Exploring stakeholders’ experiences and perceptions regarding barriers to effective surveillance of communicable diseases in a rural district of Pakistan: a qualitative study

OBJECTIVE: To explore the experiences and perceptions of health system stakeholders of a rural district of Sindh, Pakistan regarding the barriers to effective surveillance of communicable diseases. DESIGN: This qualitative descriptive exploratory design comprised in-depth interviews. Both inductive and deductive thematic analysis was applied to identify key themes from the data. SETTINGS: The study was conducted in public sector healthcare facilities and the district health office of the rural district of Thatta, in Sindh province, Pakistan. PARTICIPANTS: Fifteen healthcare managers and healthcare providers working in the eight public sector primary and secondary healthcare facilities were interviewed using an open-ended in-depth interview guide. RESULTS: Key themes that emerged from the data were: poor governance and absence of surveillance policy framework; fragmentation in the health system leading to lack of uniform reporting; inadequate (human) resources that weakened the infrastructure for disease surveillance; hospital-based reporting of cases that led to a predominantly passive surveillance system; paper-based surveillance system as the key determinant of delayed reporting; non-utilisation of surveillance data for decision making; absence of local laboratory capacity to complement the detection of disease outbreaks and lack of private sector integration in disease surveillance. CONCLUSIONS: Poor governance and lack of policy framework were perceived to be responsible for weak surveillance infrastructure. Resource deficiencies including inadequate human resource, paper-based reporting and the absence of local laboratory capacity were considered to result in delayed, poor quality and incomplete reporting. The lack of private sector engagement was identified as a major gap.