We have not registered any cholera outbreak following the vaccination in 2018 in the Albertine region. A resilience study of the Regions journey towards the elimination of cholera outbreaks

IntroductionWorld Health Assembly 2011 adopted a resolution on strengthening national health emergency and resilience of health systems and following this resolution, an operational framework for climate resilient Health systems was formulated to guide health systems resilience analysis. Cholera has been endemic in Uganda for over five decades, with the Albertine region among the most affected. The highest burden was recorded before 2000, but cases have since declined after Uganda introduced integrated prevention measures like Oral Cholera Vaccination (OVC). MethodsA qualitative study was conducted in Hoima, Kasese, and Kikuube districts. Data were collected through 13 key informant interviews with health officials and partners, 10 focus group discussions with community members, and 9 in-depth interviews with cholera survivors and caregivers, involving 87 participants in total. Participants were purposively selected based on their roles in cholera prevention and response. Analysis was done in two stages, first, the manifest content analysis followed by latent content analysis. Transcripts generated from the transcripts were read and re-read by three 3 selected research assistants, who then assigned codes (Open coding). ResultsSeven themes emerged as central to resilience to cholera shocks. OCV campaigns were seen as transformative, with districts reporting no outbreaks since. Epidemic preparedness and response planning enabled rapid mobilization, while health education improved community hygiene practices. Water and sanitation improvements, including protected sources and latrine coverage, reduced transmission. Rapid response systems and treatment centers minimized fatalities. Community mobilization through Village Health Teams enhanced surveillance and health education, while cross-border surveillance, though constrained, improved case detection. ConclusionUgandas declining cholera trend reflects synergies between vaccination, WASH, preparedness, and community engagement. Sustaining resilience requires periodic OCV booster campaigns, reinforcement of hygiene practices, improved cross-border coordination with neighbouring countries, permanent isolation facilities, and expanded safe water and sanitation access to consolidate progress toward cholera elimination.