From listening to action: how social and behavioral evidence informed multisectoral cholera response in Zambia, 2023-2024.

Rapid qualitative assessments and community feedback mechanisms are increasingly recognized as core components of risk communication and community engagement in public health emergencies, yet few documented examples exist of how this evidence has directly influenced outbreak response decision-making. This case study examines the 2023-2024 cholera outbreak in Zambia, analyzing how social and behavioral data generated through multiple rounds of rapid qualitative assessment, alongside national community feedback mechanisms, informed multisectoral response activities. Drawing on document review, consultations with response pillar members, assessment reports, feedback dashboards, and triangulation with epidemiological data, the study traces how community concerns, rumors, beliefs, perceptions and priorities were collected, analyzed and applied across health, water, sanitation and hygiene, and protection response pillars. Enabling factors included pre-existing technical capacity, strong partnerships between government humanitarian actors, and academia, and rapid feedback loops that supported near real-time adaptation. Challenges at different points in the response included delayed resource allocation, uneven subnational coordination, and limited capacity to process large volumes of feedback data. The Zambia experience demonstrates that community-generated evidence can meaningfully influence outbreak response when integrated across response pillars rather than confined to behavioral interventions alone, representing a broader shift in public health practice that positions community perspectives as central to decision-making. This, in turn, strengthens effectiveness, trust, accountability, and transparency by aligning interventions with community-identified priorities. While grounded in the Zambian context, the findings are relevant for preparedness, anticipatory action, and response across a range of public health emergencies.