From Evidence to Action: Zanzibar Uses Behavioral Insights to Strengthen Cholera Prevention

Zanzibar - Zanzibar continues to strengthen efforts toward cholera elimination under the Government-led Zanzibar Comprehensive Cholera Elimination Plan (ZACCEP) 2018-2027, which prioritizes surveillance, water and sanitation improvements, risk communication, and community engagement to prevent future outbreaks.

To support implementation of the strategy, the Ministry of Health Zanzibar, in collaboration with the World Health Organization (WHO) and with financial support from the Embassy of Ireland, conducted a social and behavioral assessment on Acute Watery Diarrhoea (AWD) and cholera across Unguja from 18-29 May 2026. The assessment aimed to better understand the social, cultural, and environmental factors influencing cholera transmission and strengthen evidence-based prevention efforts.

Findings showed that although awareness of cholera prevention measures was generally high, several barriers continued to affect adoption of protective behaviors. Some community members reported concerns about the smell and taste of chlorinated water, while others used chlorine products for purposes other than water treatment. Inconsistent handwashing and water boiling practices, overcrowding, flooding, poor sanitation, and unreliable water supply were also identified as contributing factors.

To better understand these challenges, the Ministry of Health and WHO applied the COM-B behavioral framework, which examines how Capability, Opportunity, and Motivation influence health behaviors. The initiative also trained 10 Health Promotion Coordinators and Health Officers on behavioral insights and mixed-methods data collection, strengthening local capacity to design evidence-based RCCE interventions.

"These findings demonstrate why behavioral insights matter. Traditional surveys often tell us what people know, but they rarely explain why people do or do not act. By understanding the social norms, beliefs, motivations, and environmental constraints behind behaviors, we can design interventions that are more likely to succeed and be sustained," said Jerry Mlembwa, RCCE Officer, WHO Tanzania.

"Behavior change is not achieved by information alone. Understanding why people behave the way they do is critical for designing interventions that are practical, acceptable, and effective. This assessment has helped us move beyond assumptions and generate evidence that will guide more targeted RCCE interventions," said Dr. Haji Gora, Health Promotion Manager, Ministry of Health Zanzibar. "This assessment has helped us generate evidence that will guide more targeted cholera prevention interventions."

The findings informed a co-creation workshop involving community representatives, health officials, and partners to design context-specific interventions and an implementation roadmap for future cholera prevention programming.

By integrating behavioral science into public health programming, Zanzibar is strengthening implementation of its cholera elimination strategy and advancing efforts to prevent future outbreaks through evidence-based, community-informed action.