Via The Guardian, a long IRIN: West Africa desperate for cleaner toilets to save slums from cholera. Excerpt:
Aid agencies are scrambling to treat thousands of cholera patients in Sierra Leone's capital, Freetown, where the number of infections is mounting by more than 250 per day. Most patients are from the city's urban slums, where open defecation is rife, toilets are rare, sewage is improperly disposed of and awareness of cholera is low.
Water and sanitation specialists say unless these problems are addressed, cholera will continue to flourish both in Sierra Leone and throughout west Africa.
By 15 August, more than 19,000 people had contracted cholera in west Africa, the most affected countries being Sierra Leone, Ghana, Niger and Guinea, according to the UN Children's Fund Unicef. "There is a massive failure to take cholera seriously in this region, and to publicise it," said a west Africa cholera specialist.
"Ultimately, if you want to get rid of cholera you need to address the structural issues that cause it." The money is there, "it is a question of tapping into it and taking responsibility for your citizens".
Take cholera seriously
Most west African countries are falling far short of their millennium development goal to double the proportion of citizens with access to proper sanitation facilities – only 37% of inhabitants can access a clean toilet, according to the World Health Organisation.
As in Freetown, a high proportion of the cholera cases in Conakry, the Guinean capital, and Accra, Ghana's capital, are concentrated in urban slums, where there are few clean toilets and most people openly defecate, often dangerously close to open wells that are the source of water for most residents.
Governments tend to clean up the cholera mess once it is in full swing rather than working on prevention, said an independent water, sanitation and hygiene (Wash) specialist, adding: "It is government's responsibility to address the very basic sanitation rights of its citizens."
Donors, too, prefer to fund reactively, hence "Unicef's sword and shield [response-prevention] strategy is more sword than shield," said Patrick Laurent, west Africa Wash co-ordinator at the organisation.
When aid agencies approached the African Development Bank last year for cholera prevention support in the Central African Republic, the response was: "When you report a cholera case, we'll give you the money." In Guinea, just a few aid agencies – Action Against Hunger and Unicef – work on cholera prevention with the government, while one – Médecins sans Frontièrs – is doing the bulk of the treatment and transmission containment.
Ghana: prosecution over publicity
In Greater Accra, with 77% of the country's cholera cases, at least 20,000 people have no toilet or use bucket latrines, according to the Accra health department director, Simpson Boateng. Those living near the sea defecate on the beach.
The Ghanaian government banned open defecation and bucket latrines in 2010, and arrests all perpetrators, said Boateng. "We need to continue to educate them [people], but more importantly, you will be arrested when caught," he told IRIN. "As I speak, over 1,000 landlords have been prosecuted for still using pan latrines in their houses." The city council is establishing a "sanitation court" to try the culprits. "We are simply enforcing the bylaws that frown upon this conduct," he said.