No safe water for poor majority

While government says it is ready to fight cholera, stakeholders and our observations show the country is sitting on a time bomb because the poorest of the poor, most of whom die of the disease, do not have access to safe drinking water.

Cholera is a waterborne disease spread through ingestion of contaminated water and foodstuffs.

A resident of Mtandile Township in the Lilongwe, who identified himself as Fiskani and works as a messenger in a government department, bemoaned what he described as high cost of water in the city.

He does not have running water in his house so he buys from a public kiosk. A bucket costs K50 and on average his family of four uses 10 buckets of water a day, translating to K15 000 a month.

Fiskani said: “This is just too expensive. If you add the K500 spent daily for water and then food and transport, you will realise that we are just surviving by the grace of God.”

He said on some days they cannot afford to buy water from the kiosk so they buy from a dug well at K30 a bucket, saying he is aware the water from the well is not safe for drinking but the family has no choice.

Thus for families like Fiskani’s, cholera is only a blink of an eye away.

Stakeholders in health, education and Water, Sanitation and Hygiene (Wash) sector say the statistics on the ground also show that the country is far from being safe from cholera which, as of August 2023, registered 58 979 cases and 1 768 deaths.

Meanwhile, the disease has already claimed over 400 lives in neighbouring Zambia and some cases have been reported in Lilongwe.

Water and Environmental Sanitation Network executive director Willie Mwandira, in an interview this week, pointed out that 67 percent of Malawian households have access to safe drinking water and that 77 percent of water points nationwide are functional at any one time.

This means that the rest of the households drink water from unsafe sources, rendering them vulnerable to a cholera outbreak.  

In June last year, the country’s five water boards increased tariffs by an average of 50 percent, a development commentators said made potable water out of reach of a majority of the poor, especially in urban areas. 

Said Mwandira: “The rest of the water points no longer work, catchment deterioration, neglect, lack of spare parts and inadequate community-based water management structures. Only 10 percent of households in Malawi have hand-washing facilities with soap. Changing behaviour around latrine use and hand-washing has been challenging.”

According to him, the existing gaps have been exacerbated by inadequate funding to Wash programmes, highlighting that the current budget has a K67 billion deficit while the Wash projects need an annual allocation of about K386 billion to achieve the 2030 target on Sustainable Development Goals (SDGs).

Said Mwandira: “With the K386 billion budgetary allocation, the country may just be able to put up infrastructure that is climate-resilient in the face of climate shocks such as cyclones.

“With such levels of service coverage, we should not be surprised when we are hit by a cholera pandemic. To improve on these indicators, we need to strengthen all the systems that are linked to Wash services delivery.”

He urged government to increase national budget allocation to Wash from an average of 1 percent over the past three to five years towards a minimum threshold of 5 percent of total national budget, saying this is in keeping with Malawi’s Water Sector Investment Plan (Wsip) 2012 allocation estimates.

Commenting on the threat of cholera in the education sector, an education expert, Limbani Nsapato, who is executive director Educans, a think-tank on education issues, while acknowledging the efforts by the ministries of Health and Water and Sanitation, said schools are unable to sustain cholera prevention measures due to delays to receive school improvement grants and ORT (other recurrent transaction) funds.

According to him, many schools have not yet received funds for the second-half of 2023, and, as a result, they are unable to undertake most of the initiatives.

Said Nsapato: “While accessibility to water has improved [96 percent of primary schools and 87 percent of secondary schools], there are still many schools that don’t have access to safe water. At least 234 secondary schools and 136 primary schools have no access to safe water which makes students and teachers vulnerable to cholera and other diseases.”

He further said many schools don’t have toilet facilities or toilets are in bad shape and a few schools have flush toilets while most use pit latrines which are also poorly maintained.

Weighing in on the issue, Civil Society Education Coalition executive director Benedicto Kondowe bemoaned the lack of significant inspection, inactive school and district health committees, and the absence of meetings at the National Disaster Cluster in education.

In an interview on Thursday, he said: “In the context of Malawi’s annual cholera outbreaks, this unpreparedness increases the risk of severe consequences for schools in the event of an outbreak, potentially affecting the health and well-being of students and staff.”

A visit by Weekend Nation crew to some schools in Lilongwe City found that while some, especially within the city, have started implementing cholera prevention measures such as placing buckets of water with chlorine for washing hands at strategic places, it is business-as-usual for a majority of the schools.

Ministry of Education spokesperson Mphatso Nkuonera was yet to respond to our questionnaire on th matter.

But when asked how prepared the country is to combat the disease whose spread increases during the rainy season, Secretary for Health Samson Mndolo referred us to a Ministerial Statement issued on January 8 2024.

Among other things, the statement says Ministry of Health and all other stakeholders have developed a National Cholera Elimination Plan for 2024-2030 which is a roadmap for ending cholera in Malawi.

Says the statement: “The ministry has also developed a Cholera Preparedness and Response Plan covering the period November 2023-October 2024 which provides a health sector framework for operational planning and budgeting.

“The health sector plan is costed at $18 229 586. [Of this amount] $12 272 491 is available, leaving a financing gap of $5 057 095.”

Other measures in place are:

l Strengthening coordination and stakeholder involvement;

l Resource mobilisation;

l Rehabilitation of boreholes and expanding reach with safe water, collaboration with Water, Sanitation and Hygiene (Wash) partners;

l Enhancement of clinical case management at treatment centres and ongoing training of health workers on cholera management;

l Surveillance on cholera and all other diarrhoeal diseases

l Vaccination of targeted population with oral cholera vaccines.

In a separate interview on Thursday, Water and Sanitation, Principal Secretary Elias Chimulambe said the ministry has intensified drilling of boreholes to ensure that communities, especially in cholera hotspots have adequate access to safe water and improved sanitation.

Said Chimulambe: “You are also aware of the free water connection. This programme is helping low-income Malawians to also get connected to safe water.”

Health activist Gorge Jobe, who is executive director for Malawi Equity Network, said on Thursday that a health cluster comprising various stakeholders, including NGOs and MDAs, has started meeting on cholera preparedness.

He stressed that this is the time to assemble resources for response in case of registering more cholera patients with corresponding admissions.

On her part, Lilongwe City Council spokesperson Tamara Chafunya said, in a written response, that like other councils, LCC developed a cholera elimination plan which it started implementing prior to and during the rainy season.

The plan, which is under the World Health Organisation initiative through Ministry of Health, includes massive waste management, clean-up exercises, cholera awareness and sensitisation and chlorine distribution etc.

“Lilongwe City Council has been implementing activities under the Tithetse Cholera programme which involved briefing of the full council, block leaders through HSAs [health surveillance assistants], urban executive committee,” she said.

A 2013 study by the World Bank shows that for every $1 invested in climate-resilient water and sanitation, there is a return of at least $7 for African economies.

The study also shows that Sub-Saharan Africa countries such as Malawi alone could gain more than 5 percent of its GDP, equivalent to $200 billion annually, if sufficient investment in water and sanitation are made.