Improving water access in order to combat cholera

Cholera is a waterborne disease that causes vomiting and severe diarrhoea. The disease is experiencing a dramatic resurgence in the DRC. Cholera claims thousands of victims every year. We know how contamination occurs: contaminated water is one of the ways in which the cholera bacterium is spread when water treatment and sanitation are inadequate. The link between the disease and access to drinking water was first demonstrated in the 19^th century in the UK. The link has now been proved. However, in the DRC only 16% of the population has access to drinking water*.

A first phase focusing on epidemiological research

The first studies were conducted in 2007 by Congolese doctors and French epidemiologists from the University of Besançon, supported by the Veolia Foundation. These studies highlighted the link between the development of the cholera epidemic and the lack of access to drinking water in the country. The country’s Ministry of Public Health reacted by launching a major national strategic plan to eradicate cholera (2008-2012) based on an approach incorporating health, water, hygiene and sanitation. The plan relied on a reinforced partnership between the relevant government ministries, local and international NGOs, urban water and energy infrastructure experts, and international funding bodies (AFD, EU and private foundations). The plan was extended in 2012 by a Multi-Sector Cholera Eradication Plan, a five-year programme approved by the representatives of many of the country's provinces at an important meeting arranged by the Veolia Foundation in March 2016.

The first four-year phase of the plan on the ground involved collecting data to understand how the disease spreads. This led to cholera epidemic source areas being accurately mapped so that priority intervention areas could be targeted and so that the necessary work to build and renovate drinking water networks and treatment plants could be recommended. Eight cholera outbreak towns were therefore identified in Eastern DRC with most of them being lakeside towns.

Kalemie - the first town to benefit

Kalemie is located on the shores of Lake Tanganyika in Katanga Province and was the first town to benefit from the cholera control programme. A large number of international stakeholders set to work in the area: Congolese doctors, representatives of Regideso (national water authority), NGOs such as Solidarités International and Médecins sans Frontières, and our own Veoliaforce volunteers. The Veolia Foundation’s experts helped to produce a blueprint for the town’s water networks. The blueprint has a twin-pronged objective: meet drinking water requirements and establish the priority measures required to bolster epidemic monitoring.
 
Work to renovate and secure the existing water network was successfully completed. Regideso recorded a 46% increase in water customers! The treatment capacity of the drinking water treatment plant built with Katanga Province Governorate has doubled. A new reservoir was built and the water network was extended to the northern and southern areas of the town thanks to Médecins sans frontières and Solidarités International. Regideso also became more financially independent.
 
In 2016, the Veolia Foundation worked with its partner Solidarités International to update the hydraulic modelling of the drinking water network by incorporating the work done since 2009 to improve water access. The long-term sustainability of the infrastructure is key to sustainably combating cholera.

Renovating and securing the water networks at Uvira

In 2008, alongside its work in Kalemie, the Foundation began to focus on another area. Veoliaforce experts conducted exploratory missions in another area pre-identified by the epidemiological research - Uvira in Sud-Kivu Province. The aim was to assess the state of the drinking water infrastructure.

The analysis resulted in emergency measures being taken by Oxfam GB and Regideso to secure drinking water production and distribution in the town in the short term. The Veolia Foundation then worked with Artelia Foundation to devise a drinking water infrastructure renovation and extension development plan for the town. In 2013, AFD and the EU agreed to fund the three-year rollout of this water infrastructure development programme.

Four phases of work were identified:

• Renovating and extending the distribution network ;
• Constructing a large reservoir ;
• Doubling the plant’s production capacity.

In 2016, a call for tenders was made for the construction work, monitoring, conducting audits and for starting to create the community fabric around the new water access points, which will be opened in the near future. The Veolia and Artelia Foundations are conducting the technical studies for the network and reservoir. Oxfam GB is overseeing the social component of the project: community education, prevention and hygiene awareness-raising. Finally, a local NGO, ADIR, is tasked with structuring local communities into user associations so that the local population becomes aware of the need to access drinking water in order to combat cholera.

Scientific monitoring of the programme

The programme running for the past decade in the DRC has been scientifically assessed by one of the Veolia Foundation’s long-standing partners. The London School of Hygiene & Tropical Medicine (LSHTM) has been monitoring the project right from the outset to assess its effectiveness.

The project in Planet

To date, the DRC remains the only country in Africa with a national eradication strategy, which relies a great deal on access to high-quality water.

To see more

The impact study funded by the Veolia Foundation uses a Randomized Controlled Trial cluster method. Uvira has been sub-divided into 16 clusters. Improvements are made to the drinking water network and therefore to water access cluster by cluster and are designed in such a way that work is done on each cluster separately and roughly at the same time. The order in which the work is done is random. Lots were drawn to decide it. As the work progresses, the clusters that have already benefited from improved water access are used to assess the impact of this improvement on cholera incidence, compared with reference clusters where work is yet to begin.
 
The preliminary study over 2009-2013 demonstrated the tangible link between drinking water access and cholera in Uvira. The LSHTM found that there were three times more admissions to the Uvira Cholera Treatment Facility in the 10 days following a suspension of drinking water production and that 25.3% of cholera cases were inextricably linked to a drop in drinking water production. A prestigious medical journal, PLoSMed (Public Library of Science Medicine), echoed these findings.
 
If the final results confirm the findings of the preliminary study, they will offer a powerful argument for water infrastructure initiatives in the fight against cholera.

* Source: WHO