Turning local lessons into national action for cholera control

Every year, communities across the Philippines remain at risk of cholera, particularly where access to safe water and sanitation is limited. As climate change increases the risk of outbreaks, the country is strengthening its efforts to prevent cholera before it spreads. 

Cholera is a bacterial disease that spreads through contaminated food or water. Most people recover with prompt treatment, but severe cases can be fatal. 

In 2024, there were more than 2,000 cholera cases and 24 deaths reported in the Philippines. Climate-related hazards, such as stronger and more frequent typhoons, flooding, and rising sea levels are disrupting water systems, leaving already vulnerable communities even more exposed to cholera.

These challenges strain health systems, and can delay access to care, particularly in hard-to-reach areas. Despite local prevention and response efforts in recent years, the continued spread of cholera underscores the need for a more coordinated and sustained national approach. 

In response, WHO has been working with the Department of Health (DOH) to better understand the factors driving cholera outbreaks. Lessons from local assessments have since informed a broader national strategy to strengthen prevention, preparedness and response. 

Translating local insights into subnational action 

In areas where cholera outbreaks persist year after year, understanding the local drivers of transmission was the first step toward preventing future outbreaks. Since 2023, WHO and the DOH have conducted joint field risk assessments in four cholera-affected areas to better understand access to safe water and sanitation, how cholera cases are detected and reported, and how communities receive information to help prevent the disease.

^{WHO teams and local health workers exchange insights during a joint field risk assessment in a cholera-affected area ©WHO Philippines}

Building on these findings, WHO and the DOH strengthened the capacity of regional health offices and local governments to improve cholera preparedness and response. The training helped update local Food- and Water-Borne Disease plans and strengthen coordination across sectors. 

Developing a national strategy for cholera control 

To translate regional experiences into national action, a national WASH workshop for cholera elimination was convened in November 2024, marking the beginning of the Philippines’ transition from regional experiences to coordinated national action against cholera. 

With technical support from WHO, the DOH began applying the Priority Areas for Multisectoral Interventions (PAMI) framework, endorsed by the Global Task Force on Cholera Control (GTFCC). In September 2025, WHO and the DOH brought together national and regional partners to identify the areas most at risk of cholera using disease data and other vulnerability factors. 

^{Group photo of participants from the Department of Health, the Department of the Interior and Local Government, WHO and UNICEF during the first national workshop on cholera control in Manila © WHO Philippines}

Representatives from the DOH, DILG, regional health offices, WHO and UNICEF reviewed WHO's analysis of five years of national cholera data, alongside environmental and social risk factors, to identify priority areas for cholera prevention and control. 

Building on the workshop, WHO expanded the process to include additional areas for possible inclusion in the list of PAMIs, ensuring that regions not represented in the initial workshop were also included in the prioritization process. In May 2026, the DOH formally endorsed 165 priority cities and municipalities for targeted cholera interventions. The designation allows government and partners to focus surveillance, preparedness, water and sanitation improvements, and community engagement where they are needed the most.  

“WHO's PAMI process is really helpful for us because we are able to use our epidemiological data to have an evidence basis to guide how we can focus our public health investments—including manpower, surveillance, training, and infrastructure—into building a better system, hopefully eliminating cholera within the country.”, said Dr. Ian Christian Gonzales of the DOH Epidemiology Bureau.  

The Philippines is now working toward becoming the first country in the WHO Western Pacific Region to secure GTFCC endorsement of its national cholera control strategy. With continued collaboration between government, partners and communities, the country is laying the foundation for stronger prevention, faster outbreak response, and better protection against cholera.