Enhancing Regional Cholera Preparedness and Resilience: A Health Systems Evaluation in Afar Region, Ethiopia, December 2025
1
1 Africa Epidemic Services Fellowship, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
2
3 Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
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2 Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):A605
ABSTRACT
INTRODUCTION:
cholera remains a persistent public health challenge in Ethiopia’s Afar Region due to arid climatic conditions, population mobility, and porous international borders. Despite implementation of the national cholera elimination plan, the region has reported 66913 suspected cases and 829 deaths since august 2022, with a case fatality rate of 1.24. Recurrent outbreaks raise concerns regarding preparedness and response sustainability. This evaluation assessed cholera preparedness capacity across Afar Region to identify system-level strengths and operational gaps.
METHODS:
a mixed-methods, cross-sectional descriptive evaluation was conducted in december 2025 across the Afar Region. Quantitative data were collected using a World Health Organisation (WHO)–adapted multi-pillar cholera preparedness checklist assessing 12 core domains. Qualitative data were obtained through key informant discussions with stakeholders at regional and subregional levels and structured field observations. Preparedness scores were categorised as adequate (≥80%), moderate (50–79%), or limited (<50%).
RESULTS:
Afar Region achieved an overall preparedness score of 74%, indicating moderate readiness. Risk communication and community engagement (100%), continuity of essential health services (100%), and case management (83%) demonstrated adequate capacity. Moderate readiness was demonstrated across leadership and coordination (75%), rapid response teams (75%), surveillance (57%), laboratory capacity (78%), points of entry preparedness (75%), infection prevention and control and safe and dignified burial (57%), operational support and logistics (60%), vaccination (67%), and water, sanitation and hygiene (WASH) and food safety (57%). Qualitative findings revealed operational challenges at woreda (district) level, including workforce turnover and specimen transport delays, highlighting variability between system design and frontline implementation.
CONCLUSIONS:
although Afar Region has established foundational cholera preparedness systems with strengths in community engagement and service continuity, overall readiness remains moderate. Strengthening resilience will require decentralisation of diagnostics, reinforcement of event-based surveillance, and sustained investment in climate-resilient WASH systems to enable a transition from reactive outbreak response to sustainable system-wide preparedness.
cholera remains a persistent public health challenge in Ethiopia’s Afar Region due to arid climatic conditions, population mobility, and porous international borders. Despite implementation of the national cholera elimination plan, the region has reported 66913 suspected cases and 829 deaths since august 2022, with a case fatality rate of 1.24. Recurrent outbreaks raise concerns regarding preparedness and response sustainability. This evaluation assessed cholera preparedness capacity across Afar Region to identify system-level strengths and operational gaps.
METHODS:
a mixed-methods, cross-sectional descriptive evaluation was conducted in december 2025 across the Afar Region. Quantitative data were collected using a World Health Organisation (WHO)–adapted multi-pillar cholera preparedness checklist assessing 12 core domains. Qualitative data were obtained through key informant discussions with stakeholders at regional and subregional levels and structured field observations. Preparedness scores were categorised as adequate (≥80%), moderate (50–79%), or limited (<50%).
RESULTS:
Afar Region achieved an overall preparedness score of 74%, indicating moderate readiness. Risk communication and community engagement (100%), continuity of essential health services (100%), and case management (83%) demonstrated adequate capacity. Moderate readiness was demonstrated across leadership and coordination (75%), rapid response teams (75%), surveillance (57%), laboratory capacity (78%), points of entry preparedness (75%), infection prevention and control and safe and dignified burial (57%), operational support and logistics (60%), vaccination (67%), and water, sanitation and hygiene (WASH) and food safety (57%). Qualitative findings revealed operational challenges at woreda (district) level, including workforce turnover and specimen transport delays, highlighting variability between system design and frontline implementation.
CONCLUSIONS:
although Afar Region has established foundational cholera preparedness systems with strengths in community engagement and service continuity, overall readiness remains moderate. Strengthening resilience will require decentralisation of diagnostics, reinforcement of event-based surveillance, and sustained investment in climate-resilient WASH systems to enable a transition from reactive outbreak response to sustainable system-wide preparedness.
| eISSN: | 2654-1459 |
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