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Private health care for diarrhea in Africa kills 20,000 kids annually

A nurse gives oral rehydration salts to a two-year-old in Sierra Leone.
A nurse gives oral rehydration salts to a two-year-old in Sierra Leone.

Children in sub-Saharan Africa who suffer from diarrhea are receiving lifesaving treatment at a lower rate when visiting private hospitals as compared to public ones. Closing that gap would save an estimated 20,000 lives each year.

When a child present signs of diarrhea, hospitals are supposed to instruct parents to give the child oral rehydration salts (ORS). The basic mixture of water with a little bit of sugar and salt prevents the child from dying from dehydration. It’s wide use over the past few decades has saved millions of lives. However, it is not always available nor is it recommended in every case.

“Clearly the private sector is not following public health guidelines in the way that the public health sector is doing,” said Zachary Wagner, co-author and doctoral student in public health at the University of California, to Humanosphere.

The findings from his research, with Neeraj Sood, PhD, the study’s senior author and director of research at the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, were published yesterday in the American Journal of Tropical Medicine and Hygiene.

While it has been suspected that private facilities were not providing the same services as their public counterparts, this is the first large-scale study to measure the size of the gap.

They looked at the treatment received by 19,000 children in 29 African countries, from 2003 to 2011. Children who were treated by private facilities were 22% less likely to receive oral rehydration salts. Instead, they were prescribed other treatments, such as antibiotics, that may help deal with the illness, but not fend off dehydration.

“In most countries there are several regulations governing private clinics, but in practice few of them are enforced and there is very little government oversight of care provided in the private sector,” said Sood. “What’s more, governments are generally not involved in continuing medical education to improve the capacity of these private clinics to provide better care.”

The disparity is likely the result of a few factors. Uneven enforcement of health regulations makes it harder to achieve consistency of care between health centers. Government-run facilities are nearly uniform because of the heavy involvement with local and national ministries of health. Private ones vary from services they offer to their staff make-up.

“What we don’t want people to take away from this study is to say that the private sector is bad,” said Wagner.

“We think there should be more private sector engagement because they are clearly an important part of health care service delivery.”

The majority of families measured in the study used public health centers for care  (71%). Private health centers have grown in sub-Saharan Africa in response to gaps in public and non-profit health services. The disparities between health service delivery between public and private extends beyond diarrhea treatment.

Knowing the gaps in treatment is an opportunity to improve health outcomes in countries. The study was unable to determine the actual cause. The difference in this case may be due to the fact that oral rehydration salts are made available at public health centers, making it easy to prescribe. It could also be a matter of cost, Wagner said there are many instances where ORS is free in public facilities.

“Without knowing what is happening we cannot make policy recommendations,” said Wagner.

At stake is reducing the estimated 700,000 children under five years old that die each year as the result of diarrhea. Dehydration is oftentimes the culprit for the deaths, making most of them avoidable. Given that the ORS costs only $0.50, it is one of the most cost-effective ways to save lives.


About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]