Douala’s Urban Health Push: Community Leadership and WHO Partnership Drive Change

Douala is confronting rapid urban growth, poor sanitation and recurring cholera outbreaks, but WHO’s multisectoral governance initiative is helping the city strengthen water access, community leadership and health systems. Its neighbourhood-level committees and new strategic plans mark a shift toward more inclusive, community-driven urban health solutions.

Douala, Cameroon’s bustling economic capital, has become a focal point for major global research bodies, most notably the World Health Organization’s Health Promotion Department, the WHO Regional Office for Africa, and the Swiss Agency for Cooperation and Development. Their collaborative work under the WHO Initiative on Urban Governance for Health and Well-being captures a vivid portrait of a city wrestling with the accelerating consequences of population growth, unplanned expansion, and persistent inequalities. With nearly 4.3 million residents in 2025, Douala is Cameroon’s largest and most dynamic metropolis, yet its infrastructure remains overstretched. Pollution, weak waste-collection systems, and the centralization of essential services continue to burden disadvantaged neighbourhoods. These systemic shortfalls are further intensified by the steady influx of internally displaced people fleeing conflicts in the Far North, East, and Anglophone regions.

A City Confronting Mounting Public Health Pressures

Douala faces a complex mix of health challenges, from high levels of HIV/AIDS, malaria, and tuberculosis to preventable diseases linked to poor sanitation. Cholera stands out as one of the city’s most stubborn threats. The outbreak declared in October 2021 underscored how deeply residents’ well-being depends on something as fundamental as access to safe drinking water. Only about 40 percent of the population uses safely managed drinking water, while even piped coverage, reaching roughly 81 percent, cannot reliably guarantee a safe or continuous supply. As water demand grows at more than 6 percent annually, the existing systems strain under escalating pressure, exposing vast disparities between affluent districts and underserved informal settlements.

Building Change Through Participatory Governance

In response to these widening challenges, the WHO-led Initiative helped unite more than 200 city actors during its 2020–2024 phase. Municipal officials, district mayors, civil servants, community leaders, and health specialists worked side-by-side to shape a Strategic Action Plan for 2023–2025. The plan highlights five major priorities: improving access to clean water, expanding quality health care, strengthening hygiene and sanitation, enhancing urban planning, and increasing access to sustainable energy. The collaboration led to the establishment of a multisectoral committee through a municipal by-law, enabling coordinated budgeting and more coherent monitoring across Douala’s six Municipal Districts. This marked one of the first times the city had institutionalized a shared decision-making framework across multiple layers of governance.

Grassroots Leadership Reshaping Local Solutions

The most striking transformation took place in the 3rd Municipal District, particularly in Brazzaville, a neighbourhood of almost 30,000 residents long marginalized by poverty and limited access to basic services. Here, the WHO’s Urbanlead programme empowered local “urban champions”, including city employees, journalists, and community organizers, with training in water governance, sanitation, nutrition, and health promotion. Their efforts resulted in the creation of nine Water Management Committees responsible for the upkeep and treatment of 99 public water points in the district. This grassroots model restored trust between residents and municipal authorities while enabling them to jointly identify priorities and oversee practical improvements in their neighbourhoods. The municipality also committed to constructing 15 boreholes, supported by additional water infrastructure across other districts through partner engagement. Photographs in the document showing community leaders standing behind an urbanlead banner capture the spirit of this shared civic momentum.

Douala’s Road Ahead: A Stronger Phase of Action

The gains achieved in Phase 1 have laid the groundwork for Douala’s ambitions for 2025–2028. The city plans to strengthen the multisectoral platform and inter-municipal mechanisms, widen community participation in decision-making, and increase local access to resources for small-scale development projects. It will continue to prioritize healthier environments in schools, markets, and residential areas, supported by closer coordination across water, electricity, sanitation, and health sectors. These ambitions reflect a deeper realization that the future of Douala depends on sustained, cross-sector cooperation, not isolated interventions. The Initiative’s network of trained leaders, community committees, and strengthened institutions has positioned Douala to address long-standing inequities with renewed confidence.

The City Spotlight presents a narrative of a metropolis grappling with substantial challenges but steadily gaining the tools, partnerships, and community-driven leadership needed to secure better health and well-being for millions of its residents.