Aid groups are urging donors to invest in water and sanitation in areas known as hotbeds for cholera. They say while such projects might directly affect a relatively small population, the indirect impact in terms of cholera reduction could be immense.
The call comes as NGOs, donors, and governments study lessons learned from one of the severest cholera outbreaks in years - a Guinea-Sierra Leone cross-border epidemic which broke out in coastal areas, where there is no access to clean water, then exploded in the capitals.
“Governments in this region and donors want to find long-term solutions,” said Christophe Valingot, water, sanitation, and hygiene (WASH) specialist with European Union aid body ECHO. “The identification of risk zones allows us to say, OK, we’ve got to invest here if we want to have an impact on cholera.”
“It’s clear that these zones are at a huge disadvantage when it comes to access to water and sanitation. This mapping directly flags the gaps in water and sanitation development.”
Research has shown that over the past decade Kambia District in Sierra Leone and Forécariah District in Guinea, have repeatedly been areas where cholera exploded, according to NGO Action Against Hunger (ACF), which has done mapping, prevention, and response work in the two countries.
“Cholera is not just an emergency and humanitarian issue,” said Jessica Dunoyer, an ACF cholera expert who worked in the two countries during the latest epidemic. “It is an issue for the development community.” With respect to water access, she said that given the Millennium Development Goal (full report) of halving the number of people lacking access to safe water, there is often an emphasis on the number of people covered, while considerations such as an area being a cholera hotbed may not sufficiently guide selection.
ECHO’s Valingot said while water and sanitation access is a problem across many regions, it is important to pay attention to those areas where cholera regularly erupts. “We’re not saying to put all funds here - but we say putting money into these cholera hotbeds will not only improve water and sanitation for that particular population but will help reduce cholera for the entire country.”
Prevention of epidemic disease is always a consideration in water development projects, said Phil Evans, head of the UK’s Department for International Development (DFID) for Liberia and Sierra Leone.
He said that the latest outbreak has seen NGOs, donors, and government health officials in Sierra Leone looking more closely at how to better target long-term water and sanitation work.
“If you’re in a part of the world like this where cholera is endemic and you’re able to identify in some kind of consistent way a pattern of where outbreaks tend to arise, then obviously it makes sense to make sure in the work you’re doing - in WASH education - that you cover those areas and cover them adequately.”
"What cholera shows are failures across a whole range of issues - water provision but also environmental health issues more broadly, sanitation, and preparedness on the part of the health services.”
Kambia’s water woes
Tom Sesay, district medical officer in Kambia, Sierra Leone, said investment in water infrastructure in known cholera zones would probably have a significant impact. He called the water access situation in Kambia “a very serious problem”.
He spoke with IRIN in December 2012 just after returning from a small community he visited after reports of diarrhoea. “To be honest with you the water they use for drinking is terrible. You can believe it only when you see it. It is so turbid, so dark,” he said, noting that the water is from stagnant ponds. “I asked the residents, ‘Do you actually drink this water?’ They said that is the only water they have.”
The only water sources for coastal and estuary communities in Kambia are traditional wells or rainwater. Residents often travel to communities farther inland to collect water.
Only half of Sierra Leone’s population has access to clean water and improved sanitation, and improving WASH conditions in informal settlements is particularly challenging, said Evans.
Development donors and NGOs are watching closely as the newly elected government in Sierra Leone finalizes its development plan, he added.