Still Paying the Price: Revisiting the Cholera Epidemic of 2000-2001 in South Africa

This paper revisits the cholera epidemic that South Africa suffered during 2000–2001, which killed 265 people and infected a further 117,147. The paper begins with a brief, comprehensive summary of the epidemic and then sets out the objectives, conclusions and recommendations of the research. Specifically, it focuses on the link between the state of water provision and cholera outbreaks, and highlights that even after the epidemic, poor rural and urban communities continue to be vulnerable to water-related diseases. The next chapter links the cholera epidemic to the dynamics arising around the payment for water. The paper’s aim is to examine the extent to which the response to the cholera epidemic has led to sustained provision of safe water and improved sanitation for the poor.

Chapter 3 outlines the quantitative and qualitative data-collecting methods in two cholera affected communities: Nqutshini and Nkobongo. Through key informant interviews and semi-structured interviews and surveys with households, community members are asked to revisit the epidemic and to rethink its impacts. The survey’s key questions are directed at water provision, storage and consumption and the occurrence of cholera among households.

In Chapter 4, the authors describe the results of the surveys carried out in Nqutshini and Nkobongo, and focus on water supply and sanitation. The surveys reveal that despite piped water provision in Nqutshini, there were three limitations: the scheme didn’t cover all communities; many were unable to pay water registration charges; and piped water wasn’t accompanied by provision of sanitation. However in Nkobongo, the cholera outbreak was spurred by the privatization of the water supply in 2000, which brought an end to free water services for households living in black informal settlements. The fifth chapter outlines how cholera is contracted, how the government reacted and how communities responded to infection. The research highlights that cholera spread for several key reasons. First, the stigma attached to cholera makes people too ashamed to seek help. Second, families can be too poor to afford the time needed to collect water or the cost of treating water. Third, some have confidence in the power of prayer to purify water while others believe that white communities put cholera in their river water.

Chapter 6 discusses the post-epidemic improvements as well as the areas where there was no change. The authors highlight that the “free basic water” policy, which arose from the epidemic, has increased piped water services and sanitation to poorer communities. However, many poor households report interruptions to their water supply caused by vandalism, burst pipes and general repairs, causing many to revert to traditional unclean water sources or to store large volumes of water to guard against cut-offs. Chapter 7 questions the relationship between poverty, municipal services and health. The authors illustrate the link between income and disease, and specifically identify the factors that increase vulnerability to water-related disease in the case studies, such as low household income, number of containers with stored water and the experience of children suffering from diarrhoea.

In conclusion, the authors highlight that cholera does not only affect deep rural areas with no access to piped water. Rather, the South African epidemic shows that cholera can be intense in many “serviced” areas. They suggest that this illustrates a deeper malaise in water service management, namely too great a focus on cost recovery, and the interruptions in supply that make people return to unsafe sources.