Oxfam publishes advice on handling a cholera outbreak – but are we right?

Source: Oxfam Policy and Practice Blog, Aug 13, 2012, by Elizabeth Lamond, HSP Public Health Engineer Coordinator

Oxfam’s Cholera Outbreak Guidelines were developed as an internal resource, but today we are sharing them externally in order to seek input from the international humanitarian community. We hope that this feedback will inform later editions in order to develop a powerful resource for anyone looking to prepare for, prevent and control a cholera outbreak. Here, one of the authors of the Guideline, Bibi Lamond, explains more. 

I have been responsible for implementing and coordinating cholera outbreak programmes since 2006. In my work I have found that, although there are numerous documents and books on medical intervention for cholera control, there are no comprehensive water, sanitation and hygiene promotion (WASH) guidelines.

Oxfam’s new publication, the Cholera Outbreak Guidelines aims to meet this need and could set standards for other emergency WASH actors.

The content of the Guidelines has evolved from firsthand field experience in Oxfam’s emergency cholera programmes in Haiti, Democratic Republic of Congo, Ethiopia and Zimbabwe. It has also drawn on information from other NGOs, such as Médecins Sans Frontières, renowned for their cholera work in the field.

Factors determining the effectiveness of Oxfam’s public health promotion approach in Haiti

Factors determining the effectiveness of Oxfam’s public health promotion approach in Haiti, 2012.

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Nadja Contzen, Hans-Joachim Mosler. Eawag.

In response to the devastating Earthquake of January 12th 2010 and the cholera outbreak of October of that same year Oxfam Great Britain, Oxfam Quebec and Intermón Oxfam conducted public health promotion and cholera response in Haiti. Different promotion activities were applied which aimed at changing hygiene behavior by changing perceptions and beliefs about healthy behaviors amongst people affected by crisis.

In February 2011 four Oxfam affiliates in Haiti in partnership with a team of behavior change researchers from Eawag launched the present research project to do an in-depth evaluation of the promotional activities that had been conducted with the goal of further improving the WASH situation for people in Haiti and worldwide by understanding how to make hygiene promotion more effective. The main focus of the research project was around the question which specific promotion activities were strongly associated with perceptions and beliefs about handwashing with soap and were thus capable of changing handwashing behavior at key times.

OXFAM – Hygiene promotion: determining what works

OXFAM – Hygiene promotion: determining what works, 2012. Humanitarian field studies | Cholera response in Haiti

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When a massive earthquake struck Haiti in January 2010, followed by a cholera epidemic that broke out in October of that year, Oxfam rushed assistance—clean water, sanitation, and hygiene materials and information—to hard-hit areas to protect public health.

Hygiene promotion is arguably the most important intervention in a cholera epidemic: the route of cholera transmission is fecal-oral, and contaminated hands are often the principal vector. So Oxfam engages in a wide range of hygiene-promotion activities to encourage washing hands—specifically, washing hands with soap at key moments, such as before eating and after defecation.

But which of our interventions have been the most effective, and why? Is it more important to put resources into hygiene-themed theater productions or radio call-in shows? There is little hard evidence to suggest that—in Haiti or in emergencies anywhere—one hygiene-promotion activity works better than another. But lives, not to mention valuable resources, may depend on the answer, so in the spring of 2011, Oxfam engaged Eawag, the Swiss Federal Institute of Aquatic Science and Technology, to study the effectiveness of our hygiene-promotion activities in Haiti.

OXFAM – Water, Sanitation and Hygiene Sector in Liberia

Life and Dignity at Risk – The Water, Sanitation and Hygiene Sector in Liberia, 2010.

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Liberia‘s newly approved water and sanitation policy states that ‘water is life‘ and ‘sanitation is dignity‘. At present, however, the dire state of water, sanitation and hygiene (WASH) services in Liberia constitutes a public health crisis that is killing Liberians and robbing many more of their dignity: three out of four people have no access to safe water, six out of seven are without access to safe sanitation facilities, and altogether unsafe water, sanitation and hygiene practices cause 18 per cent of all deaths in Liberia.

This new paper from the Liberia WASH Consortium argues that these deaths can be prevented, but that Liberia’s government and donors need to rise to some serious challenges. These include speeding up coordination of policies and institutions; increasing the woefully inadequate government and donor financing in order to fill the $94 million financing gap; and dramatically improving aid coordination in the WASH sector. The challenges are serious, but can and must be met in order to halt the scandal of preventable disease and deaths – the denial of life and dignity – that confront millions of people in Liberia through lack of safe water and sanitation.

Key recommendations

• The Government of Liberia should speed up the process of finalising sector policies and improve coordination, improve data collection, increase funding for WASH to between 4 and 5 per cent of its total budget and engage better with civil society.
• Liberia’s donors should dramatically increase funding to meet the $93.5m financing shortfall, greatly improve their own coordination and alignment with the government including by ensuring that the lead donor is effectively driving this process, and support long-term planning by the government which meets both urban and rural needs.
• Liberian civil society should strengthen their engagement in the WASH sector policy and planning processes and provide a means for communities to express their needs, understand their rights and demand services in the water, sanitation and hygiene sector.

Joint Agency Paper: Liberia WASH Consortium

Author: Muyatwa Sitali, WASH Advocacy Coordinator, Liberia

Publication date: 17 June 2010

Zimbabwe declares national emergency over cholera

Zimbabwe has declared a cholera outbreak that has killed more than 560 people [with the capital Harare the worst affected] a national emergency and appealed for international help to deal with the crisis.

[...] “Our central hospitals are literally not functioning. Our staff is demotivated and we need your support to ensure that they start coming to work and our health system is revived,” Health Minister David Parirenyatwa was quoted as saying in an appeal to donors.

[...] Zimbabwe’s health sector is collapsing with not enough money to pay for essential resources and doctors and nurses often striking over pay. The water system is in disarray, forcing residents to drink from contaminated wells and streams.

[...] Analysts said worsening conditions may force Mugabe’s government to mend relations with donors and other governments.

[...] Zimbabwe’s neighbours, faced with cholera patients fleeing across their borders, moved to help the country, while the World Health Organisation said it was preparing to send a team to help deal with the cholera outbreak.

[...] Deputy minister for water and infrastructural development Walter Mzembi said the ministry had only enough water treatment chemicals to last about 12 weeks, and called for donor support, the Herald reported. “I am appealing for at least 40 million rand ($3.9 million) to purchase chemicals for the next two months and the money is needed between now and next Monday,” the paper quoted him as saying.

Source: MacDonald Dzirutwe, Reuters, 04 Dec 2008

WASH response

The humanitarian community continue to scale up responses to cholera. UNICEF and OXFAM GB [who lead the WASH Clsuter], GAA, and ACF and other humanitarian partners are enhancing hygiene education; and emergency supplies. [T]he Health and the WASH Clusters will be holding weekly joint meetings, [while] UNICEF is working on a database indicating emergency supplies prepositioned by WASH Cluster members for the response.

{…] So far, Matabeleland North remains the only province which has not reported any cases.

The rapid deterioration of the health service delivery system in Zimbabwe, lack of adequate water supply, and lack of capacity to dispose off solid waste and repair sewer blockages in most areas will continue to contribute to the escalation and spread of the outbreak.

For more information contact: Ben Henson at bhenson@unicef.org for WASH

Read more: OCHA, Weekly Situation Report on Cholera in Zimbabwe, 03 Dec 2008

Regular updates and background information can be found on the UN OCHA Zimababwe web page.

See below a report by Sky News on cholera victims who have fled toSouth Africa for treatment

Canada: Talking Toilet Taking to the Streets

This will likely draw some attention in downtown St.John’s today. There will be a walking and talking toilet on Water Street between 11am and 1pm. Local Oxfam spokesperson Daniel Miller says it’s all about raising awareness of sanitation issues.  (…)

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Canada: Toilet Festival Starts Today

August 11, 2008.      The St. John’s Toilet festival gets underway today. It’s a week of events organized by Oxfam and dedicated to raising awareness about water and sanitation issues in developing countries. (…)

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