PT - JOURNAL ARTICLE AU - Sarah E.K. Bradley AU - Lauren Rosapep AU - Tess Shiras TI - Where Do Caregivers Take Their Sick Children for Care? An Analysis of Care Seeking and Equity in 24 USAID Priority Countries AID - 10.9745/GHSP-D-20-00115 DP - 2020 Sep 04 TA - Global Health: Science and Practice 4099 - http://www.ghspjournal.org/content/early/2020/09/04/GHSP-D-20-00115.short 4100 - http://www.ghspjournal.org/content/early/2020/09/04/GHSP-D-20-00115.full AB - Key FindingsOut-of-home care-seeking levels were similar for the 3 illness classifications, ranging from 63% for diarrhea to 70% for acute respiratory infection symptoms.Among caregivers who sought out-of-home treatment or advice for their sick children, 51% went to the public sector and 43% went to private sector sources.There are substantial disparities in illness prevalence and care seeking: 74% of caregivers from the wealthiest households and 63% of caregivers from the poorest households sought out-of-home care for their sick children.Key ImplicationStewards of the public and private sectors—including governments, nongovernmental organizations, civil society, donors, and implementing partners must understand sources of sick child care and collaborate to improve access to and quality of affordable care. Pneumonia, diarrhea, and malaria are leading causes of under-5 mortality. Accelerated reductions in illness burden are needed to meet childhood Sustainable Development Goals. Understand-ing where parents take sick children for care is key to improving equitable, high-quality treatment for these childhood illnesses and catalyzing reductions in morbidity and mortality. We analyzed the most recent Demographic and Health Survey data in 24 of the United States Agency for International Development’s maternal and child health priority countries to examine levels and sources of care for children sick with 3 illness classifications: symptoms of acute respiratory infection, diarrhea, or fever. On average, across countries analyzed, one-third of children had recent experience with at least 1 of the 3 classifications. The majority (68.2%) of caregivers sought external advice or treatment for their sick children, though the level is far higher for the wealthiest (74.3%) than poorest (63.1%) families. Among those who sought out-of-home care, 51.1% used public sources and 42.5% used private-sector sources. Although sources for sick child care varied substantially by region and country, they were consistent across the 3 illness classifications. Urban and wealthier families reported more use of private sources compared with rural and poorer families. Though 35.2% of the poorest families used private sources, most of these (57.2%) were retail outlets like pharmacies and shops, while most wealthier families who sought care in the private sector went to health facilities (62.4%). Efforts to strengthen the quality of integrated management of sick child care must therefore reach both public and private facilities as well as private pharmacies, shops, and other retail outlets. Stakeholders across sectors must collaborate to reach all population groups with high-quality child health services and reduce disparities in care-seeking behaviors. Such cross-sectoral efforts will build clinical and institutional capacity and more efficiently allocate resources, ultimately resulting in stronger, more resilient health systems.