A long term program to combat cholera

In the Democratic Republic of Congo, the resurgence of cholera is a major public health problem, especially in urban areas. Many players in development, including the Veolia Foundation, have accordingly decided to implement a concerted strategy to fight the propagation of cholera. Here's why.

The spread of the cholera epidemic is inherent in the lack of access to drinking water

The first studies conducted in 2007 by Congo doctors and French epidemiologists from the University of Besançon pinpointed the correlation between the development of cholera epidemics and the lack of access to drinking water. This waterborne disease, which causes vomiting and shattering diarrhea, is in fact responsible every year for thousands of deaths in the Democratic Republic of Congo: 15 % of the cases of cholera and 20 % of cholera related deaths in the world (2000 -2008). Besides, only 16 % of the population of Congo enjoy access to drinking water (source WHO).

Based on these preliminary results, the DRC Public Health Ministry launched a major strategic national plan to eradicate cholera (2008-2012) and set up an integrated Epidemiology-Water, Hygiene and Sanitation (EHA) approach. The plan relies on a reinforced partnership of the Congo ministries concerned, local and international NGOs, experts in urban infrastructures for water and energy, and international lenders (AFD, European Union, private foundations). Together, these four stakeholders form a "magic square" for effective and sustainable action. At the same time, and to boost the argument for sustainable financing and coordinate targeted projects, the Veolia Foundation and its partners created an international alliance, the Global Alliance Against Cholera (GAAC) in 2010.

A long term program to combat cholera 9785,raw,carre-magique-londonEN.jpg

The "Magic Square"

Identifying the epidemic source areas

Over a four-year period, the teams gathered the essential data for understanding how this disease propagates at a given time and in a given place; with the aim of charting an accurate map of the cholera epidemic source areas and of their drinking water networks. This twofold task initially helped target the priority action areas, and then served to determine the operations required in terms of rehabilitation of the drinking water networks and stations.

Eight towns that are centers for the initiation and spread of these epidemics in eastern DRC were identified, most of them situated on the shores of lakes. Many players are now aware of the need to act: epidemiologists from the Congo Health Ministry, Regideso (national authority for water management), partner NGOs such as Solidarités International and Veoliaforce.

The first town in which the program is being implemented is Kalemie, on the shore of Lake Tanganyika, in the Katanga province. Many missions are underway, gathering Congo doctors, Regideso, the NGO Solidarités International, and Veoliaforce volunteer experts. The latter helped produce a blueprint of the town's water networks in order to target the needs for drinking water, and to specify the priority measures to reinforce epidemic monitoring operations.

Rehabilitating and securing the water networks of Kalemie and Uvira

Work to rehabilitate and reinforce the existing water network is completed (Regideso and Solidarités International). The first results: 46 % more subscribers and Regideso's financial self-sufficiency consolidated (Phase 1); doubling of the capacity of the drinking water treatment plant carried out with funding from the Katanga governorate (Phase 2); extension of the Southern network - nearing completion by the NGO Solidarités International (Phase 3); and the construction of a reservoir and the extension of the network to the northern part of the town (Médecins Sans Frontières) should be completed by end 2014 (Phases 4 & 5).

In 2008, alongside its involvement in Kalemie, the foundation conducted exploratory surveys in the town of Uvira (another area pre-identified by the epidemiological surveys), South Kivu province, in order to assess the need for drinking water infrastructures. "Emergency" measures were subsequently identified and implemented by Oxfam GB and Regideso, in order to secure the drinking water production and distribution in the town, in the short-term. At the same time, the Veolia Foundation performed a major task, with the support of the Artelia Foundation, to design a scheme for the development and rehabilitation and extension of the town's drinking water infrastructures.

 

In 2013, Agence Française du Développement and the European Union agreed to finance the three-year implementation of the development scheme for the water infrastructures. Four operational steps were identified for the rehabilitation and extension of the infrastructures:

  • Rehabilitation and extension of the distribution network;
  • Construction of a large capacity reservoir;
  • Doubling of the production capacity of the plant;
  • Securing the energy supply by installing a micro-hydropower plant specifically dedicated to supplying the Regideso plant.

Each of the partners is involved in carrying them out. The Veolia and Artelia foundations and EDF for technical studies associated with the installation of the network and the reservoir, plus the micro- hydropower plant, the NGO Oxfam GB for education, prevention and hygiene awareness aspects.

Study of the impact of access to water on the incidence of cholera

No impact study is currently available on the link between improved infrastructures for access to drinking water in urban environments and the epidemiology of cholera in Africa. This is why the foundation wants to intensify its approach and - based on the Uvira hydropower development - to evaluate the impact of the project for population access to drinking water on the incidence of cholera. It therefore decided to entrust a three-year impact study of the project to the celebrated university specialized in tropical diseases, the London School of Hygiene & Tropical Medicine (LSHTM), which responded immediately by sending out one of its epidemiologists in order to clarify the health context of the town and to determine a working method for the impact study over the project period.

In early 2014, the LSHTM epidemiologists returned to the area and analyzed the logs of admissions to the Uvira cholera treatment center, in order to compare them with the production of drinking water. The results of this preliminary study are clear, demonstrating a tangible link between access to drinking water and cholera: three times more admissions in the ten days that follow a suspension of drinking water production, and 25.3 % of cases inherent in a drop in drinking water production over the 2009-2013 period.

Choice of a randomized control method

The impact of the project will be assessed by Randomized Controlled Trial (RCT). Uvira will be subdivided into 16 "clusters", each comprising a number of UGB. Operations to improve the drinking water network, and hence access to water, will be carried out cluster by cluster, and are defined so that the operations can be conducted on each separately, and in approximately the same time.

The operations will be conducted at random: lots will be drawn between the 16 clusters to determine the order in which they receive the operations. As the operations advance, the clusters in which access to water was improved will serve to assess the impact of this improvement on the incidence of cholera, in comparison with reference clusters that have not yet benefited from the operations. If the final results confirm the preliminary study, they will offer a powerful argument for structural actions in the area of water to fight cholera.

Global Alliance Against Cholera (GAAC)

Guidance for the elimination of cholera epidemics in a sustainable manner in the Democratic Republic of Congo and other high risks countries.

Download the leaflet
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Clean drinking water is a cornerstone of the campaign to eliminate cholera in the Democratic Republic of the Congo. Humanitarian, medical, technical and financial organizations have teamed up as part of a program to combat the disease, backed by the Veolia Foundation.

  • Publications
    Global Alliance Against Cholera (GAAC)

    Guidance for the elimination of cholera epidemics in a sustainable manner in the Democratic Republic of Congo and other high risks countries.

    Download the leaflet
    Planet #2
    Ibrahim Mayaki: A vision for Africa

    Former Prime Minister of Niger Ibrahim Assane Mayaki is a key name in African politics and is now beginning his second term as CEO of the New Partnership for Africa's Development (NEPAD). His somewhat unconventional career path refl ects his vision for a changing continent. A vision that is both clear and bold.

  • Planète
    Planète
    Tackling the problem at its source

    Clean drinking water is a cornerstone of the campaign to eliminate cholera in the Democratic Republic of the Congo. Humanitarian, medical, technical and financial organizations have teamed up as part of a program to combat the disease, backed by the Veolia Foundation.