June 2025 — Zambia has faced one of its most severe cholera outbreaks in decades. By March 2024, over 20,000 cases and more than 700 deaths had been reported, with Lusaka—the capital city—at the epicenter. Children were among the hardest hit, with high infection rates and an alarming case fatality rate of 3.4%. In response, the Ministry of Health (MoH), UNICEF, and a coalition of partners launched a bold, community-driven emergency response that is now being recognized as a model for integrating social science into public health action.

Understanding the Crisis

The outbreak was driven by a combination of environmental, infrastructural, and behavioral factors. Informal settlements—locally known as “compounds”—suffered from overcrowding, poor sanitation, and limited access to clean water. During school closures, children were often unsupervised, playing in contaminated floodwaters and consuming unsafe food and water. Despite high awareness of cholera symptoms, prevention practices like handwashing with soap and reheating food were inconsistently applied due to cost and access barriers.

Community Voices Driving Action

At the heart of Zambia’s response was a commitment to listening to communities. Through four rounds of Rapid Qualitative Assessments (RQAs), UNICEF and partners gathered real-time insights from over 200 focus group discussions and interviews across Lusaka, Central, Copperbelt, and Southern provinces. These included survivors, caregivers, health workers, traditional leaders, and community volunteers.

Key community concerns included:

• Fear of Treatment Centers: Many feared contracting cholera at Cholera Treatment Centers (CTCs), leading to delays in seeking care.

• Stigma and Trauma: Families of survivors and the deceased reported being shunned by neighbors, compounding their grief and financial hardship.

• Children’s Vulnerability: Children were often unsupervised in contaminated environments, lacked access to clean water and soap, and were exposed to misinformation or inadequate care.

• Cultural Practices and Remedies: Home treatments like kachasu (a local spirit), herbs, and ash were commonly used before seeking formal care.

These voices were not just heard—they shaped the response. Community feedback was triangulated with RQA data and shared through interagency dashboards, action trackers, and weekly coordination meetings. This ensured that the response remained grounded in the lived realities of those most affected.

Turning Data into Action

The Zambia cholera response stands out for how quickly and effectively it translated insights into action:

• Health System Strengthening: Seven ambulances were rehabilitated and fueled to improve emergency transport. Health workers received training to improve case management and infection prevention.

• Targeted Supplies: UNICEF distributed Stop Cholera kits—including chlorine and soap—through Red Cross volunteers, reaching thousands of households.

• Cash Transfers: Emergency cash support was rolled out to 2,000 vulnerable households, helping families afford transport, food, and burial costs.

• Behavior Change Campaigns: The “3Cs to Stop Cholera” campaign—Clean water, Clean hands, and Cooked food—was co-created with communities and adapted for schools, festivals, and persons with disabilities.

• Inclusive Communication: Over 5 million people were reached through radio, TV, and community-based volunteers. Materials were translated into local languages and adapted for children and people with disabilities.

• Community Engagement: Faith-based networks, youth groups, and traditional leaders were mobilized to spread accurate information and counter harmful rumors.

These actions were coordinated through the national Incident Management System (IMS), with UNICEF playing a key leadership role in the Risk Communication and Community Engagement (RCCE) pillar.

Lessons for the Future

Zambia’s cholera response offers a powerful case study in how community-centered, data-driven strategies can transform emergency health interventions. Several key lessons have emerged:

1. Institutionalize Rapid Qualitative Assessments (RQAs): RQAs provided real-time insights that directly informed response strategies. Institutionalizing them across all emergency response pillars will ensure future responses are equally agile and people-centered.

2. Invest in Local Partnerships and Capacity: Long-standing partnerships with institutions like UNZA, ZRCS, and ZINGO enabled rapid mobilization. Continued investment in local capacity will strengthen preparedness.

3. Embed Community Engagement in All Pillars: RCCE was integrated across all sectors, ensuring that community feedback informed every aspect of the response.

4. Accelerate Decision-Making and Resource Mobilization: Fast-track mechanisms for approving and funding emergency interventions saved lives and reduced disease spread.

5. Address Structural Barriers to Health Access: Systemic improvements in health infrastructure, logistics, and social protection are essential to ensure equitable access to care.

6. Leverage Emergencies to Build Resilience: The response catalyzed improvements in surveillance, case management, and WASH infrastructure that should be embedded into long-term strategies.

7. Promote Multi-Sectoral Collaboration: Coordinated action across health, education, social welfare, and disaster management addressed the full spectrum of community needs.

8. Prioritize the Needs of Vulnerable Populations: Tailoring interventions for children, persons with disabilities, and the urban poor must remain a priority in all future responses.