As cases of cholera continue to rise, commentators are heaping the blame on government for failing to empower communities with right information regarding the waterborne disease—a situation they fear may worsen.
More than once, the Ministry of Health (MoH) has blamed poor hygiene practices and superstition for fuelling the spread of cholera, which has claimed 26 people since November last year.
Experts also fault what they term “poor communication strategies”, saying Capital Hill ought to be more strategic in reaching out to communities.
In an interview, Water and Environmental Sanitation Network national coordinator Chris Bokho said government has failed to allocate enough resources for community engagement which would have helped cut down costs incurred when the outbreak strikes.
He said engaging communities regularly would lead to better understanding than what government does “to intensify awareness when there is an outbreak”.
“We have not done enough to raise awareness continuously to make people understand the benefits of good hygiene practices as well as the need for safe water.
“The cases recorded so far are an indication that we have not done enough. The awareness campaign that government has embarked on now is likely to achieve nothing because it is reactive and only to fulfil the word. We need to engage communities beyond the outbreak,” said Bokho.
Hit-and-run approach failing
Social and behaviour change communication specialist Mike Nazombe, who is also a lecturer at the Polytechnic, said behaviour change is a process which demands a strategy and not ‘the-hit-and-run’ approach government engages most of the times.
He said the country has been hit hard by cholera this time around because policy makers have not prioritised the issue of awareness as regard waterborne diseases such as cholera.
Nazombe said the focus has been so much on HIV and Aids at the expense of more deadly diseases such as cholera.
“We have underrated the impact of cholera. Because a few past years we have not experienced it has made everyone [government] to forget about the seriousness of cholera. We are paying for our laxity. We need to raise awareness systematically not just fulfilling our plans as is the case in government,” he added.
The lack of information on the part of communities remains an issue. When Weekend Nation crew visited one of the affected areas in Lilongwe-Mitengo Village in Area 36, the randomly interviewed affected households could hardly connect cholera to poor hygiene or the use of unsafe water from streams and wells.
We visited a neighbourhood where three people, two children and a man survived from cholera.
The houses are closely built and share a toilet which stands just about a meter away.
By the time of our visit flies could be seen hovering between the open toilet and the kitchen where a woman appeared to be preparing a meal.
The surrounding did not generally look clean but when asked if they had learnt a lesson from the cholera infection which hit one of the family members—the mother to a child who survived the outbreak said: “I do not think it is because of poor hygiene.
“We have lived like this for so many years, why have we not suffered from cholera? It is just one of the diseases due to bad whether maybe.”
A man sitting next to the woman who we had been speaking to was also in agreement.
“In fact we were surprised when we were told at the hospital that we had been infected by cholera due to unsafe water. We have been drinking this water for a long time without any problem. Why now and why only us?” he asked.
The MoH has blamed communities for negligence and superstition as a cause for the rising numbers, but Nazombe thinks government is largely to blame for perpetuating misconceptions.
Rising death toll
So far, cholera outbreak cases continue to rise in the country with the death toll now at 26.
According to MoH spokesperson Joshua Malango, the number of cumulative cases, as of Thursday, is at 830.
Three new cholera cases were reported with 10 people in cholera treatment camps.
Lilongwe still remains the district with the highest number of fatalities with 12 and 294 cumulative cases since the onset of this rainy season.
Chancellor College lecturer in sociology Charles Chilimampunga says the outbreak cannot be contained easily as it has to do with mindset change.
He said there is much to be done to change the mindset of communities who do not believe that the outbreak is caused by poor sanitation.
Chilimampunga observed that government alone cannot successfully contain the outbreak because it requires a lot of effort and time to change the mindset of the community.
He emphasised the need for government to engage developmental partners to contain the outbreak.
“The main problem is that we have few health workers in the country. To contain the outbreak requires a lot of resources which I think as a country we don’t have the financial muscle because we need to recruit more health surveillance assistants to sensitise communities on how to prevent cholera.
“We need developmental partners to come in because the issue is to do with behaviour change which you cannot change in hours but it needs time and money,” he said.
Malawi Health Equity Network (Mhen) executive director George Jobe expressed worry over the increase of cases.
He suggested that government finds new strategies of dealing with the outbreak by suspending the use of water from wells and rivers for domestic purposes.
“Though government is saying it is containing the outbreak, at district level it is appalling. Government should focus on the hotspot areas and suspend the use of water from wells and rivers as the disease is to do with hygiene,” said Jobe. n