A Race against Time: Responding to Cholera Outbreaks in Ghana

When Cholera strikes, it is devastating. It moves quickly, infecting people who unknowingly pass it on to others. High-density communities around city centers are often the hardest hit by an outbreak, and efforts to contain the disease become a race against time. Since the early 1970s, Ghana has reported intermittent Cholera outbreaks, with significant epidemics in the recent past. In 2014, 60 percent of Ghana’s districts reported Cholera infections and in 2014 and 2015 combined, nearly 30,000 new cases and over 250 deaths were reported.

More than half of Ghana’s urban population live in informal settlements where access to safe water systems is unreliable and basic sanitation services are limited. Within these neighborhoods it is easy for diseases like Cholera to spread rapidly.

But with access to clean water, improved sanitation, and proper hygiene practices, the disease can be prevented or stopped in its tracks. Global Communities and the United States Agency for International Development (USAID) collaborated with a variety of key stakeholders throughout Ghana to respond to the 2014/15 Cholera outbreak in the Cape Coast district, just outside the capital, Accra.

Volunteers talk to community members.
Volunteers educate community members on how to prevent the spread of Cholera.

Their efforts build on nearly a decade of working to address water and sanitation needs in Ghana: first, through a seven-year project that focused on improving drinking water and access to sanitation facilities for urban communities (Water and Sanitation for Urban Poor-WASH-UP), and most recently, through a new five-year project focusing on WASH activities for rural populations (WASH for Health). Throughout both of these projects, Global Communities has worked closely with local, regional and national government counterparts to build their capacity and strengthen systems.

When Cholera erupted in 2014, Global Communities partnered with the Ministry of Local Government and Rural Development, the Ghana Health Service (GHS), the International Red Cross, UNICEF and the World Health Organization to respond to the outbreak.

Global Communities donated 20 liters of Sodium Hypochlorite, 20 boxes of Aquatabs, and 100,000 Ghana Cedis to GHS to support their logistical operations and contact tracing efforts; Global Communities also mobilized hundreds of volunteers to educate urban populations on key hygiene behaviors and distribute millions of Aquatabs to urban communities. Additionally, because research conducted early in the WASH-UP project found that over 50 percent of residents in poor urban communities rely on food that is cooked outside the home, it was essential that food vendors in the Cholera-affected communities be trained in appropriate hygiene and food preparation behaviors. Knowing this, Global Communities implemented targeted outreach to food vendors, training on proper techniques for food preparation in order to minimize the spread of the disease.

The 2014 epidemic was quickly brought under control, and in 2015, the number of Cholera cases reported fell to 687, with 10 fatalities. And throughout 2016, no new cases were reported until late October 2016. Once again, Global Communities sprang into action and within two months, distributed enough Aquatabs to purify over 7.2 million liters of water and helped with the formation and support of WASH teams that worked to disinfect affected households, refuse dumps, public toilets and bathhouses.

Volunteers distribute Aquatabs
Neighborhood volunteers helped distribute millions of Aquatabs to urban communities. Aquatabs are water purification tablets which kill micro-organisms in water to prevent cholera, typhoid, dysentery and other water borne diseases.

Dr. Franklin Asiedu-Bekoe, Head of Disease and Surveillance at GHS, praised Global Communities for its rapid response in leading the effort to contain Cholera outbreaks. “They realized that if you do not address the outbreak early, it’s going to cascade outside the region - the capital, greater Accra - and it’s going to cause more harm…so they were keen that we stop the outbreak as early as possible. And what we observed is [their] passion and the desire to achieve the results,” he said, adding that the partnership helped prepare GHS to address future outbreaks.

Since the initial outbreak in 2014, Global Communities has provided communities with Aquatabs to purify approximately 48 million liters of water, improving clean water access for thousands of individuals. Through financial and material support, and with organized action from dedicated staff, volunteers and partner organizations, Global Communities quickly helped get the outbreak under control. These efforts were reinforced by consistent messaging and education to the most at-risk populations, which ensured that no cases were reported for nearly a full year. Global Communities’ continues to build the capacity of local and national government entities, and raise awareness throughout communities of the risks of the disease in order to prevent a future Cholera outbreak in Ghana.