Evaluation of the Coordination of Cholera Outbreak response in Harare City, 2018

Abstract

Background: Zimbabwe declared a cholera outbreak on 6th September 2018 with cases rapidly increasing during the first week of the outbreak. Despite early detection of the outbreak and various coordination activities for the outbreak response, the cases continued to rise in Harare City and by the 21st of September 2018 the city had recorded 5 802 suspected cholera cases. Poor coordination may result in avoidable morbidity and mortality. We evaluated the effectiveness of the coordination for preparedness and response during 2018 cholera outbreak in Harare City to identify gaps and make recommendations for improvement. Methods: We conducted a descriptive cross-sectional study. We used interviewer-administered questionnaires to collect data from key informants who were purposively recruited at Ministry of Health head office (MOHCC), City health department and West-South-Western district in Harare City and partners. Checklists were used to assess the quality of coordination meetings and Emergency Operations Centre (EOC) according to the Emergency Management British Columbia guidelines. Records review of stock cards for medicines and sundries and random physical counts were conducted to assess stock management. We analyzed data by themes and frequencies. Results: Coordination framework, coordination structures and clarity of roles were in place. The EOC was located at MOHCC with well-established security measures; however it was operating for only 8 hours daily, had space for only 20 personnel and no hotline. Eight meeting minutes were reviewed. They had an agenda, appropriate participants, identified action items but lacked timelines for the action items and had no action matrix for identified tasks. Stock management was conducted manually resulting in delayed resource distributions. Conclusion: The coordination framework and structures were well established. There are opportunities for improvement if timelines and an action matrix are added to the meeting minutes. The EOC was operating for eight hours and without a hotline. Keeping the EOC operational for 24 hours daily during outbreaks can improve the outbreak response. Delays in resources redistribution and consequent delayed response may improve with use of an electronic stock management system.