There are grounds for optimism. For example, more than half of the population have access to health facilities within a 5-kilometre radius, and the economy is growing at around 5%, albeit from a low base. Nevertheless, around 46% of health expenditure in the country is ‘out of pocket’. More critically, Niger’s 2006 National Strategy to progress UHC, which focused on revamping free healthcare for pregnant women and children under 5 years, has failed to be properly implemented due lack of funding and weak management, despite having high-level support. To overcome these challenges, a high-level, multi-stakeholder approach is required – a solution the country hopes to facilitate with the support of L4UHC.