CHIKWAWA, Malawi, Sept. 14 (UPI) -- Most people probably think of cholera as an inevitable consequence of a natural disaster. However, the sinister disease is far more prevalent than that. And that in itself is a tragedy.

In the 1950s cholera was almost eradicated. Unfortunately a number of factors have led to its resurgence, including nearly two decades of neglect of water, sanitation and hygiene and health issues.

To take one example, health officials in the district of Chikwawa, Malawi, recently said there were about 570 official cases of cholera and seven deaths in that district. Those statistics are likely to be significantly underreported because deaths that occur outside of hospitals are often not reported.

Chikwawa is in the southeastern corner of Malawi that sits on the banks of the crocodile-infested Shire River. The population survives on subsistence farming, growing staple crops to eat such as maize, sorghum and millet. Most villagers live on less than $1 a day and don’t have access to safe drinking water and sanitation.

Despite well-intentioned efforts of the Malawian government and local and international non-governmental organizations, the people of Chikwawa are suffering. One international NGO, for example, is only able to work in about 28 of 503 villages. Other NGOs are present, but sanitation coverage -- an indicator of progress toward eradicating diseases such as cholera -- remains at less than 40 percent, said Charles Banda, the executive director of Fresh Water Project, a local organization that installs water wells and promotes sanitation.

“The demand is great out there; the communities are in dire need of water and sanitation facilities,” said Banda. “The biggest challenge that we -- Malawi as a nation -- have right now is the lack of clean water and sanitation.”

Banda and other NGO leaders say, the government has improved on previous policies by allowing local organizations to implement water and sanitation programs. But he also said that there aren’t enough programs and that some are not being carried out effectively. The often myopic focus on “hardware” or infrastructure can limit the impact of water and sanitation initiatives.

“We provide a lot of infrastructure but it is not being properly used,” said Banda.

The solution he proposes involves conducting more “software” programs, such as hygiene education and sanitation promotion campaigns.

Fresh Water Project and other NGOs in Chikwawa have been involving community members in what they are calling “citizen action.” Through an interactive learning process, group members begin to grasp the implications of unsafe water and inadequate sanitation. They see that they can improve health, the environment, agricultural production, education and income generation by improving their water and sanitation conditions. The citizen action process creates a framework for positive development such as the construction of latrines and improvement in hygiene behavior.

Where efforts have been made to do a full package of interventions, both the hardware and the software, progress has been achieved. An environmental health project spearheaded by Scotland Malawi Partnership realized a 30 percent reduction in diarrheal disease in five villages in Chikwawa. In many parts of Malawi, cholera has been eliminated due to improved water and sanitation infrastructure and programs that change hygiene behavior and increase the use of toilets.

“When we started implementing this program there was a dramatic drop in cases of cholera and bloody diarrhea,” recalled Banda. “I would like to see Malawi having clean water everywhere. A woman should be able to get water at the doorstep. Every household should have a good latrine. That way we are going to reduce the incidence of waterborne diseases. That way Malawi will be a happy nation.”

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