What it takes to reach Zero Cholera outbreaks in DR Congo
Cradle of humanity in which appeared the first traces of human life, Africa, in the romantic imagination, appears as the crossroads of all possibilities and arouses both wonder and fascination. Nevertheless, it unites some of the poorest countries in the world. It arguably offers the most flagrant image of the current concept of the Third World concept as well as the example of deficient health systems, unable to stem, treat and prevent diseases. From North to South, from East to West health systems are under tension. Between infectious danger, epidemics and pandemics that assail it, Africa is still, unfortunately, the region of the world where it is the least good to live.
While at the time of its independence, The Democratic Republic of Congo had the best-organized health system and among the best performing in Africa, today the Congolese health system is among the worst-performing in the world leading to an uprise of epidemics such as cholera, ebola to name these (Kambamba, 2017). The purpose of this article is to explore the meanders of the Cholera epidemic which, although being an elementary disease to eradicate, remains a sword of Damocles for the Congolese health system and its population, creating a crisis today that has taken away thousands of lives and continues despite international assistance.
Facts around Cholera
Cholera is a vaccine-preventable food and water-borne disease that causes severe diarrhoea and dehydration. Treatment includes antibiotics and fluid replacement which can reduce the case fatality rate from 50% to 0.2%. However, the lack of safe water sources and sanitation can contribute to explosive outbreaks (Outbreak observatory, 2019).
DRC makes up to 5-14% of outbreaks worldwide (Outbreak observatory, 2019). In 2017, there were 53,037 cases and 841 deaths. In 2018, there were 29,304 suspected cholera cases and more than 930 deaths. Complex emergencies in eastern DRC have enabled cholera to continue its spread along the banks of the Great Lakes and into surrounding areas due to water supply interruptions, high population densities and population movement. The 2019 outbreak is affecting 20 of DRC’s 26 provinces, particularly Haut-Katanga, South Kivu, Tanganyika, Haut-Lomami and North Kivu.
According to the Lancet, 550 Million people are at risk of Cholera in Sub-Saharan Africa and there are 1.7 million cases every year. Coming down to DRC, 189,000 outbreaks every year which is 5 to 14 of the total outbreaks worldwide.
The poor statistics of this epidemic show that it is serious and if nothing is done, could lead to an escalated human loss. Nevertheless, what accounts for this occurrence of Cholera?
The precarious infrastructural development and access to basic sanitation services
First of all, According to Professor Bompangue (2018), the root cause of cholera is “the imbalance between population density and infrastructure.” The Congolese water management, even at full capacity, is below the water needs of the population. In a vicious cycle during this rainy season, the overflow of water due to lack of pipes and the accumulation of domestic garbage in the sewers, lack of maintenance, aggravate the risk of flooding and stagnation of dirty water, potentially contaminated. According to a 2015 report of the United Nations Environment Program (UNEP), about 51 million people or three-quarters of DRC’s population do not have access to safe drinking water, even though the country holds more than half of Africa’s water reserves. Also, UNICEF remarks that an estimated 37 million rural inhabitants in the DRC are at risk of contracting a disease because they have no alternative but to consume untreated water directly from rivers or lakes sources that are likely to be contaminated. UNICEF estimates that more than 2 million Congolese children under the age of five are regularly sick with diarrhoea. The highest number of cases has been recorded in the Luka camp neighbourhood of Kinshasa (Lalibre Afrique, 2018), which concentrates all these problems: high density of population, unpaved roads and floodplains, lack of sanitation.
The monopoly of the private sector over the health sector
In addition, the Congolese government has thrown in the towel; the alternative was the private (lucrative and not-for-profit). We should note here that in the health sector in DRC, there is virtually no demarcation between the lucrative and nonprofit (i.e. religious denominations) in terms of price-setting care. In the health sector in the DRC, the private sector plays an active role in providing health services (sometimes of dubious quality). The private sector manages a vast number of health centres and half of the hospitals throughout Congolese territory. It also contributes to the financing of the health system, through contributions to consultation fees or medical examinations and direct contributions to supplement salaries (Contrepoints, 2012). Health services provided by private hospitals are costly (which may also be the case in many public hospitals). According to a local NGO, a study conducted by a local NGO in Maniema province in 2005 found that 30% of patients had sold their property and 15% had become indebted to meet the costs of healthcare. If money does not make happiness, it is unquestionably healthy. As with any other economic good, the demand for medical care depends on income. Because health care costs are high, in turn, the use of health services is low. According to the report on the state of health and poverty in the DRC in 2006, the average rate of use of health services is about 0.15 consultations per inhabitant per year, which corresponds to less than one consultation per person every six years.
Insufficient trained health personnel
Furthermore, Human Resources for Health is a severe problem for the sector as a whole: a decline in professional quality, the blossoming of schools and universities offering affordable medical education, few qualified personnel. The brain drain of qualified doctors out of the country in search of better working and living conditions affect hundreds of Congolese doctors who will make a career in South African health facilities (Contrepoints, 2015). According to the Director of Human Resources at the Ministry of Health, DRC has 5967 doctors for a population of 70 million. It amounts to 1 doctor for 11731 inhabitants.
An unstable political situation
The conflicts in the DRC and their consequences remain a source of significant concern, insofar as they constitute a multidimensional challenge to economic and human development in the country and the region. The war in the Democratic Republic of the Congo (DRC) has claimed an estimated five million lives in the past two decades. It’s the deadliest conflict in the world since World War II (Ledevoir, 2015). The DRC is now home to 2.9 million displaced people, 450,000 refugees and 6.8 million people affected by armed conflict. At the same time, the Congolese refugees worldwide are estimated at 443,000 (UNHCR, 2019).
But the effects of war go far beyond the loss of life and injury to the population. Wars have a development dimension. It is essential both to understand the causes behind the wars and to develop strategies to resolve them. Conflicts, consolidate peace and put the country back on the path of sustainable development. On the one hand, to some extent, the lack of development has created an environment conducive to war and conflict. Development strategies implemented since independence have failed to improve the well-being of the Congolese population significantly.
On the other hand, chronic conflicts and wars have hampered economic development. The Democratic Republic of the Congo is positioned at the bottom of the scale of countries in progress in terms of social and human development (it occupied the 186th place out of 187 countries and territories in 2012). With a human development index of 0.304 against an average of 0.466 for the countries in the low social development group and 0.475 for sub-Saharan Africa (UNDP, 2013). They also generated the deterioration of governance and national institutions, preventing the country from drawing taking full advantage of the significant growth potential associated with the abundant resources with which the country is endowed and at its strategic location within the region.
It is crucial today for the DRC to take a big step to counter this epidemic which, added to the political unrest in the country, is causing irreversible damage. For the government to get rid of cholera fight cholera, the following recommendations are suggested:
The government must take charge of the health system and make it accessible and affordable for the population. It should be noted here that the first duty of a government is to ensure that its people are healthy because it is vital to have a healthy people who will contribute in particular to the development of this one. The government must vote a large budget for the health sector to provide it with quality equipment and also take care of the health personnel who fly to unknown destinations. They can also provide medical insurance for their population which will help them get access to cheap medical services. Strict monitoring and control of the channelling of this budget must be put in place by the government to ensure that the funds do not end up in the pocket of government officials.
It is also necessary for the government to invest in the construction of primary sanitation infrastructures. It would be needed to expand the water distribution circuit and ensure that the water supplied to the population is of good quality. A high-quality water treatment centre can be built to provide the potability of the water before distribution. Also, we should ensure the insalubrity of Congolese cities while creating a parastatals company which will be responsible for cleaning and ensuring the cleanliness of cities as is the case of HYSACAM in Cameroon.
Last but not least, the DRC must create a research centre specializing in epidemics. this centre will be able to take care of the surveillance and the prevention of the occurrence of epidemics were they cholera or ebola and provide objective recommendations to the government to stop the spread of this epidemic which is very easy to eliminate if all the parameters are set up.
In closing remarks
Cholera has caused and continues to cause enormous human loss. We understand that it is very difficult to eradicate this epidemic when we are trying to put an end to a conflict that has been going on for ages. Still, the minimum effort must be made to stop this epidemic which does not only affect human health but also the economy. The government must make incredible efforts that will help to eradicate this epidemic. Knowing all that the risk 0 does not exist, we must at least ensure that we have a minimal risk of occurrence of the cholera epidemic. Our wish is that the DRC does not turn into a cemetery. The DRC has the enormous potential to be a world power and we hope that the government and the international community will find a solution to these obstacles to development.
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