Table 4 Zanzibar IDSR implementation challenges by the healthcare delivery system level

National

Lack of electronic system/database for infectious disease reporting

Inadequate financial resources for conducting regular supervision visits and training

Lack of back-up system for data security

District

Lack of electronic system for infectious disease reporting

Inadequate resources including fund for conducting supervision visits

Low staff knowledge on IDSR strategy particularly at health facilities

Delay of reports from health facilities particularly privately owned

Poor communication system for reporting suspected outbreaks

Unreliable internet service

Lack of incentives for IDSR reporting leading to low staff motivation

Health facility

High staff workload

Filling paper-based surveillance forms time consuming

Late report collection by DSOs

Absence of airtime vouchers for submitting weekly cell phone-texted data

Lack of regular trainings or capacity building on disease surveillance and IDSR reporting tools

Inadequate supervision and feedback from higher levels

Lack of designated personnel responsible for IDSR at the hospital level