Abstract
<title>Abstract</title> <p> <bold>Introduction</bold> Cholera is a public health problem in low- and middle-income countries, characterized by limited access to safe water, inadequate sanitation, and weaknesses in surveillance and outbreak response systems. In Mozambique, the occurrence of outbreaks is exacerbated by high vulnerability to extreme weather events, which compromise water and sanitation infrastructure, favoring disease transmission. In 2026, the district of Caia, in Sofala province, experienced a cholera outbreak that resulted in a multidisciplinary response. This study aimed to identify operational gaps and factors potentially associated with the persistence of cholera transmission in affected communities. <bold>Methods</bold> A descriptive cross-sectional study with an operational evaluation component was conducted during the outbreak response. Data were collected through direct observation, document review, and interviews with health professionals and community actors involved in the response. The pillars of clinical management, infection prevention and control, logistics, and WASH were evaluated. The CTC was assessed using 27 indicators distributed across five domains. The WASH and community surveillance components were evaluated based on cholera control recommendations. <bold>Results</bold> The CTC (Cholera Control Center) showed leading performance in the areas of infection prevention and control and logistics (100%), and preparedness and activation reached 80%. However, clinical management (67%) and operational capacity (60%) were identified as functionally at risk due to insufficient human resources. Gaps were identified related to the use of partially protected water sources, lack of water treatment, persistence of open defecation, inadequate latrines, and low availability of soap among family members. Community surveillance revealed limitations in the early detection of cases and the training of activists. <bold>Conclusions</bold> The persistence of cholera transmission in Caia was favored by interconnected weaknesses in the WASH, community surveillance, and rapid response pillars. The observed specificities at the community level compromised the capacity to cut transmission. The integrated strengthening of WASH systems, envisioned on a community-based basis and with systematic implementation of CATI, constitutes a priority for the resilience of the outbreak response and to reinforce cholera elimination efforts in Mozambique. </p>