Saturday, May 21, 2011

Cameroon: cholera epidemic and the politics of disease control

By Mofor Samuel
Since May 2010, the Ministry of Public Health has been working overtime to put the cholera epidemic under control across the nation. In spite of all the efforts put in place by the government and some of its partners, the cholera germ has become so defiant punching its way from one locality to the other like a wild wind across the window. Going by the statistics from May 2010 to the present day, more than 10,000 affected cases have been reported nationwide with close to a thousand deaths.
Sanitary amenities like pure water supply, safe disposal of human wastes and adequate housing with the population affording to live in conditions which reduce the degree of contact between members of the community and disease producing agents are just some of the ways to prevent and control cholera and other diarrhoeal diseases.

The Growth Strategy and Employment Document, a guide to governmental action for the period 2010-2020, has this to say concerning water and sanitation. Big towns with the majority of the population have potable water supply system. This gives a coverage rate of 82%. The situation on the ground as far as access to potable water supply to households in urban areas is concerned stands at 29% with an estimate of 226,638 consumers. But for some actions aimed at building structures for the evacuation of rainwater in Douala and Yaoundé, there is practically a non-existent network for the collection and evacuation of wastewater.

 Access to potable water and basic sanitation in the rural areas is limited. There is a real need to rehabilitate the existing infrastructure most of which are more than 20years old, extend the existing network which has not been following population increase and the expansion of urban areas, facilitate the realization of large scale connection and distribution programmes.

Government intends to increase access rate to potable water to 75% by 2020. Certain priority actions have to be undertaken within this timeframe- the realization of 700,000 connections in the urban areas, 40,000 water points in the rural areas, 1,200,000 latrines and the rehabilitation of 6,000 water points in the rural areas.

The urban hydrology policy letter of 2007 saw the creation of a state owned corporation- Cameroon Water Utilities Corporation (Camwater) which is incharge of construction, maintenance and management of water catchment infrastructure, transportation and storage of potable water. Camerounaise des Eaux on her part as a private concern is incharge of production, distribution, maintenance of equipment and the commercialization of potable water.
 Finally the document talks of the government aiming at increasing the access rate to sanitation infrastructure from 15-60%. This shall be achieved by putting in place a programme for the construction of latrines having water points in public facilities. The concept of total sanitation piloted by councils is in its pilot phase and has to spread in the country.
Public health activities which are suitable for the prevention of cholera are: the construction of protected wells, protection of springs, composting of wastes and construction of houses of better design etc.
Cameroon government’s inability to prevent and control the cholera epidemic for close to a year now is a classic example of conspiracy and collusion of the different arms of society to participate in the national pastime of looting and pillaging, of fiddling with the national treasury while cholera kills poverty-stricken Cameroonians from north to south with all impunity. How can one explain the fact that in the face of an outbreak of a water borne disease, instead of the Minister of Mines and Water Resources to lead the Minister of Health to the affected area, he is instead trailing him?
As Minister of Water Resources was he not supposed to be the first person to go and assess the situation on the ground before bringing in other ministers and partners to salvage the situation? There is equally this callous indifference exhibited by the authorities of Camwater and Camerounaise des Eaux in the face of the epidemic. Just like their supervisory ministry, they are just procrastinating.

How can one imagine that the Far North Region which is one the region hardest hit by the epidemic for years has its own son the Speaker of the House of Assembly going around in a bid to raise one hundred million francs to enable the population to make ID cards to enable them vote in upcoming presidential elections when this same population is dying under the scourge of cholera for want of potable drinking water? Can this same House Speaker not campaign for his colleagues, bigwigs of the ruling party to raise money to enable their poverty-stricken people to have access to potable drinking water? The same applies to all CPDM big wigs currently going round the nation under the cover of raising money to enable their followers to establish ID cards to enable them to vote for their party’s natural candidate.

Health statistics have ceased to be of any value for planning, intervention and monitoring the state of health. They have become instruments of looting national resources, manipulative game for pillaging and raiding the national treasury by civil servants, administrators and politicians. Cameroon is rejoicing in squalor, celebrating her disease burden, exulting in self-inflicted pain, a nation that is pleased and satisfied with its deplorable health situation.

Apart of telling Cameroonians how low we stand in our respect for human life and the welfare of the nation, our policy makers and health authorities also use WHO and UNICEF Reports to get more funds which they use to worsen our already bad health situation. We are neither able to prevent nor control cholera for which we have everything it takes to put it under control.

From where did we start? Where are we going? Have we missed the way? If so, are we prepared to retrace our steps and rediscover ourselves? Are we ready to be what we once were- the untainted and self-respecting, reliable and trustworthy nation? We are a people who now have little respect for learning, a near disregard for excellence and a disdain for quality. We live in a nation that generally and daily celebrates mediocrity and places the mundane on the golden pedestal of repute.
 The story of this nation in the 21st century where the talk of the day is attaining the Millennium Development Goals and becoming an emerging nation by 2025 is one of missed opportunities, ignored chances and abandoned vision. It is the unbelievable but true tale of misplaced priorities, lost hope and unfulfilled expectations. It is the chronicle of a nation going astray. As we mourn for a lost past, lament about a disastrous present and agonize over an unknown future, we must ask ourselves these questions (governors and the governed): where did we come from? What direction should we take?

And unless we put the train back on the rail now, then rather than becoming the emerging nation we look forward to by 2035, we would have submerged into the abyss of underdevelopment by then.
Meeting the needs of the present and future Cameroonian populations for food, water and energy without depleting or damaging the national resource base, while avoiding the adverse health and environmental consequences of industrialization and uncontrolled urbanization, can be achieved if only people have the knowledge and the means to influence action.

This calls for changes in the way government plans and manages national development. Participatory partnerships between local authorities and community organizations need to be developed. People dependent on natural resources like water, forest, land etc should be fully involved in decision making about their use and protection. Major determinants of development include economic, social, technological, institutional, attitudinal and political variables. Secondly, there is much in common between the factors or condition that determine both health and development.

Current approaches to development, each with its own constraints are economic growth, basic needs and people centred strategies. How are policies determined by health authorities and policy makers correspond with local health needs?

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