAM

23. “The ‘target groups’ interviewed included married women and
men, elders, youths, local chiefs, ambulant medicine vendors, vendors of plants and
local remedies, nurses at the local dispensary, nuns at the confessional dispensary,
marabouts (Islamic priests and scholars) and zimas (the priests of the spirit possession
cult). Direct observation was done in the local public dispensary, in the confessional
dispensary, during a spirit possession ceremony as well as with ambulant medicine
vendors. ”
•Like the vendors of pharmaceuticals, ambulant vendors of medicinal plants come
to Saga to sell. Some wheel a small cart full of plants and others carry baskets. They sell
bunches of dried leaves, roots and bark from medicinal plants. The prices vary from 25 CFA to 100
CFA per bunch. The vendors are not herbalists as they do not diagnose and treat illnesses, they
merely sell medicinal plants and indicate how they should be used.
LAHIYA VITESSE AND
THE QUEST FOR RELIEF

24. •Some of the traditional healers are specialists in one particular therapeutic area. For
instance, the bone setter heals fractures and the blacksmith (forgerons) heals burns. The
wanzam or barber is a kind of traditional surgeon who in addition to shaving and
cutting hair also performs specialized surgery, such as circumcision, bloodletting and
ritual and therapeutic scarifications
•The yenaandi is held in each village at the end of the hot-dry season in order to ensure
a good rainfall and a bountiful harvest. Occasional ceremonies are held for individual
members of the spirit possession troupe, for instance in the case of illness or death.
LAHIYA VITESSE AND
THE QUEST FOR RELIEF

25. AY SAABU!
NA GOODIYA
THANK YOU!