A study by WHO-AFRO assessing the five-year progress of the regional cholera prevention and control framework, adopted in 2018, reveals that the region is not on track to eliminate cholera by 2030.
The evaluation found that all four key targets set to combat cholera are falling behind. These include the global goal of eliminating predictable cholera epidemics, reducing the scale of outbreaks by 50%, ensuring regular monitoring and evaluation, and adapting the regional cholera framework.
While progress was noted in the first two targets—contributing 59% towards the goal of eliminating epidemics and 54% towards reducing outbreaks—none of the targets are on track to meet the 2030 deadline.
The WHO-AFRO study, assessing the five-year implementation of the regional cholera prevention and control framework, shows that the region is struggling to meet its goal of eliminating cholera by 2030. While overall progress has been fair, with a completion rate of 53%, the study highlights unsatisfactory progress on key targets.
Targets 3 and 4, which focus on regular monitoring and adapting the cholera framework, are particularly lagging, with only 39% and 43% progress, respectively. The insufficient dissemination of the framework to key national stakeholders is one possible reason for the delay in implementation, which has contributed to recurring cholera outbreaks, even in countries that were not previously considered endemic.
Of the 47 countries in the region, 27 participated in the study, including 11 from West Africa, five from Central Africa, five from East Africa, and six from Southern Africa. A significant portion, 24 countries (89%), are cholera-endemic, while only three non-endemic countries (11%) were part of the study.
Ghana is among 14 African countries that have made fair progress in the fight against cholera, alongside nations like Benin, Burundi, Cameroon, Democratic Republic of Congo, Guinea, Mali, Sierra Leone, Nigeria, Mozambique, South Sudan, Tanzania, Togo, and Zimbabwe. These countries make up 52% of the region showing notable efforts in cholera control.
However, ten other countries, including Angola, Burkina Faso, Central African Republic, Chad, Guinea-Bissau, Liberia, Malawi, Mauritania, South Africa, and Uganda, showed unsatisfactory progress, accounting for 37% of the region.
A recent study by WHO-AFRO assessing the progress of cholera prevention and control in the African region reveals that only three countries—Ethiopia, Kenya, and Zambia—are on track to meet the goals, representing just 11% of the region. While overall progress varies significantly, some countries like Ethiopia made substantial headway, achieving 76% progress, while others, such as Mauritania and South Africa, lagged behind with only 19% progress.
The study, titled “An assessment of the progress made in the implementation of the regional framework for cholera prevention and control in the WHO African region,” published in BMJ Global Health, also highlighted the slow pace of progress on 21 key milestones that are crucial for cholera elimination. These milestones, mainly falling under the first three targets of the framework, are moving much slower compared to others.
Key Milestones in Cholera Prevention
The region has seen notable progress in four critical milestones:
- Hotspot mapping: 85%
- Establishment of multisectoral and partner coordination: 79%
- Strengthened national capacities for cholera preparedness and response: 84%
- Implementation of functional epidemiological and laboratory surveillance systems: 79%
In addition, seven other milestones showed fair progress, including appointing national cholera focal points (63%), developing cholera outbreak preparedness plans (61%), and enhancing cross-border surveillance (52%). However, progress in several other areas remains insufficient or unsatisfactory, with ten milestones not advancing as expected.
Areas of Insufficient Progress
The study identified several areas where progress has been unsatisfactory:
- National Cholera Plans (NCPs): 43%, with only six countries on track
- Funding of NCPs: 16%, with no country on track
- Mobilizing technical and financial resources for cholera: 40%, with only five countries on track
- Multisectoral cholera prevention in hotspots: 44%
- Social mobilization strategies and community interventions: 43%
- WASH investment and operational costs: 23%
- Water quality interventions in hotspots: 31%, with no country on track
- Development of investment cases for cholera: 14%, with no country on track
The findings emphasize the need for urgent action to address these critical gaps and ensure that the region is better prepared for the challenges of cholera prevention and control.
Cholera remains a global threat
Cholera continues to pose a significant public health threat worldwide, with annual cases ranging from 1.3 million to 4 million, resulting in deaths between 21,000 and 143,000 each year.
This disease primarily affects regions in Sub-Saharan Africa (SSA) and Asia, where its impact is most severe on impoverished communities. The highest burden is borne by individuals in low-income areas, highlighting a clear connection between cholera and factors like poverty, poor sanitation, and lack of access to clean drinking water.
Effectively controlling and reducing cholera transmission and fatalities requires a multifaceted approach. While regions like Europe, North America, South America, and parts of Central America have managed to eliminate cholera due to advancements in safe drinking water access, sanitation, and hygiene, the disease still causes frequent outbreaks in Africa and Asia.
The Global Task Force on Cholera Control (GTFCC), formed in 1992, has been instrumental in uniting global efforts to combat cholera. In 2017, the GTFCC launched the “Ending Cholera: A Global Roadmap to 2030,” reaffirming its goal to eradicate cholera worldwide. Following this, in August 2018, 47 African nations adopted a regional framework at the WHO Regional Committee for Africa, aligning with the global roadmap’s strategy.
The framework lays out a comprehensive plan that includes four key targets and 21 milestones designed to support member countries in their ongoing efforts to prevent and control cholera.
SOURCE: Mahmud Mohammed-Nurudeen
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