Table 2.

Best practices, challenges and priority actions from the cholera IAR, kadoma, 2024

Pillar	Best Practices	Challenges	Priority Actions
Incident Management (Coordination)	- Timely activation of IMS which led to effective coordination, decision-making and resource mobilization. - Response was coordinated through an Incident management system and Incident action Plan (IAP) which were effective in initial response activities, particularly in ensuring availability of contingency stocks - Clearly defined roles, responsibilities and boundaries for partners through signing of memorandum of understanding (MOU).	- Weak coordination between city health authorities and local ministry of health and childcare (MoHCC) which resulted in s duplication of efforts at times. - Lack of a physical Emergency Operation Centre (EOC) affected coordination of activities especially across different organizations involved in the response. - Repurposing of departmental personnel and facilities resulted in gaps that affected continuity of other essential health services.	- Establish a physical PHEOC within Kadoma City Council/setup a makeshift PHEOC for coordinating response activities.
Plans and Surveillance	- Developed an Incident Action Plan (IAP) with clear objectives for each response pillar providing a strategic framework for responding to the outbreak. - Surveillance and epidemiological data/information was analysed routinely, producing critical information requirements (CIRs), essential elements of information (EEIs) and situation reports (SitReps), shared with all stakeholders and used to inform programming of response activities. - Use of community health workers (CHWs) enhanced public health surveillance through community event-based surveillance (CEBS). - Engagement of the community in response planning and implementation e.g. training of church leaders to assist with risk communication in the community.	- Use of paper-based data collection tools resulted in incomplete data, causing delays in analysis affecting ability to fully utilize epidemiological data to inform decision making. - Delayed sharing of Cholera Situation Reports, impacting the timely dissemination of critical information needed for strategic decision making. - Inadequate laboratory surveillance capacity, with limited capacity to meet the demand for RDT and culture testing resulting in a few cases being screened through RDTs.	- Digitize data collection tools to allow for real time sharing of information.
Logistics	- Use of locally available expertise and resources from previous outbreaks to set up a CTC with a capacity to accommodate over 50 patients and five community ORPs.	- Frequent breakdown of vehicles in the response. - Shortage of transport at the CTC for transporting patients, response personnel and supplies	- Collaborate with local leaders and business personnel to support city council with vehicles when needed during emergencies.
Finance and Administration	- Adequately trained human resources for emergencies - Engaged partners to support response activities (e.g. UNICEF, Red Cross, IMC, WHH) and the funds received from these partners were disbursed adhering to council procurement protocols.	- No incentives for staff involved in response leading to demotivation. - Lack of an emergency response fund for city council which delayed and affected implementation of some response activities.	- Setup an emergency response budget line for Kadoma City council
Risk Communication and Community Engagement (RCCE),	- Use of a multimedia campaign strategy that included Radio/Print/social media/digital and community-based channels. helped target different audiences, empower people with real-time information on how to prevent and protect themselves from cholera and encourage health-seeking behaviours. - Conducted a knowledge, attitudes, and practices (KAP) survey on cholera among residents which helped inform planning of RCCE activities. - Involvement of community leaders and stakeholders in planning, community mobilisation and response increased awareness at all levels and mobilisation of resources and ownership. - Use of cholera survivors to support RCCE activities and work at the Community ORPs.	- No adequate human resource to assist in risk communication and community engagement activities. - Duplication of efforts arising from poor coordination among response partners - Most of the IEC materials used had not been translated to local language (Shona/Ndebele). - Lack of social inclusion in information dissemination for people with disabilities	- Use of modern communication and information sharing platforms such as social media and AI chatbots to improve RCCE activities.
Case Management	- Engaged uniformed forces to assist with management of cholera cases, strengthening local case management capacity. - Establishment of a cholera treatment centre and community ORPs improved access to treatment services at community level. - Early dissemination of guidelines and SOPs for case management, coupled with training support on guideline implementation ensured standardisation of treatment and case management.	- Shortages of personal protective equipment - Transport challenges for movement of patients from the community and ORPs to CTC. - Staff shortages and long working hours led to work overload, staff fatigue and burnout - Shortage of Vomitus buckets at ORPs.	- Implement staff rotation schedules to prevent burnout and ensure adequate rest periods
Infection Prevention and Control	- CTC and ORPs established according to the GTFCC and Zimbabwe Cholera Control guidelines (4th Edition) (Hand washing facilities and footbaths were available at all entrances and exit points, Unidirectional patient and staff flow was maintained, a canteen was built at the CTC to prepare and provide food onsite). - Trained health care workers both professionals and non-professionals in public and private sectors on IPC.	- Shortage of IPC resources: scrubs, waterproof gowns, mops and bed linen. Shortage of staff at CTC - The transport used to ferry staff and patients was the same. - Inadequate sacks for foot bath	- Establish an IPC committee an capacitate its members to ensure effective IPC implementation during emergencies
Water, Sanitation, and Hygiene (WASH).	- Provision of Non-Food Items (NFIs) to the community through case area targeted intervention e.g. soap, tapped bucket and water guard/aqua tablets. - Regular water quality monitoring, at least 10 samples per week at all communal water points. - There was strict burial supervision, and no gatherings were allowed at funerals. - Waste generated at the CTC and ORP (Vomit and Faeces) was disinfected first and disposed at a designated pit offsite.	- Difficulty in ensuring a consistent supply of piped tap water by the city council due to inadequate infrastructure. - Public toilets in some residential areas were blocked leading to sewer bursts and overflow. - Refuse collection in suburbs/communities was not consistent contributing to illegal dumping by residents	- Unblocking and disinfection of areas with sewage overflows