Exploring enablers and barriers for implementing community-based surveillance strengthening early detection and response in District Mardan Khyber Pakhtunkhwa Pakistan
Year: 2026
Type: article
Abstract: Community-based surveillance (CBS) compliments early warning alert and response beyond health facilities by identifying events at source through community engagement, enabling detection of disease outbreaks before facility-based reporting systems. In Pakistan, repeated outbreaks of dengue, measles and other infectious diseases highlight the need for event detection at community level. Although community-based surveillance is globally advocated, implementation at district level remains limited. Successful CBS implementation depends on understanding local contexts, stakeholder readiness, and enabling factors. Before implementing CBS in District Mardan, Khyber Pakhtunkhwa, this qualitative study assesses implementation readiness by exploring multi-stakeholder perspectives on barriers and enablers. The study engages district health officials, Lady Health Workers, facility staff, and community volunteers to identify contextual factors and strategies needed for effective community participation in outbreak detection and response systems. A qualitative exploratory study was conducted from June to August 2025 in District Mardan, Khyber Pakhtunkhwa, Pakistan. We conducted five key informant interviews (KIIs) with district officials (DHO, Provincial Coordinator, 3 program managers/officers) and three focus group discussions (FGDs) stratified by stakeholder role including Lady Health Workers (LHWs, n = 17), health facility staff (HFS, n = 13), and community volunteers (CV, n = 15) totaling n = 50 participants. Data were collected using semi-structured guides, audio-recorded with consent, transcribed and analyzed using both inductive and deductive coding in NVivo 12. Data triangulation across four stakeholder groups strengthened credibility of findings. CBS was perceived a value addition in identification of events and to compliment early warning alerts and response component of national surveillance system. Community alerts often go undocumented. Participants described perceived gaps in LHW coverage, particularly in peri-urban and remote areas. Strengthening of CBS implementation included motivated frontline workers, strong community engagement and increasing use of digital tools. Challenges included passive reporting, limited training, weak data integration, and mistrust in vaccination campaigns. Participants recommended revitalizing village health committees, unified real-time reporting, continuous training, and stronger feedback mechanisms. CBS in Mardan provides a promising foundation but remains fragmented. Expanding LHW coverage, strengthening reporting systems, and rebuilding trust with communities are key steps toward more effective early detection and response.
Source: Discover Public Health
Institutions: Health Services Academy, National Institute of Health
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223023536