/ 15 May 2023

Malawi cholera outbreak: consequences of under-investment in water in Africa

Malawi Cholera
Healthcare workers move a body from a makeshift mortuary at a cholera treatment centre at Bwaila district hospital in Lilongwe in February. Photograph: Fredrik Lerneryd/AFP/Getty Images

March 2023 marked a year since Malawi began its battle against the worst cholera outbreak in decades. 

In one year, over 50 000 cases have been recorded and 1 600 lives lost. Of these, more than 12 000 children have contracted cholera and 197 have died.  

The case fatality rate currently stands at 3.07%, which is in sharp contrast to the World Health Organisation’s 1% global average.

On the surface, the cholera outbreak makes no sense in a country in which, according to Malawi’s 2022 voluntary national review report on the sustainable development goals (SDG), 87.9% of the population have access to improved sources of drinking water and 80% have access to improved sanitation. 

These statistics belie a more fragile infrastructure that has been decimated by a series of tropical cyclones that have killed hundreds of people and destroyed property, including water, sanitation and hygiene (WASH) structures and facilities. Authorities are still counting the cost of the damage.

Water quality in Malawi has long been a concern, especially in high-density urban areas. Water tests conducted by the Lilongwe Water Board in the country’s capital found that the water is contaminated with faecal coliforms, a form of bacteria found in human or animal waste, making it unsafe for human consumption. The board says the contamination was from pit latrines.

Investments in climate-resilient water infrastructure

While some investments have been made to improve water sanitation access, these have not been made to withstand the impacts of climate change. 

In January 2022, Malawi was one of the countries affected by tropical cyclone Ana and a Malawi government assessment indicated that for the WASH sector, 54 000 latrines collapsed and about 340 boreholes were destroyed in the disaster.

The World Bank estimates that during tropical cyclone Idai, which hit Malawi in March 2019, about 190 000 sanitation units were damaged and 211 000 people were left with restricted water access.

The gains made towards attainment of 2030 SDG targets on water and sanitation are being eroded according to the Global Water Leadership (GWL) programme which is being implemented in Malawi by the Global Water Partnership (GWP) and Unicef with FCDO funding. In Malawi, GWP in collaboration with the government, is working to identify strategies to increase investment in climate-resilient water and sanitation infrastructure.

Public financing for water

A 2022 snapshot of Malawi’s water and climate resilience status developed by GWP and Unicef under the GWL programme shows that public financing for recurrent water expenditure and development resources is low, affecting implementation of the country’s WASH agenda. Unicef noted that capital projects, mostly donor-funded, account for a disproportionately high share (over 90%) of WASH resources at the expense of recurrent investments to support operations, maintenance and salaries. 

There is a need for the Malawi government to strive for balance and sustain functionality of water and sanitation facilities which may require a greater investment than the current 0.081% of GDP.

There was however an increase in the 2022-2023 budget of around 200% bringing the total budget for WASH to $155 billion. Water and sanitation stakeholders hope that this trend will continue and will help in Malawi’s efforts to end the cholera outbreak.

Unicef has made an appeal of $52.4 million to be used for the cholera fight, and in April the Blantyre water board through the ministry of finance signed a$145 million grant from the World Bank for the Malawi water and sanitation project, which aims to make operational improvements to increase access to improved water supply and safely managed sanitation services in one of Malawi’s major cities.

In Africa, over 300 million people do not have access to clean drinking water and over 700 million live without access to good sanitation. Financing water is generally a low priority in most African countries, amounting to about $10-19 billion/year, which is why the continental africa water investment programme is seeking to mobilise at least $30 billion annually to meet SDG6 and meet the continent’s water-related economic and social needs.

Improving access to clean drinking water and sanitation is a sure way to improving the health of nations and preventing the spread of communicable diseases such as cholera. 

With only seven years to go before the 2030 SDGs mark, we cannot continue to lose lives to preventable diseases. We need more financing for the sector which would result in more climate-resilient water and sanitation infrastructure.  

Deborah Muheka is the programme coordinator at GWP South Africa. Teresa Temweka Chirwa-Ndanga deals with regional communications and is a Malawi Partnership Specialist.

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian