South Africa is registering a decline in the quality of drinking water and the country’s water infrastructure while simultaneously reporting its first outbreak of cholera in decades.
The country recorded the first cases of cholera in February 2023. While the first three “were imported or import-related following travel to Malawi”, subsequent cases were infected locally and are therefore classified as indigenous cases, according to the National Institute for Communicable Diseases (NICD).
In terms of the local or indigenous cases, the Department of Water and Sanitation (DWS) believes it is “highly likely that the cholera outbreak which started in Hammanskraal in Tshwane (Pretoria) is related to the pollution of water sources in the area from the City’s Rooiwal Waste Water (sewage) Treatment Works upstream of Hammanskraal, which has not been well-maintained for many years, and which has insufficient capacity to deal with the volume of waste water entering the works”.
The country has recorded 1,073 suspected cases of cholera in five of its nine provinces, of which 198 were laboratory-confirmed between 1 February and 4 July 2023. The deaths related to the cholera outbreak (both suspected and confirmed) stood at 47 as of 4 July 2023.
The World Health Organization notes that cholera is “primarily linked to insufficient access to safe water and proper sanitation” adding that about 30 countries experienced cholera outbreaks in 2022.
Poor water quality
In South Africa, wastewater services are delivered by 144 water services authorities, also known as municipalities, across the country’s nine provinces. The water network is comprised of 850 wastewater treatment works with a treatment capacity of 6,971 Ml/d, 3,211 pump stations and 47,449 km outfall and main sewer pipelines.
According to a Green Drop Watch Report released by the DWS this year, risk ratios have surged with 70.1% of treatment plants now categorised as high-risk as opposed to 65.4% being at medium risk position in 2021.
Key among the findings last year was that 334 (39%) municipal wastewater treatment works, in 90 water services authorities, were in a critical state with Green Drop scores below 31%. In line with regulations, the municipalities were identified as requiring closer monitoring and evaluation through corrective action plans (CAPS).
The report notes that over the past year, 168 CAPS were received, translating to a 50% response rate with “only 34 of the CAPs received being implemented to date of the Watch Report, with the balance being in the planning phase or no progress reported” according to a statement released by the Minister of Water and Sanitation, Senzo Mchunu.
Meanwhile, those water services authorities that have not submitted CAPS are facing criminal charges, the statement added.
Writing in a local media publication, Anja du Plessis, an associate professor at Unisa and a specialist in water resource management, noted that “many parts of South Africa are expected to become more vulnerable to water-related risks such as unreliable or no water supply, no functioning sanitation services and overall water insecurity. The projected 17% water deficit to be achieved by 2050 is driven by the problems of water insecurity.”
Cholera as government’s failure?
As cholera continues to spread in South Africa, response teams have been activated to deal with the outbreak, working on contact tracing, health promotion and the distribution of hygiene packs to households and schools in the affected communities.
The DWS is continuing to examine water sources to determine any source of contamination. Earlier in June Health Minister Joe Phaahla noted that the DWS was “confident in the measures taken as there was a significant downward trend showing”.
Nevertheless, some voices are blaming the government for the cholera outbreak. Dhesigen Naidoo, World Bank Senior Advisor and Climate Adaptation Lead to the South African Presidential Climate Commission, as well as Senior Research Associate at the Institute for Security Studies, noted that the Drop Report “merely reinforced the government’s failure” adding “South Africa’s cholera outbreak highlights the government’s extreme negligence and slow pace in ensuring clean water access and safe sanitation and eradicating open defecation and the bucket system.”
Visiting a water treatment plant in the worst-hit province of Gauteng, South African President, Cyril Ramaphosa, admitted the failure to prevent the outbreak, stating “The water that comes out of the Temba water works is not fit for human consumption so we have really dropped the ball for our people here in Tshwane, and I went on as much as to admit that.”
