Table 1

Themes and codes emerging from data

The absence of a surveillance policy framework and poor governance leads to an ill-defined disease surveillance system
  • Lack of provincial policy on infectious disease surveillance

  • Lack of laws

  • Lack of surveillance standards

  • Lack of resource planning leading to dysfunctional digital information systems

  • Lack of planning to ensure integrated surveillance of infectious diseases

Fragmentation in the healthcare system is a hindrance to a uniform reporting system
  • Poor coordination between health system stakeholders

  • Lack of integration between different levels of health facilities

  • Lack of defined reporting lines for surveillance data

  • Different organisations managing various levels of health facilities in the district

Inadequate resources translate to poor disease surveillance
  • Inadequate provision of facilities and equipment

  • Lack of dedicated human resource for surveillance

  • Lack of financial support

  • Lack of dedicated line item for surveillance in provincial/district budget

In the current system surveillance is predominantly passive
  • Hospital-based surveillance

  • Surveillance data collected from patients presenting to hospitals

  • Lack of human resource to conduct surveillance in communities

  • Low level of surveillance activities outside hospitals

Paper-based reporting is a key determinant of delayed disease reporting
  • Surveillance data compiled on hard copies

  • Hard copies are delivered from health facilities to the district health office

  • No dedicated human resource to transfer health facility reports to the district health office

Surveillance data are underutilised for evidence-based decision making
  • Monthly report submission by health facilities to the district health office is mandatory

  • No feedback was provided from the district health office to facilities on submitted reports

  • Submitted reports are not reviewed for data errors

  • No one from the district or provincial makes monitoring visits to check the fidelity of reported data

Lack of laboratory testing capacity takes a toll on disease surveillance
  • There is no laboratory capable of conducting tests for diseases under surveillance

  • Samples are sent to a regional laboratory for testing

The lack of integration of the private sector in disease surveillance is a major gap
  • At the provincial or district level, no measures are taken to bring surveillance data from the private health sector into the mainstream

  • The private health sector does not report surveillance data to the district health office or provincial health department except in case of COVID-19