Implementation of the Integrated Disease Surveillance and Response (IDSR) Strategy in Somalia, 2023-2024: A Mixed Method Evaluation of Performance, Challenges, and Opportunities for Strengthening Health Security

Abstract Background Somalia adopted an integrated disease surveillance and response (IDSR) in 2023 to develop an integrated and coordinated system for early detection and response to priority health conditions. This study evaluated early implementation performance, challenges and opportunities for improvement. Method A convergent mixed methods cross-sectional study was performed between January and December 2024. Quantitative indicators (reporting timeliness, completeness, and alert verification rate) were extracted from the District Health Information Software (DHIS-2) and analyzed via descriptive & inferential statistics (χ², p < 0.05) with 95% confidence intervals. The qualitative data were collected through 50 key informant interviews via an IDSR supportive supervision tool. The data were analyzed via thematic analysis. The qualitative component adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure methodological rigor and transparency. Result As of 31 December 2024, all the states had functional electronic IDSR at the facility level, but community-based surveillance (CBS) and event-based surveillance (EBS) were not yet operational. All the states achieved the ≥ 80% WHO benchmark for timeliness and completeness, with the exception of Banadir (timeliness = 44%), and had at least 1 dedicated trained IDSR officer at the facility level. However, only 46.5% of public health alerts reported through IDSR have been verified (state range 33–67%). Chi-square analysis indicated significant interstate differences in timeliness (p = 0.012) and alert verification rates (p < 0.001). The qualitative findings identified six major themes influencing IDSR performance: human resource capacity, availability of surveillance tools, funding and infrastructure, data management and feedback, epidemic preparedness, and governance and ownership. The participants reported frequent shortages of IDSR materials, a lack of incentives, poor laboratory capacity, and weak community-based surveillance. Despite these challenges, IDSR improved coordination and data availability at the facility level and enhanced government ownership. Conclusion Two years of IDSR implementation have strengthened weekly aggregate facility-based reporting and surveillance coordination, but immediate case-based reporting, alert verification, data analysis capacity, outbreak investigation and response and laboratory support remain weak. Prioritizing these areas and the development of CBS & EBS is highly recommended to enhance the health security of Somalia.