Decentralized vs. Centralized Cholera Treatment Centers: Addressing A Flexible, Phase-Based Approach During the Largest Outbreak in Zambia’s History (2023-2024)

Background: The 2023–2024 cholera outbreak in Lusaka, Zambia, highlighted the need for flexible, phase-based strategies for cholera treatment. Decentralized cholera treatment centres (CTCs) were established early in the outbreak to improve accessibility and reduce patient delays, while centralized CTCs were introduced later to standardize care and manage severe cases. This study evaluates the effectiveness of these two models for patient management and outbreak control. Methods: A structured analysis was conducted using semi-structured interviews with key stakeholders and publicly available situation reports. Data on patient consultations, transfers, and treatment outcomes were collected to compare the performance of decentralized and centralized CTCs. Results: By the end of May 2023, decentralized CTCs in Lusaka District had managed 14,529 consultations, with 5,847 patients transferred to centralized CTCs for advanced care. The decentralized CTCs improved accessibility and community engagement but faced challenges in terms of quality standards, resource allocation, and supervision. Centralized CTCs facilitated standardized treatment protocols and efficient patient management but required substantial initial setup costs, faced logistical and security concerns, and had limited geographic coverage. Conclusion: A phased approach—balancing decentralized and centralized care based on outbreak progression—is essential for optimizing resource utilization, improving patient outcomes, and reducing mortality. For enhancing cholera outbreak response strategies in the future, key measures include pre-established surge structures, availability of healthcare staff pre-trained in incident management, proactive risk communication, pre-season oral cholera vaccination campaigns, and a well-defined coordination framework. Keywords: Cholera, Outbreak, Surge capacity, Cholera/therapy, Cholera/prevention & control, Cholera Vaccines, Disease Outbreaks, Zambia/epidemiology, Disaster Planning, Health Policy