Considerations of population vulnerability, potential secondary benefits and ethics in the context of anticipatory action for cholera in the eastern Democratic Republic of the Congo
K.W. Bowman, MSW, PhD (University of Toronto)
Y. Manialawy, MSc, MD (University of Toronto)
Introduction
Overview
In 2022, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in collaboration with UNICEF, WHO and the National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL-MD) developed an anticipatory action (AA) framework to get ahead of large cholera outbreaks in the Democratic Republic of the Congo (DRC). The framework is designed to anticipate flare-ups of the disease becoming large epidemics. This is the first AA framework for infectious diseases that OCHA has facilitated.
OCHA commissioned this study to better understand the context and vulnerability as well as elucidate the secondary benefits and limitations of delivering anticipatory assistance and earlier cholera control measures in the eastern part of the country, an especially complex and volatile environment. The study also intends to inform other research and impact evaluations that OCHA will commission to learn from this project.
This study’s findings stem from direct observations during an onsite visit about the operational environment and lived realities of people, including internally displaced persons (IDPs), in targeted locations in the DRC (i.e., qualitative, ethnographic study). The visit coincided with the first activation of the AA framework in December 2022.
The study contrasted the views and work of researchers, practitioners, and experts from UN agencies and partner organizations against the perspectives and testimonies of people in IDP camps in North Kivu (including Kibati, Kanyaruchinya, and Bushagara).
It is important for readers to remember that this evaluation was enacted shortly after AA funding was disbursed; therefore, we cannot definitively correlate all of the findings in this paper with the implementation of AA. However, the spirit of this paper was very much to explore the factors surrounding the application of cholera intervention and their significance to this population, as well as potential secondary benefits thereof.