The government of Democratic Republic of the Congo (DRC) launches an ambitious plan to eliminate cholera in the country

The Democratic Republic of the Congo (DRC) has been one of the countries most burdened by cholera outbreaks ever since 1994, when the large-scale epidemic occurred on the heels of the Rwandan genocide (1). Currently, cholera is considered endemic in the eastern part of the country, while non-endemic provinces in the west have also sporadically been affected by outbreaks (2). As of October 1, 2023, a total of 39,638 suspected cholera cases, including 342 deaths, have been reported, with cases concentrated in the eastern Great Lakes Region (3).

The DRC was one of the first countries in the world to develop a Cholera Elimination Plan, based on research that identified the areas, periods and populations most at risk (4). Since the implementation of the first plan in 2008-2012, the country has updated and improved the plan every five years (4). In October 2023, the government of DRC launched an ambitious plan to eliminate cholera by 2027, Multisectoral Cholera Elimination Plan (MCEP) 2023-2027 (5). The plan is characterized by a strategic approach that focuses on the key risk factors underlying population vulnerability to cholera onset and diffusion, notably limited access to safe drinking water and sanitation infrastructure as well as poor hygiene practices (WASH) (6). Indeed, only 50.4% of the population of the DRC have access to improved water points and less than 29% of the population have access to improved sanitation (5). 

The MCEP aims to address the factors responsible for repeated cholera outbreaks by prioritizing interventions in cholera sanctuary zones, all of which are located in the Great Lakes region and make up 50% (39/78) of the priority cholera zones identified in the latest update of the cholera hotspot map (5). These cholera sanctuaries are also affected (to varying degrees) by conflict and population displacement, which exacerbate cholera epidemics and hamper both access to health structures and response efforts (7). 

To achieve cholera elimination, the plan applies a multisectoral approach, mobilizing more than 22 key ministries. This MCEP 2023-2027 consists of eight strategic axes: (1) strengthened disease surveillance, (2) case management, (3) emergency WASH, (4) sustainable WASH, (5) vaccination, (6) communication for behavior change and community engagement, (7) operational research, and (8) coordination and advocacy (5).

The overall budget for MCEP 2023-2027 amounts to USD 192M, 58% of which is allocated to improving WASH conditions, both sustainably (37%) and on an emergency basis (21%), with the ultimate aim of reducing the annual incidence rate of cholera to below 1 confirmed case per 100,000 inhabitants in the eastern provinces and 1 confirmed case per 1,000,000 inhabitants in the western provinces (5). The Ministry of Planning will ensure the alignment of all national and international actors, private and state, with the strategic orientations included in this plan. Substantial efforts will also be made to mobilize resources and strengthen the coordination of actors and sectors involved in the implementation of this plan.

The process of developing and validating the MCEP 2023-2027 was conducted under the scientific guidance of the Department of Ecology and Control of Infectious Diseases of the Faculty of Medicine at the University of Kinshasa, with support in part from the Veolia Foundation (5).