The international health agenda is failing to save the lives of millions of children by not responding appropriately to causes of child deaths, according to a new WaterAid report released.

Hard-hitting figures published in the report reveal that the aid system is not responding rationally to disease burden. Despite diarrhoea being the second biggest killer of children, critical interventions to prevent these deaths attract a dismal amount of international aid.

In 2004, diarrhoea killed 1.8 million children, yet between 2004-2006 only $1.5 billion was spent globally on improved sanitation – vital in the fight to protect children from diarrhoea.

In the same period, $10.8 billion was spent on interventions for HIV/AIDS (responsible for 315,000 child deaths), and $3.5 billion on those for malaria (responsible for 840,000 child deaths). [see graphic left side]

The report stresses that the aid system must continue to tackle diseases such as malaria and HIV/AIDS but calls for a comparable effort to address diarrhoea.

'Fatal neglect: How health systems are failing to comprehensively address child mortality' argues that to reduce under-five deaths by two-thirds and therefore meet Millennium Development Goal Four, the aid system must target its resources to diseases that are killing the most children – such as diarrhoea – and focus on providing cost-effective interventions such as improved sanitation that can prevent these diseases.

"The aid system's response to the global child health crisis is not rational – put simply, a major cause of child mortality is being neglected," said Oliver Cumming, report co-author and WaterAid Sanitation Policy Officer.

"Diarrhoea kills more children than HIV/AIDS, malaria and TB combined, yet compared to these diseases receives little financing and is not prioritised by governments in donor and developing country governments alike."

Fatal Neglect shows that the global imbalance of aid allocations is matched at the national level in developing countries. The report calls for national health challenges, rather than international campaigns to determine the allocation of aid:

• In Zambia, the Ministry of Health notes that "over 80% of the health conditions presented at health institutions are diseases related to poor environmental sanitation." Yet environmental health receives just one eighth of the funding provided for malaria, a disease which kills a similar number of children to diarrhoea.
• In Madagascar, UNAIDS (The Joint United Nations Programme on HIV/AIDS) found the number of deaths from HIV/AIDS was too small to estimate, whereas diarrhoeal diseases kill 14,000 children every year. Yet HIV/AIDS received five times more aid than sanitation between 2004-6.
• Rwanda has a 3% AIDS infection rate, but in 2005 almost 75% of donor assistance for health was for HIV/AIDS and only 2% for health care services for childhood illnesses.

"Disease burden is not informing aid decisions," said Cumming. "Donors need to take a long hard look at their financing and priorities and see if it actually matches the reality on the ground.

"It is not a matter of choosing between one disease or another. Developing countries could provide a balanced response to child mortality if the 2005 G8 commitments to increase aid volumes were met."

The report also warns that by neglecting sanitation, the effectiveness of current health systems is being reduced.

"There is no doubt that diarrhoea is one of the biggest child killers. The aid system is failing to respond to the evidence, and this is contributing to millions of preventable child deaths."

WaterAid 2009