The cost of cholera in Somalia

Cholera continues to pose a significant public health challenge in Somalia. From 2018 to 2023, Somalia reported nearly 55,000 suspected cases¹. Cholera outbreaks not only have severe repercussions in terms of morbidity and mortality, but they also result in extensive economic consequences. A recent study by Figuereo et al. aimed to estimate the costs associated with cholera illness and treatment borne by households and health facilities in Somalia².

Patients are treated in cholera treatment centers (CTCs), where suspected cases with moderate to severe dehydration are admitted, and patients with mild dehydration are managed through outpatient care. The inpatient services include extensive medical intervention, such as intravenous infusion and antibiotics. Meanwhile, outpatient services include oral rehydration solutions and minimal medication. The costs to manage cases are covered by the Ministry of Health and supported by international aid agencies².

For patients, treatment at the CTC is free. However, households with a cholera patient often bear other costs for treatment sought before visiting the CTC. Households also endure non-medical costs such as transportation and the loss of wages for patients and their caregivers². 

The cost-of-illness study found that the average total cost for a health facility to treat an episode of cholera was $82.65 USD. Meanwhile, the average total cost for a household was $33.94 USD, of which half represented indirect costs such as lost wages for the patient and caregivers due to missed work. Transportation was the highest direct non-medical cost ($6 USD). As approximately 55% of the Somali population lives below the national poverty line³, the costs associated with illness pose a significant economic burden on affected families. To cover the costs, about 62% of households were forced to use family savings and 15% had to borrow money. Others resorted to more drastic measures and sold their land to cover the expenses².

Beyond the direct economic repercussions caused by cholera outbreaks, the negative impacts also extend to other factors of socio-economic stability, including missed education for children, disruptions in productivity and businesses due to missed work, and further strain on the already challenged healthcare system - diverting resources away from other essential health services.

Ultimately, strengthened prevention strategies not only save lives, but they could also yield significant economic offsets for the country - relieving the financial burden borne by affected families and health facilities. These findings highlight the need for a more effective use of limited resources and increased investment in cholera prevention and control programs, including WASH (water, sanitation and hygiene) interventions, vaccination campaigns, and improved healthcare facilities. Prioritizing cholera hotspots and other high-risk areas can substantially increase the efficiency of such prevention and control initiatives.