Over 10 million children die each year due to preventable causes. The vast majority of child health interventions (vaccination) are delivered via the public sector which is often incapable of assuring access. Capacity building to strengthen public infrastructure requires funding and technical assistance for efficient scale-up; unfortunately child health initiatives and programs are chronically underfunded. Despite a recent 64% increase (2003-6) in overall development aid towards child health, child health funding still comprises a mere 3% of total donor funding. The majority of this funding is earmarked for specific programs rather than true infrastructure capacity building.
68 developing countries responsible for over 90% of all child deaths. In a 2008 report WHO found that few of these countries have made any progress in reducing child mortality.
The Private Sector and Child Survival
Leading Causes of Child Mortality
- Acute Respiratory Infection / Pneumonia
- Diarrheal Disease
- Birth Complications
There is growing evidence that private providers and NGOs are more frequently consulted than public sector health care providers for diseases that cause the majority of child morbidity and mortality. Simply stated, this is already where a vast majority of child health care is being delivered, regardless of income level (see charts below).
The significance of private sector influence on child health is substantial, and goes far beyond service provision. Manufacturers, marketers and distributors both preventive (vitamin supplements, fortified foods) and curative (pharmaceuticals) health commodities are an important part of the private sector response for child survival. Contracting, regulation, social marketing, and training and dissemination of information have all been successfully used in several settings in developing countries to engage the full range of private sector players.
Several studies highlight the potential and success of the private sector in addressing the needs of children in developing settings. There is growing consensus that developing governments with limited resources must focus on stewardship of the private sector to succeed in improving child health. With the proper market incentives and regulatory environments, governments could maximize the growth and effectiveness of the private sector towards improving child health.
Criticisms of private sector child health care include higher cost due to supplier induced demand; neglect of preventive practices; and non-evidence-based practices. There is growing consensus that private pediatric treatment is of poor quality, often inappropriate, unnecessary, and overly costly. While education of providers by itself has been shown to have little or no lasting effect on quality, other more sustained engagement initiatives, incorporating IEC, regular programmatic contact, professional bodies, and adjusted incentives have had measurable effects, though not on a large scale.
Graphs: Percent of children treated in the private sector: richest and poorest quintiles (click on graph to see larger image)
- Commercial distribution networks
- Existing local outlets
- Social Marketing experience
- Fast scale-up
- Counterfeit drugs and goods
- widespread technical limitations
- Focus on curative, responsive care
- Few proven successful interventions
- Monitoring and evaluation difficult