Attachments
Risk Analysis and early action selection
Prioritized hazard and its historical impact.
Prioritised Hazard
The Zimbabwe Red Cross Society (ZRCS) initiated Forecast Based Actions (FBA) programming in 2018 through a scoping study and a subsequent Roadmap for FBA in Zimbabwe (Annex 1) which provides guidance towards the phased progression of hazards which could be addressed by FBA in Zimbabwe, based on historical impacts, forecast availability and feasibility. Informed by these assessments the roadmap recommended that drought, cholera and flooding be addressed sequentially, supported by a planned capacitation of ZRCS anticipatory action capacities. During 2019-2022 ZRCS successfully developed a full Early Action Protocol (EAP) for Droughts which was approved by the IFRC Validation Committee in December 2022. In line with the recommendations of the Roadmap the ZRCS began to address anticipatory action programming for cholera in 2023, with the support of a DG ECHO funded cholera preparedness project. This process coincided with a large regional outbreak of cholera during 2023-2024 which seriously affected Zimbabwe and required a significant intervention by the ZRCS focused on community level interventions, which were based on the Red Cross Red Crescent Movement Branch Outbreak Response Team (BORT) and Oral Rehydration Point (ORP) approaches. Lessons from this intervention and ongoing cholera preparedness programming have informed the development of this simplified Early Action Protocol, its trigger methodology and the Early Actions which have been included in this Protocol.
During 2023-2024 the country was affected by the largest cholera outbreak since 2008, which has affected all of the country’s 10 provinces and 62 districts and resulted in 34,549 cases and 631 deaths. The outbreak was declared over in August 2024, however new outbreaks of cholera have emerged in multiple hotspot districts around the country since November 2024.The growth of poorly serviced peri-urban informal settlements, with insufficient water, sanitation and solid waste management sustains the potential for future largescale outbreaks, particularly in the Cities of Harare, Mutare and Chitungwiza. These three cities along with the rural districts of Manicaland Province accounted for 78% of the suspected cholera cases during 2023-2024. The infrastructural interventions required to address these challenges are limited by underinvestment and outpaced by population growth and urban densification*,* ensuring that the risk of outbreaks will persist.
The approach and actions included in this sEAP recognize that unplanned urban growth in Zimbabwe will continue to outpace the required expansion of infrastructure in the foreseeable future, exposing both urban and rural populations to conditions conducive for cholera. Addressing this requires a flexible and scalable approach that is aligned with Government of Zimbabwe’s (GoZ) capacities. Additionally, the sEAP recognizes the risk of regional transmission of cases and the need for strengthened and proactive monitoring, coordination and the adoption of regionally applicable anticipatory actions.
An important consideration in the risk analysis of cholera is the impact of climate change. Zimbabwe is expected to have an increased likelihood of both flooding and droughts[1], both of which have correlations to increased cholera risk, which can be seen in the previous large scale outbreaks.
Drought: There is a clear, though often indirect, correlation between drought conditions and cholera outbreaks in Zimbabwe[2], primarily driven by reduced access to safe water, sanitation and shifts in population behavior. The 2008–2009 cholera outbreak, which recorded over 98,000 cases and more than 4,000 deaths, coincided with a multi-year drought period (2007–2009). Similar patterns were observed during the 2018–2019 outbreak, centered again in Harare, where cholera cases surged following dry spells and extensive sewer system failures. Zimbabwe was experiencing a significant meteorological drought in 2018, with below-average rainfall affecting safe water availability and sanitation services, particularly in informal urban settlements. More recently, in 2023, the worst recent drought conditions in Zimbabwe coincided with the largest cholera outbreak since 2008, It can be reasonably expected then that as climate change intensifies the frequency and severity of droughts, the risk of cholera will also increase, especially in contexts of weak public health systems, informal urban growth, and poor WASH service coverage.
Flooding**:** Zimbabwe is also predicted to be increasingly affected by condensed seasonal rainfall patterns, where periods of heavy rainfall will be followed by prolonged dry spells. The heavier rainfall, combined with poor drainage infrastructure results in increased urban flooding, particularly of semi formal peri urban areas, which overlap cholera hotspots[3]. The heavy rainfall can increase contamination of informal water sources and also increases the demands on wastewater treatment infrastructure prior to its entry to lake Chivero, the City’s main reservoir, a significant contributor to the large-scale outbreak in 2008.