A study by WHO-AFRO evaluating the five-year progress of the implementation of the regional cholera prevention and control framework adopted in 2018, has shown that the region is not on track to eliminate cholera by 2030.
All four targets, which include contributing to the global goal of eliminating predictable cholera epidemics, reducing the scale of cholera outbreaks by 50%, ensuring regular monitoring and evaluation, and adapting the regional cholera framework, are off track.
Fair progress was observed in targets 1 and 2, at 59% and 54%, respectively.
However, targets 3 and 4 show unsatisfactory or insufficient progress, at 39% and 43%, respectively. Overall, the region made fair progress with a completion rate of 53%.
One potential reason for this is the insufficient dissemination of the framework among key stakeholders at the national level.
The delayed implementation of the framework may explain the repeated cholera outbreaks in both endemic and non-endemic countries.
Out of the 47 countries in the region, 27 including 11 from West Africa (Benin, Burkina Faso, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Nigeria, Sierra Leone, and Togo), five from Central Africa (Burundi, Cameroon, Central African Republic, Democratic Republic of Congo, and Chad), five from East Africa (Ethiopia, Kenya, South Sudan, Uganda, and Tanzania), and six from Southern Africa (Angola, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe) participated in the study.
Twenty-four (89%) are cholera-endemic, with only three non-endemic countries (11%) taking part.
Ghana is one of 14 African countries that have made fair progress in implementing the regional framework for cholera prevention and control.
Along with Benin, Burundi, Cameroon, the Democratic Republic of Congo (DRC), Guinea, Mali, Sierra Leone, Nigeria, Mozambique, South Sudan, Tanzania, Togo, and Zimbabwe, these nations represent 52% of the countries in the region that are making strides in addressing cholera.
Ten other countries, including Angola, Burkina Faso, Central African Republic, Chad, Guinea-Bissau, Liberia, Malawi, Mauritania, South Africa, and Uganda, showed unsatisfactory or insufficient progress, accounting for 37% of the region.
Only three countries, Ethiopia, Kenya, and Zambia were on track, representing 11%. The overall progress among countries varied, with Mauritania and South Africa scoring as low as 19%, while Ethiopia achieved the highest progress at 76%.
The study titled, “An assessment of the progress made in the implementation of the regional framework for cholera prevention and control in the WHO African region,” published on BMJ Global Health also captured 21 key milestones critical to cholera elimination progressing much slower than the others. These key milestones are primarily spread across the first three targets.
Progress on regional milestones for cholera prevention and control
The region showed strong progress in four milestones, fair progress in seven, and insufficient or unsatisfactory progress in ten.
The four milestones that were on track included hotspot mapping at 85%, the establishment of a solid multisectoral and partner coordination mechanism at 79%, strengthened national capacities for cholera preparedness and response at 84%, and the implementation of functional epidemiological and laboratory surveillance systems at 79%.
The region made fair progress in 7 out of the 21 milestones.
These included appointing cholera focal points at the national level at 63%, developing cholera outbreak preparedness and response plans at 61%, enhancing cross-border surveillance at all levels at 52%, establishing rapid response teams for field investigations and risk evaluations at 63%, conducting risk assessments and mapping at 67%, strengthening specific capacities for cholera case management at 69%, and documenting challenges and lessons learned for decision-making at 63%.
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