Gauteng acts on lessons from Cholera outbreak in Tshwane

The Gauteng department of health and the Tshwane municipality say they have already put measures in place to ensure monitoring and surveillance should another cholera outbreak occur.

This comes after the Water Research Commission conducted an investigation on the recent cholera outbreak in Hammanskraal in Tshwane, in which the commission said lack of resources hampered the timely surveillance and reporting of information on the water-borne disease.

“At the onset of an outbreak (one case confirmed), early detection, surveillance, treatment and case management are critical in managing the spread of cholera,” said report.

“During cholera outbreaks, accredited laboratories play a critical role in confirming diagnoses and identifying the causative strain for tailoring treatment and implementing targeted control measures. For water quality surveillance, only two laboratories in the whole country were operational, which hampered the timely surveillance and reporting of information,” it said.

However, both Tshwane municipality and provincial health department said they were ready to respond to any future outbreaks.

Gauteng health said it had setup a cholera incident management committee, composed of government and partner organisation experts, to respond with the outbreak of the waterborne disease.

Department spokesperson Motalatale Modiba said the strategic objectives of the committee, which has a chairperson and a secretariat, included reducing the transmission of the disease in communities and health facilities as well as mortality rate. The committee meets twice a week.

It also aims to provide safe and quality care of those that are affected in the communities, and control risk factors, which include food supply and storage.

“The committee has provincial and district outbreak teams which have been activated to coordinate the preparedness and response activities,” said Modiba.

“The committee is composed of a division that coordinates the work of the department’s partners, including WHO [World Health Organisation] and USAID [United States Agency for International Development], to ensure that they work towards the same goal.

He said the clinical division looked at the epidemiology and surveillance – the trajectory of the disease, contact tracing, case management and reporting, and case mapping. They looked at how to manage confirmed cases to ensure that the right protocols were followed and developed standard operating procedures.

“They will tell us how many people are still at health facilities receiving care and how many have since been discharged. They also ensure that tests are done in laboratories rapidly to get results quicker…” Modiba said.

“Surveillance and epidemiology is around ensuring that even in that area [where there is cholera] the collection, collation and analysing of data from districts, including portfolios of evidence, are used to produce daily reports.

“As a province we believe we are well poised in terms of our response to deal with cholera outbreaks. [However], you can never be too well prepared but you can be prepared to ensure that whatever outbreak happens you are able to activate the necessary teams and resources to respond to that.”

The commission said both Rooiwaal and Temba wastewater treatment plants were dysfunctional and needed urgent attention.

The City of Tshwane said it had signed a memorandum of understanding (MoU) with the Development Bank of Southern Africa (DBSA) to address the issue of the plants.

A joint steering committee, including the technical steering as well as the sub-finance committees, has been formed to oversee the implementation and model the project funding for various phases of the Hammanskraal intervention support project.

Sipho Stuurman, the spokesperson for Tshwane mayor Cilliers Brink, confirmed the MoU was deliberated and finalised during a mayoral committee meeting. DBSA, the implementing agent, is expected to start procuring service providers on August 1. 

Tshwane spokesperson Selby Bokaba said a disaster operations centre was established every time an incident defined within the ambit of a disaster was encountered. “Drinking water from all sources, wastewater effluents and receiving water bodies are routinely sampled and analysed on a pre-determined frequency, serving as early warning and detection systems,” said Bokaba.

He said the city had allocated R450m over the medium term revenue and expenditure framework (three year budget) for Rooiwal wastewater treatment works.

“A budget of R150m is approved in the current financial year (2023/2024) to commence with completion of the phase one project. The project will commence as soon as DBSA has been appointed as implementing agent,” said Bokaba.

Foster Mohale, the spokesperson for the national department of health, denied they faced lab capacity constraints.

“During the cholera outbreak, a number of public and private sector laboratories [which] have been accredited for water testing were utilised.

“These very same laboratories are used for routine water sampling and environmental surveillance activities … cholera-related water samples were given priority by the respective laboratories. We did not, and have not, experienced laboratory capacity challenges,” said Mohale.