Nearly two million children die each year from diarrheal diseases, which account for nearly 20 percent of the deaths of children under five. Development advocates say much more can be done to bring those numbers down. But there's one problem: governments are focusing instead on other diseases that, while serious, kill fewer children than diarrheal illnesses.
In May, two development organizations, WaterAid and PATH, both issued reports outlining the problem and calling for change. They want governments and donors to recognize the seriousness of diarrheal diseases and to increase financial support for fighting the problem.
Too little too late
They say between 2004 and 2006, only $1.5 billion was spent on sanitation, while 10 times as much went to HIV/AIDS treatment. But experts say that many more children die of diarrheal diseases than from AIDS.
National governments spent three times as much on fighting malaria than they did on improving contaminated water sources and poor sanitation, which kills twice as many children by causing diarrhea and other illnesses.
WaterAid and PATH cite figures showing that Rwanda has a 3% rate of HIV/AIDS infection. However, the latest numbers show that almost 75 % of donor assistance for health went toward fighting HIV/AIDS, while only two percent targeted childhood illnesses.
WaterAid and PATH have several recommendations. They say the international aid system and developing governments must respond to evidence showing diarrheal diseases as one of the leading causes of child mortality, and they must target resources appropriately. That means taking a number of steps to curb the spread of cholera and other water-borne diseases and to treat diarrhea in young children. Solutions include campaigns to encourage breastfeeding over untreated water, and oral rehydration therapy. WaterAid and PATH also suggest widespread use of vaccines against the most common and lethal form of diarrheal disease called rotavirus.
Nancy Bwalya-Mukumbuta, WaterAid's program manager in Zambia, says much of the government's funding for anti-diarrheal measures is funneled to departments that treat the illnesses. But she says more money should go to the Environmental Health Department which works to prevent them.
A coordinated government response
Bwalya-Mukumbuta says it should teach the public better hygiene and other sanitation practices that can help prevent pneumonia including regular hand washing. Instead, she says department health technicians are being used to diagnose disease and dispense medicines at health centers.
Bwalya-Mukumbuta would also like to see funding made available for the
purchase of vehicles that technicians can use to travel deep into rural areas.
And, she'd like to see improved coordination between various departments of the government.
"There is a need to coordinate across different sectors," she says. "We have a Ministry of Local Government and Housing, which is responsible for providing water and sanitation. They are not working closely with the Ministry of Health, which is responsible for disease prevention and treatment."
She says Zambia has a good health information system, and she'd like to see more of its material used for planning national and local budgets.
WaterAid and PATH say neglecting sanitation undermines the effectiveness
of current health systems. Meanwhile, health specialists warn that it sets back
efforts by Africa to meet the UN Development
Goals, which include cutting child mortality rates in half by 2015.