Cholera: Spread of poverty, inequality

After two decades, Malawi finds itself grappling with another devastating cholera outbreak. On February 6 2023, the country woke up to depressing news of 1,254 lives lost to the disease since it was first reported in March 2022.

With startling 38,566 cases registered across the 29 districts, the outbreak has undeniably exerted undue pressure on the overstretched health system in the country.

The Malawi Government, through the Ministry of Health, has already pressed a panic button and appealed for more support from well-wishers and development partners.

The government said in a recent press release that the support would enable the Ministry of Health to cover gaps being seen in prevention, control and management of cases across the country.

However, beyond the frantic efforts aimed at limiting the spread, a stubborn inequality and poverty picture is unfolding.

According to WaterAid, a water, sanitation and hygiene (Wash) non-governmental organisation in Malawi, one in three people do not have clean water, with an estimated 9.6 million people lacking a decent toilet.

Now, for a country where one-third of the population does not have access to basic Wash facilities, it bespeaks high susceptibility to cholera outbreaks.

While on a work-related assignment in northern Malawi late November 2022, I encountered a group of women fetching water from a nearby dirty Lunyina River in Rumphi District. I later learnt that the water was for domestic use, including drinking and cooking.

I believe the situation is not different in most parts of the country, where, due to lack of clean and safe water, poor communities resort to unsafe sources of water for domestic use.

Fortunately, for some communities in Rumphi, ActionAid Malawi’s local partners provided support in the form of medical supplies and behaviour change interventions which have eventually seen cholera cases drop.

But the support by ActionAid and other stakeholders is surely not enough.

In this era of climate change, which is mostly associated with heavy rains and floods, a lot of water could be contaminated, resulting in further spread of cholera.

This is particularly the case in urban settings where there are densely populated slums with compromised Wash facilities.

This is confirmed by recent Lilongwe Water Board water tests conducted on wells in Area 36, Mtandire and Mtsiriza, which are some of the densely populated slums in the city.

The tests revealed faecal coliforms, indicating that the water is contaminated. The board says this is due to pit latrines constructed in these areas.

Any wonder that cholera is spreading faster in the cities of Lilongwe and Blantyre than in districts?

Now, another interesting thing about the efforts to contain the spread of the outbreak is government’s decision to ban the sale of food in market restaurants and along the streets.

While the move appears crucial, it does not really address the root causes of the cholera outbreak in the country.

If anything, it is only denying people running fast food businesses their constitutional right to economic activity.

With the World Bank indicating in 2022 that 74 percent of Malawians will live below $1.90 per day in the next two years, government’s interference with citizens’ legal means of earning a living is tantamount to pushing them further below the poverty line.

It must dawn on government that it has the primary duty to ensure that every citizen has access to clean and safe water. And that can only be achieved if Wash is prioritised in national budgets.

It goes without saying that cholera remains a Wash issue. While citizens need to play their part in practising hygiene and sanitation, that needs to be supported by the provision of clean and safe water by government.

In 2014, government obtained a K9 billion loan to construct toilets and drill boreholes in trading centres. Whether that loan was put to good use is an accountability topic for another day.

The crux of it all is that government’s investment in the Wash sector remains vital in not only preventing the spread of waterborne diseases like cholera, but also reducing the unpaid care work burden for women and girls who waste their productive time fetching water for domestic use.

Investing in Wash is investing in the fight against poverty and inequality.

Fletcher Simwaka is the Communications Officer at ActionAid Malawi