Increasing Care-Seeking Behaviour for Childhood Illnesses in Nigeria (ICARE)

Diarrhoea is the second leading cause of death for children under 5 in Nigeria. ORS and zinc are cost-effective treatment which can prevent the majority of deaths.This programme seeks to increase coverage of Zinc/ORS by adopting a market-based approach.

Diarrhoea is still the second leading cause of death for children under five[i], accounting for over a million deaths each year. Roughly 60% of those deaths occur in 10 high-burden countries, of which Nigeria is one. Cost-effective treatment exists in the form of Oral Rehydration Salts (ORS) which together with zinc offers a proven treatment that can prevent the majority of deaths. However, coverage is low, and a majority of children with diarrhoea do not receive treatment. In fact, only 38% of children in all developing countries receive ORS – a level that has remained stagnant in recent years – while less than 5% receive zinc. For those that do seek treatment, the private sector is a significant provider (sometimes in the form of clinics but more typically through shops or pharmacies).

Reasons for low coverage vary according to country context, but in most high-burden countries, zinc/ORS is characterized by a market ‘trap’ in which limited demand from caregivers and clinical providers deters suppliers from investing in, and marketing, quality, affordable products. On the demand side, the majority of caregivers are aware of ORS but much fewer actually use it for their child. They may perceive it as a weak or ineffective treatment and prefer to request antibiotics. Others underestimate the dangers of diarrhoea, while the large majority of caregivers are unaware of the importance of zinc. On the supply side, provider awareness of the clinical benefits of zinc/ORS is limited and availability is poor. In the public sector, this is associated with inadequate training as well as weak supply chains and procurement. In the private sector, it reflects factors like poor technical skills among private facilities and drug retailers and limited awareness due to a lack of marketing. For suppliers and manufacturers, the limited demand and low margins deter entry into the market (or a willingness to import) and investment in distribution and marketing. This deters competition and keeps prices higher than they should be.

These market imperfections are further exacerbated by weaknesses in the overall enabling environment – such as limited political focus and funding (domestically and from donors), inadequate market information (e.g. demand forecasts) and inappropriate regulatory frameworks.

This programme, supported by HANSHEP members DFID and the Gates Foundation seeks to increase coverage of Zinc/ORS by adopting a market-based approach that will create a virtuous cycle of growing demand to motivate increased supply, deliver public health benefits and generate further demand. In Nigeria alone, scale-up of zinc/ORS coverage to 80% by 2015 would save 50,000 children a year, and the learnings from this programme can then be extended to support similar scale-up initiatives in other high-burden countries where Zinc/ORS uptake is low.

Timeframe: January 2014 – January 2016

Lead Implementing Partner: PACT Nigeria

[i] UNICEF, Pneumonia and Diarrhea: Tackling the deadliest disease for the world’s poorest children. 2012