Table 5. Barriers and related solutions identified by caregivers in Niger.

Financial	Identified barriers:	Lack of money
		Cost of medicine on prescription (direct and indirect)
		Limited empowerment of women (economically)
	Suggested solutions:	Economically empower women (small-scale businesses for women were raised as a solution to financial constraints more often in Madarounfa than in Kollo)
Distance and location	Identified barriers:	Distance (in villages with no health post)
		Location (far from pharmacy, particularly for villages with no health post)
		Lack of transport
		Limited outreach
	Suggested solutions:	Establish health posts in villages that currently do not have one and ensure they have a reliable supply of free medicine to overcome challenges of access associated with onwards referral to a pharmacy
		Expand routine outreach services and improve the support for health workers to provide these services
		Expand the role of relais so that they continue to provide health education and support, but also carry out tracing and follow up, and actively encourage uptake of health services
Socio-cultural and gender dynamics	Identified barriers:	Lack of support and responsibility from some male household heads in care-giving and care-seeking
		Use of traditional practices including plant medicine and spiritual healers
		Limited empowerment of women (socially)
	Suggested solutions:	Parallel to the social and financial empowerment of women, encourage men to take responsibility and provide adequately for their wives and children
		Promote greater involvement of the village chief and local leadership structures to ‘lead by example’
		Encourage health facility attendance whilst educating the community not to be reliant on local healing practices such as plant medicine or traditional and spiritual healers
Knowledge and information	Identified barriers:	Limited knowledge of causation, prevention and treatment (diarrhoea and pneumonia)
		Lack of strategic and targeted health education at community level
		No relais in villages with no health post
	Suggested solutions:	Recruit and train more male relais to encourage engagement with fathers and household heads, and to provide a positive role model for male members of the community
		Conduct regular health education activities targeted at fathers and household heads (separately from women)
		Conduct regular health education activities for women in their homes
		Support the work of relais who are important sources of information and are very helpful, both in terms of delivering key messages, and supporting care giving and care-seeking
Health facility deterrents	Identified barriers:	Perception that health post is understaffed
		Restricted opening times, particularly at night
		No admission and limited services
		Supply-side issues (lack of drugs, equipment and diagnostic capability; limited tracing and follow-up)
	Suggested solutions:	Ensure a reliable supply of drugs at the health post, particularly free medicine for children under 5
		Support community investment in the health post
		Introduce incentives (such as plumpy nut distribution) to encourage attendance
		Provide adequate resources to health workers and relais (accommodation and transport for outreach)