Evaluating the Incident Management System Performance During a Cholera Outbreak: Evidence From Kadoma, Zimbabwe, 2024: A Cross‐Sectional Study

Introduction Public health emergencies (PHEs) require strong coordination systems to ensure effective response, particularly in resource‐limited settings. In Zimbabwe, the incident management system (IMS) framework was adopted to strengthen outbreak response at the national level, yet evidence on its implementation at the subnational level remained limited. In 2024, Kadoma City activated a virtual PHE operation center (PHEOC) and applied IMS during a cholera outbreak. This study presents the first systematic evaluation of IMS implementation at subnational level in Zimbabwe, examining its functionality and effectiveness during the 2024 cholera outbreak in Kadoma City. Methods We used a mixed‐methods cross‐sectional design combining a quantitative survey ( n = 83), key informant interviews ( n = 15) and systematic document review. Response personnel from Kadoma City Council and partner organizations who participated in the outbreak response were included. IMS functionality was assessed across four domains: coordination and leadership, information management and situation awareness, planning and monitoring, and logistics and resource mobilization. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically and triangulated with document review findings. Results Eighty‐three respondents were interviewed. Only 16 (19.3%) had received prior IMS training, and 33 (39.8%) demonstrated knowledge of the functions of at least one IMS section. A virtual PHEOC was activated within 48 h of outbreak detection, with 71 (85.5%) respondents reporting clear role understanding. Five memoranda of understanding (MoU) with partner organizations were signed, facilitating coordination and resource mobilization. Only three formal situation reports (SitReps) were produced; however, daily updates on case counts were shared informally via a WhatsApp work group. Resource challenges included supply shortages and insufficient staffing, despite surge support from other governmental departments. Conclusion This first IMS evaluation in Zimbabwe demonstrated that rapid activation and clear coordination structures can be achieved at the subnational level even with limited resources. However, critical functionality gaps were noted in IMS training, information management, and resource mobilization. Strengthening subnational emergency response capacity requires systematic investments in pre‐event IMS training, standardized documentation protocols, dedicated emergency budgets, and surge capacity planning to reduce dependence on external support and ensure sustainable outbreak response at the municipal level.