Confronting cholera from regional perspective


When 16 Southern African Development Community (Sadc) member states launched the Sadc Hygiene Strategy in August 2022, Malawi was already feeling the pinch of a cholera outbreak that started, five months earlier, as a joke.

Eight months later, cholera cases show no signs of dissipating.

In fact, things are getting worse. Malawi has since beaten the 2002 record of 33,000 cholera cases, which are now hovering above 50,000 cumulatively.


To make matters worse, neighbours Zambia and Mozambique have caught the bug of cholera, along with regional economic powerhouse South Africa.

Cholera has become regional in nature.

Fortunately, Sadc has a tool for addressing challenges like these, and this is in the form of the Sadc Hygiene Strategy.


However, some organisations, notably non-State actor WaterAid, have started losing patience.

The organisation indicates that August 2022 is such a long time that the Sadc secretariat should have started making headway in implementing activities outlined in the strategy.

WaterAid has since urged African governments to, through the strategy, prioritise the provision of safe water to citizens if they are to avoid disease outbreaks such as cholera.

The development comes at a time the World Health Organisation (WHO) has escalated the cholera outbreak to ‘grade three emergency’— the highest level in WHO’s internal grading system.

To do so, WHO assesses case fatalities, the potential for further spread and severe limitations in vaccine supply.

In a statement, WaterAid Regional Director, Southern Africa, Robert Kampala has cited five factors as drivers of cholera and other disease outbreaks.

“Amongst the usual contributing factors like poverty, weak infrastructure, conflict and humanitarian crises, climate shocks are increasingly driving multiple severe outbreaks and posing an enormous challenge to effectively control and ultimately eliminate the disease [cholera],” he says.

And, in a joint statement, WaterAid Malawi Country Director Mercy Masoo, Zambia Country Director Leah Mtolo and Mozambique Country Director Adam Garley call for immediate action.

“Like the Covid pandemic, the current cholera outbreak in the region underscores the urgent need for governments to invest in water, sanitation and hygiene. Improving access to sustainable water and sanitation services will not only serve to control cholera, it will also help to stop the spread of a range of other waterborne diseases such as diarrhoea, which is responsible for 20 percent of hospital admissions in Mozambique and is the second leading cause of death for children under the age of five.

“Zambia is among the top 30 countries in the world with the highest number of deaths due to diarrhoea diseases. An estimated 9.7 percent of deaths are due to diarrhoea diseases. In 2021 alone, 1.2 million cases were recorded. The age adjusted death rate due to diarrhoea stands at 54.75 percent per 100,000 of the population, according to the Ministry of Health 2021 Disease Burden report,” the country directors say.

Their sentiments come at a time a number of countries in Sadc are experiencing the most serious outbreak of cholera.

This has culminated in WHO describing the cholera outbreak in Malawi, which recorded its first case under the current wave in March 2022, as “the deadliest in the country’s history”.

The outbreak has not spared Mozambique, Zambia, Zimbabwe and South Africa.

Coincidentally, this happens to be a storm season, such that there have been floods in Mozambique, Zambia and South Africa.

As at March 8 2023, Malawi had registered 52,167 accumulated cases across all the 29 health districts.

As for neighbouring Mozambique, cholera has spread to more than 18 districts, with 41 deaths and over 7,300 cases.

In another neighbouring country, Zambia, six districts in two provinces have been affected by the outbreak.

As at March 4 2023, Zambia had recorded a cumulative 212 cases, including five deaths.

In the Rainbow Nation of South Africa, six cases were recorded by the first week of March 2023.

This means cholera has, really, taken a regional dimension, such that the Sadc Hygiene Strategy may become handy.

It is a fact WaterAid is well aware of.

“The Sadc Hygiene Strategy presents an ideal instrument to address [the] recurrence of cholera and other hygiene-related diseases. WaterAid is therefore calling for action and urging the Sadc leaders to make a commitment to deliver on the recommendations in an urgent and decisive manner.

“The Sadc Hygiene Strategy was signed by the 16 Sadc member states in 2022 but implementation is seriously lagging behind. Ensuring that the strategy is adequately resourced, both in financial and human terms, is a critical factor in contributing to eliminating cholera in the region in line with global ambitions. Sadc should also incentivise the private sector to play a role in Wash [water, sanitation and hygiene] infrastructure development, according to WaterAid’s regional office.

The Sadc Hygiene Strategy 2021-2025 seeks to, among other interventions, upscale capacity building for the region’s hygiene sector and provide a framework for the financing of hygiene activities.

The organisation adds: “Due to climate change and poor Wash infrastructure and hygiene practices/ behaviours, cholera outbreaks have become a frequent occurrence in Sadc region in recent years and especially during the rainy season. The outbreaks are deadlier, affecting larger numbers of people including loss of thousands of lives each year.

“This year, Malawi and Mozambique have been the worst affected with cholera outbreak and floods compared to the other countries in the region. South Africa, Zambia and Zimbabwe continue to register a growing number of infections.”

Hope is not lost, though.

As one way of addressing cholera-related problems, Sadc Health, Environment, Water and Sanitation Ministers started attending a two-day emergency meet ing in Li longwe from yesterday.

The forum presents them with an opportunity to assess progress made in implementing activities outlined in the Sadc Hygiene Strategy. Malawi’s Health Minister Khumbize Kandodo Chiponda is attending.

The hope is that, after lessons are drawn from the current cholera outbreak, there could be light at the end of the tunnel.

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