By Edwin Mauluka

Health rights groups say the re-emergence of cholera in Malawi has exposed persistent weaknesses in the country’s water, sanitation and hygiene (WASH) systems, as well as gaps in preventive public health measures.

The Ministry of Health and Sanitation has confirmed two cholera cases in Lilongwe and Balaka districts.

According to the ministry, the Lilongwe case involves a five-year-old boy from Area 25 Township, while the Balaka case involves a 42-year-old man from Kalembo.

Principal Secretary for Administration, Bestone Chisamile, said laboratory tests conducted by the National Public Health Reference Laboratory in Lilongwe confirmed the samples as positive on December 11, 2025.

“The ministry would like to assure the public that it has adequate supplies and logistics in all health facilities to manage cholera cases,” said Chisamile. “The public is therefore advised to immediately report any suspected cases of cholera to their nearest health facilities for prompt treatment.”

Reacting to the development, Malawi Health Equity Network (MHEN) executive director George Jobe said that even a small number of confirmed cases should raise concern.

“While reported cases are few, any confirmed cholera case is a red flag, signalling deficiencies in water, sanitation, hygiene, urban planning and preventive public health systems,” said Jobe.

He said Malawi’s recurring cholera outbreaks are driven by inadequate access to safe water—particularly in high-density urban settlements and rural trading centres—alongside poor sanitation infrastructure, including unsafe pit latrines, open defecation and weak waste management systems.

Jobe also cited rapid and unplanned urbanisation, especially in cities such as Lilongwe and Blantyre, where population growth has outpaced investment in WASH services. Seasonal flooding and climate shocks, he added, often contaminate water sources and overwhelm already fragile sanitation systems.

According to Jobe, the challenges are compounded by missed opportunities in prevention, preparedness and accountability, including insufficient public health financing, weak enforcement of sanitation and urban planning regulations, and limited coordination across sectors such as health, water, local government, housing and the environment.

“There is also limited community-centred surveillance and early warning. Communities are often the first to detect outbreaks, yet community-based surveillance and early response systems remain under-resourced, delaying timely containment,” he said.

Jobe further noted accountability gaps at local government level, saying decentralisation has not been matched with adequate financing, capacity and accountability mechanisms to sustainably manage WASH services.

MHEN has called on government and stakeholders to prioritise long-term investment in safe water and sanitation as a health right, rather than treating cholera as an emergency-only response. The network has also urged stronger urban planning and sanitation enforcement, particularly in informal settlements.

“Government should fully operationalise multi-sectoral cholera prevention frameworks linking health, water, environment, community development and local government, empower communities through robust health promotion, surveillance and social accountability mechanisms,” said Jobe, underscoring the need for transparent and equitable allocation of resources to cholera-prone districts before outbreaks occur.

To prevent further spread of the disease, the Ministry of Health has urged the public to observe proper hygiene practices, including drinking safe water, washing hands thoroughly with soap, eating well-cooked food, using toilets properly and avoiding open defecation.

Malawi has experienced recurrent cholera outbreaks since 1998, with seasonal spikes typically occurring during the rainy season from November to May. Between March 2022 and February 2023, the country recorded 36,943 cases and 1,210 deaths across all 29 districts, making it the deadliest cholera outbreak in Malawi’s history.

According to the Public Health Institute of Malawi, as of August 2024, a total of 305 cholera cases and 14 related deaths had been recorded nationwide.

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