How Cholera outbreak exposed WASH gaps in peri-urban areas
While millions of people globally gained access to safe water and other sanitation facilities in the last decade following effort towards the Sustainable Development Goals, the story is different for developing countries such as Malawi.
Poor access to potable water remains one of the difficult challenges in the country’s peri-urban areas where majority of the poor and vulnerable population live.
Ruth Miliyasi, a 35-year-old woman from the high-density area of Mgona in Lilongwe, is among the many women who live in Mtandire, Kauma and Area 36; and Bangwe, Ndirande, Makhetha in Blantyre where they spend much of the day searching for potable water.
Miliyasi believes that the problem, compounded by constant dry wells and taps, has birthed myriad dire health infections, cholera inclusive.
In hindsight, she feels that her dwelling circumstances, like that of many others, have contributed to a surge of waterborne diseases such as cholera in her area and many other places.
“It is my wish that government should find a way to get rid of slums, I don’t know how but I think staying in slums has contributed to poverty levels,” Miliyasi said.
SDG goal number six pushes for access to potable water and sanitation for all, and yet this remains a far-fetched dream for many Malawians like Miliyasi.
It is just over a year since Malawi reported its first case under a new wave of cholera; an outbreak that has so far claimed hundreds of lives, exceeding all previous cholera outbreaks recorded in the country.
As of March 6, 2023 approximately 52,000 cases and 1,616 deaths had been reported from across the country, giving a case fatality of 3.1 percent compared to the World Health Organisation (WHO) recommended fatality rate of less than one percent.
The available data from Ministry of Health shows that that all 28 administrative districts of the country have been affected by the outbreak.
Health experts say Malawi’s worsening cholera crisis is a result of long-term neglect of the country’s water supply system and water testing is urgently needed.
Traditionally, cholera outbreaks are synonymous with the rainy season on account of its close association with contaminated food and untreated water but that has not been the case this time around.
The first cholera cases occurred and exacerbated weeks after tropical storm Ana and Tropical Cyclone Gombe ravaged parts of the lower Shire area in the Southern Region of the country in close succession.
There is a possibility that Malawi’s deadly cholera outbreak could worsen in light of Tropical Cyclone Freddy which has recently ravaged the Southern Region.
Health activist Maziko Matemba points out that the continuing spread of the cholera outbreak, over and above, documents low coverage with safe water and adequate sanitation in the country.
He pinpoints usage of unsafe water, low latrine coverage and usage, and poor food hygiene.
“These are compounded by substandard risk perception, and low community awareness and engagement,” Matemba said.
Unicef’s 2022 report says only 67 percent of Malawi’s households have access to safe drinking water, and distribution among districts, and between urban and rural areas, is uneven.
“Approximately only 26 per cent of the population has access to basic sanitation services, and sanitation services are unequally spread across the country,” it reads.
The report further says 6 percent of rural communities continue to openly defecate, principally resulting from inadequate health infrastructure such as toilets, and is a key health concern in rural areas of the country.
A 2022 Voluntary National Review (VNR) report, which also provides progress on SDGs, says Malawi is unlikely to meet thirteen of its goals without drastic and strategic interventions.
The report has singled out poverty as one driving factor; peri urban areas face a variety of challenges related to poverty, environmental degradation, a mixture of cultures and unclear physical and social boundaries.
As a consequence, for decades, the health of the people dwelling in peri urban areas has been constantly afflicted by a lack of safe drinking water facilities, sanitation facilities and poor hygiene.
Minister of Water and Sanitation Abida Mia says the country needs $45 million (K50 billion) for the provision of water and sanitation services in the country.
“Cholera situation has exposed how vulnerable the country is when it comes to water and sanitation and public infrastructure, we are in a crisis that needs long lasting solution,” Mia said.
Historically, urban communities themselves give little thought to safe water, sanitation, and general and food hygiene which turn out to be a major problem in some areas.
Poor access to facilities and services for safe disposal of human waste or in short, basic sanitation, tends to result in contaminated shallow wells and other water sources highly prevalent in peri-urban areas, and increases exposure to water and food borne diseases and causative agents.
The edges of many urban streets are piled with garbage which could include dead animals along with untreated human waste
At individual level, the communities in peri-urban areas tend to have no, or poor water and sanitation facilities.
Environmental commentator, Mathews Malata, says what is needed is to put deliberate strategies that include social and economic needs of peri urban community’s implementation of deliberate urban water and sanitation initiatives that encompass management of water provided for human consumption.
“Implementation of deliberate initiatives for adequate treatment and disposal of human excreta and sewage in the urban and peri urban environment settings,” Malata said.
In urban settings, appropriate regulatory processes need to be incorporated into programme design to ensure safely managed service and regulated delivery at every stage of the service chain.
Sustainability of safely-managed water and sanitation infrastructure, as recommended under the Sustainable Development Goals (SDGs), helps ensure universal access to safely managed sanitation where everyone should have access to an improved facility for disposal of excreta.
