Mozambican children learn about hygiene in a WaterAid initiative
Ahead of the high-level emergency ministerial meeting on cholera epidemics and climate-related public health emergencies, WaterAid urges SADC governments to implement immediate action
Several countries in Southern Africa are experiencing the most serious outbreak of cholera for many years. The World Health Organization (WHO) has called the current outbreak in Malawi “the deadliest in the country’s history”. It has also spread to Mozambique, Zambia, Zimbabwe and South Africa. The outbreak coincides with the storm season, which has brought floods in Mozambique, Zambia and South Africa and has severely impacted people’s access to decent drinking water, sanitation and hygiene (defined as WASH by the WHO) in affected areas.
Ahead of an emergency meeting of Southern Africa Development Community (SADC) Health, Environment, Water and Sanitation Ministers in Lilongwe, Malawi this week, WaterAid’s Southern Africa Regional Office is calling on governments to urgently focus on addressing the root causes of the disease, which spreads due to dirty water and poor sanitation and hygiene.
Due to climate change and poor WASH infrastructure and hygiene practices, cholera outbreaks have become a frequent occurrence in the SADC region in recent years, especially during the rainy seasons. The outbreaks are deadlier, affecting larger numbers of people, leading to the loss of thousands of lives each year. This year, Malawi and Mozambique have been the worst affected with cholera outbreaks and floods compared to the other countries in the region. South Africa, Zambia and Zimbabwe continue to register a growing number of infections.
The current outbreak began in March 2022, at the end of the last cyclone season. As of 5 March 2023:
- Malawi registered 50 981 accumulated cases and 1 605 deaths across all 29 health districts;
- In Mozambique, cholera has now spread to more than 18 districts, with 41 deaths and more than 7 300 cases reported;
- In Zambia six districts have ongoing cholera outbreaks in two provinces. By 4 March 2023, the country had recorded a cumulative 212 cases, including five deaths; and
- In South Africa, six cases were reported by the first week of March 2023.
WHO has escalated the cholera outbreak to a grade three emergency — the highest level in its internal grading system, due to high case fatalities, the potential for further spread and severe limitations in vaccine supply.
“Among 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 controlling and ultimately eliminating the disease,” said WaterAid’s Regional Director, Southern Africa, Robert Kampala.
WaterAid’s Country Directors Mercy Masoo in Malawi, Leah Mtolo in Zambia and Adam Garley in Mozambique said in a joint statement: “Like the Covid-19 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% of hospital admissions in Mozambique and is the second leading cause of death in children under five in the country.”
In Malawi, diarrhoea is also a leading cause of death among children under the age of five.
In Zambia, the case for increased investment in WASH is also evident. Poor water, sanitation and hygiene are the main causes of infections like cholera and diarrhoea and a leading cause of death for children under the age of five, according to UNICEF. Zambia is among the top 30 countries in the world with the highest number of deaths due to diarrhoeal diseases. An estimated 9.7% of deaths are due to diarrhoeal diseases — in 2021 alone, 1.2 million cases were recorded. The age adjusted death rate due to diarrhoea stands at 54.75 per 100 000 of the population, according to the Ministry of Health’s 2021 Disease Burden report.
WaterAid Southern Africa applauds the emergency high level ministerial initiative to meet in Malawi, and sees it as a positive step towards a concerted regional effort to specifically address the water and sanitation challenge, a leading cause of cholera, in a decisive manner. WaterAid calls for stronger political will to address cholera before it claims any more lives, and for the implementation of the target to spend at least 1.5% of national GDP on WASH, as per the eThekwini Declaration.
The SADC Hygiene Strategy presents an ideal instrument to address the recurrence of cholera and other hygiene-related diseases. WaterAid is calling for action — the SADC leaders must make a commitment to deliver on the Strategy’s recommendations in an urgent and decisive manner.
The SADC Hygiene Strategy was signed by the 16 SADC member states in 2022, but its 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.
The SADC should also incentivise the private sector to play a role in WASH infrastructure development, according to WaterAid’s regional office.
As the SADC ministers meet this week in Lilongwe, Malawi, for the High-Level Emergency Ministerial Meeting on Cholera Epidemics, Polio & Climate-related Public Health Emergencies, WaterAid urges them to view WASH as a “no regrets” investment. Not only will it help to eliminate cholera, it will also reduce the burden of various other diseases, reduce pressure on the curative health system, reduce curative health costs, enable children (particularly girls) to go to school and increase economic productivity.
About WaterAid
WaterAid is working to make clean water, decent toilets and good hygiene accessible for everyone, everywhere within a generation. The international not-for-profit organisation works in 28 countries to change the lives of the poorest and most marginalised people. Since 1981, WaterAid has helped to supply 28 million people with clean water and nearly 29 million people with decent toilets.
For more information, visit the website wateraid.org/uk
Water statistics
- 771 million people in the world – one in 10 – do not have clean water close to home.
- Almost 1.7 billion people in the world – more than one in five – do not have a decent toilet of their own
- Over 300 000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation. That’s more than 800 children a day, or one child every two minutes
- Investing in safely managed water, sanitation and hygiene services provides up to 21 times more value than it costs.