Pneumonia is the leading killer of children under five globally. Approximately one million children under the age of 5 died from a pneumonia-related causes in 2015 — more than from HIV/AIDS, tuberculosis and malaria combined. And it’s not because we don’t know how to treat pneumonia or it’s too expensive to do so. In fact, there is a highly effective, affordable treatment (about $0.50 per course of treatment) that is recommended by the World Health Organization: amoxicillin dispersible tablets (amox DT). But access to this lifesaving commodity is a huge problem in many low- and middle-income countries.
Results for Development set out to find out why so many children are dying from pneumonia and to reverse this trend. To do this, we completed a diagnostic analysis that included country visits to Ethiopia, Nigeria, Tanzania and Uganda (four countries with especially high burdens and low treatment rates) and interviews with more than 140 demand, supply and global actors across 65 organizations. We engaged all levels of the marketplace — procurers, manufacturers, distributors, donors and other key players — in order to identify the top barriers to accessing amox DT.
In all countries, we found similar factors, including demand-side barriers such as regulatory issues, problems with accurately forecasting and planning for needs and limited options for governments’ procurement processes. On the supply side, we found that manufacturers were not willing to engage in complex registration processes without clearer market information, including knowing what the demand was for the product. But the greatest challenge was the lack of funding for this important issue, which was particularly acute in Ethiopia and Tanzania where a 75 — 100 percent funding gap was predicted after 2015.
Armed with this data, we made the case to several global donors that large, time-limited investments could catalyze real and lasting change by permanently clearing market bottlenecks and galvanizing domestic support (and resources) to end child deaths from pneumonia. Due to the particularly high rates of untreated children in Ethiopia — only seven percent of the children under five with pneumonia symptoms are treated with antibiotics — and the strong political will demonstrated by the Ethiopian government to address this issue, the Bill & Melinda Gates Foundation committed $3 million to scale up treatment over five years.
This funding will lead to treatments for approximately four million children, but it will also remove access barriers and obstacles, thus enabling the Ethiopian government to continue to scale up treatment after the program ends. R4D has also continued to increase transparency in the global amox DT market to improve access, and has continued to advocate for greater prioritization and catalytic investments to address childhood pneumonia in other high-burden countries.