Devolving power to local authorities is helping Cameroon step up its fight against a two-year cholera outbreak, say government and aid agency staff.
In 2010 decision-making and financing on health, water infrastructure and education was devolved to the country’s 376 local government councils. Slow to get going at first, since early 2011 these councils have more effectively fought to prevent cholera, said Casimir Youmbi, programme manager of Plan International in Cameroon.
Since four councillors took charge of preventing transmission in Mokolo, capital of Mayo Tsanaga Department in the Far North Region, which had the highest concentration of cholera cases in 2010, there have been no new cases, said Mayor Martin Geedeme Rewetem of Koza Council, near Mokolo City. Councillors have sent volunteers house to house to spread awareness of the importance of hand-washing and good hygiene practices.
A number of regions have set up emergency funds to battle the disease and prepare for future crises, which has sped up the response, said Youmbi. An emergency fund set up by the mayor of Founban, in Western region, has led to a decline in new cases reported at the local hospital, according to aid agencies.
Local government is quicker to respond, and much better placed to identify which areas are most in need of cholera treatment and prevention-messaging, said Mayor Rewetem.
“Local councillors are now in the forefront of the battle. More and more, they are taking the lead... That is the only long-term possibility to stem the cholera outbreak and prevent new cases,” said Plan’s Youmbi.
As of mid-June 2011, 8,450 cholera cases had been reported, and 281 people have been killed by cholera in nine of the country’s 10 regions since the beginning of 2010. The South West, Littoral, West and Central regions are currently the worst-affected, as the disease spread southwards.
Reduced, not eliminated
But even with boosted efforts, cholera cases are likely only to be reduced, not eliminated, due to the shortage of clean toilets, and of clean drinking water points: Just 20 percent of people can access clean water across the country, according to André Zamouangana, response coordinator at the International Federation of the Red Cross and Red Crescent (IFRC) in Cameroon.
Even in cities access is poor, said Youmbi. “In the capital [Yaoundé] you can go two weeks without running water - there is simply not enough for everyone.” Countrywide, most drink from open wells while those in the bush drink river water.
|Previous cholera outbreaks in Cameroon|
|1970: 2,000 cases, 300 deaths|
|1985: 1,000+ cases, 90+ deaths|
|1991: 4,000 cases, 480 deaths|
|1996: 5,786 cases, 480 deaths|
|2004: 8,000 cases, 100 deaths|
|Source: WHO Global Task Force on Cholera|
Other factors impeding elimination of cholera include heavy cross-border movement to and from Nigeria and Chad in the north which helps infections to spread; lots of north-south population movement, which aided the spread of the disease to southern regions; traditional practices whereby numerous people simultaneously wash a dead body, but not necessarily disinfect it of cholera; and very low public hygiene levels, according to interviewees.
“The main problem lies at the community level. There is very low awareness of how people’s behaviour causes diseases to spread, and this requires a long-term effort,” said Zamouangana.
Investment up, but more needed
Investment in water infrastructure has recently increased in the country’s largest cities Douala and Yaoundé now that the government has completed restructuring basic services, freeing up money for investment in public works, according to Youmbi. But it will take time for the funding to trickle down to council level, he said.
Councils do not have enough equipment to disinfect wells on a large scale or to distribute water purification tablets to all who need them, according to Mayor Rewetem.
His council has been able to repair just six water pumps this year - relying on NGOs and UN agencies to help with others. Aid agencies have also helped pre-position rehydration fluids and disinfectant stocks in clinics.
Severe staff shortages mean many councils rely on volunteers to spread the prevention message - tapping into the IFRC’s network of 300 trained volunteers in the four hardest-hit regions, or into their own volunteer networks at the village level. The latter are often untrained, said Zamouangana, and do not have the money to buy bicycles to travel village to village, or communications materials, like posters.
Plan International has also trained up dozens of “cholera soldiers” to spread prevention messages.
Despite these difficulties, councillors are working hard to spread prevention messages, particularly in the north where the rainy season has already begun, said Rewetem. If prevention efforts had been stepped up at the beginning of 2010 the disease might not have spread south, he said. “This was not done in time last year,
but this year we are learning the lessons.”