The transformative power of community action: improving access to safe drinking water in Douala, Cameroon

As part of WHO Initiative on urban governance for health and well-being, the district mayors of the city of Douala, Cameroon, under the leadership of the Mayor of Douala, Roger Mbassa Ndine, worked closely with local communities to strengthen participatory governance mechanisms and multisectoral action. The goal was to promote health and well-being and better address their determinants, as identified by over a hundred stakeholders from municipal authorities, regional delegations of relevant technical ministries, civil society organizations-including community leaders-and academic partners.

With a population of nearly four million, Douala is one of the two largest cities in Cameroon, representing 20% of the country's total urban population. Home to the main seaport, it is also Cameroon's economic capital. The city faces various sources of pollution. In 2016, 39% of the country's businesses were concentrated in the city and it hosts the largest industrial zones, which have a significant impact on the urban ecosystem. Sanitation and drainage systems are inadequate-of an estimated 250km of drainage needed, only 50km have been constructed. Access to water is also a challenge; only 42% of households in the city have reliable access to potable water (within 500 metres of a tap). This situation contributes to the prevalence of waterborne diseases, the most common being malaria, typhoid and cholera. Cholera, in particular, has become endemic since October 2021.

Using a participatory and multisectoral approach to address the priorities of the city of Douala, the Urban Governance for Health and Well-being initiative was launched in December 2020. In 2021, among the five priorities identified by stakeholders in the city, the top one was improving access to safe drinking water. Stakeholders collectively selected the Brazzaville neighborhood-home to over 30 000 residents-for piloting a Small Intersectoral Project (SIP) aimed at improving access to drinking water. The area was experiencing a severe shortage of potable water. Private wells and boreholes, residents' only water sources, provided water of questionable quality during an active cholera outbreak. Additionally, the neighborhood faced socioeconomic and health challenges, including poverty, poor sanitation and inadequate drainage.

Led by the first cohort of Urbanlead champions, this SIP contributed, among other achievements, to strengthening the commitment of the Mayor of Douala 3rd Municipal District, Mr. Epoupa Bossambo Valentin. He spearheaded advocacy efforts that led to the adoption of a municipal resolution and issued a decree in favor of improving access to drinking water across his municipality. This was followed by the establishment of the Brazzaville Water Management Committee, the transfer of local water facilities (including a water tower and related infrastructure) to this committee, and the training of more than 150 residents on WASH (Water, Sanitation, and Hygiene) in collaboration with UNICEF, the Nylon Health District, the Regional Delegation of the Ministry of Water and Energy, and with technical and financial support from WHO.

As the SIP action plan was steadily progressing in the Brazzaville neighborhood, its effects triggered similar action in other neighborhoods and Municipal Districts of Douala. The Mayor of Douala's 3rd Municipal District extended a field visit to all 118 neighborhoods and villages within his jurisdiction to gain a firsthand understanding of local conditions. More than 1 500 points were recorded, with the majority found to be in a critical sanitary condition, including some public boreholes with questionable water quality that had been taken over by individuals - limiting access for the broader community.

The outcomes of this field visit led to a range of follow-up actions, including the systematic scaling up of the Water Management Committee model in neighborhoods with public water points or boreholes, and the launch of a major chlorination campaign by the municipal hygiene services to make water safe for drinking.

To date in Douala's 3^rd Municipal District, more than nine Water Management Committees have been established in other neighborhoods, and over 15 boreholes have been constructed or rehabilitated. It is estimated that more than 37 500 people have improved access to safe drinking water as a result of this initiative.

The momentum initiated by Douala's 3rd Municipal District through the SIP has had a ripple effect across other municipal districts in Douala that face similar challenges in accessing safe drinking water. The clear success of the intersectoral water project approach helped demonstrate the vital role of participatory and multisectoral urban governance, as well as community engagement, in promoting health and well-being. A similar model could be applied to address public health challenges in Douala's markets.

The WHO initiative is an integral part of the Douala Healthy City Action Plan 2023-2025, an initiative coordinated by Dr. Roger Mbassa Ndine, Mayor of the city of Douala. The Healthy City Action Plan aims to promote sound local urban governance for health and well-being through citizen engagement and multisectoral coordination.

The WHO Initiative on urban governance for health and well-being (2020-2028), supported by the Swiss Agency for Cooperation and Development, aims at improving the health status and well-being of populations in cities through participatory and multisectoral urban governance. The Initiative is implemented in six core cities: Khulna (Bangladesh), Douala (Cameroon), Bogotá (Colombia), Mexico City (Mexico), Pasig City, Metro Manila (Philippines), and Tunis (Tunisia).

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WHO Initiative on urban governance for health and well-being