Table 4.

Zanzibar IDSR implementation challenges by the healthcare delivery system level

Level	Expressed challenges
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