Adoption and use of the 7-1-7 metrics for effective detection, notification, and early response actions to public health events: A mixed-methods study in Cambodia, January 2023 to July 2025

<ns3:p>Background The 7-1-7 metrics with ≤7days for detection, ≤1 day for notification, ≤7 days to complete early response actions during public health outbreaks, enable early detection, notification, and rapid response. We evaluated the adoption, use of 7-1-7 metrics, and the bottlenecks and enablers for achieving the metrics in the public health sector of Cambodia. Methods A sequential explanatory mixed-methods design was used. A cross-sectional study using a structured checklist was employed to assess the level of adoption (26 participants) and a cohort design to assess use of 7-1-7 metrics for the public health events reported between Jan’23 and Jul’2025. A qualitative descriptive study using 6 focus group discussions and 22 key informant interviews was conducted to explore the bottlenecks and enablers in 7-1-7 adoption and implementation. Results Adoption of 7-1-7 metrics was achieved at national level and is in progress at the subnational level. Health system readiness, intersectoral coordination, capacity building, budget and resources, and digital data collection were major themes that influence adoption. Among 58 events, 26 were respiratory illnesses. The median(range) time was 6(&lt;1-149)days for detection, with 36(62%) events meeting the target; less than 24 hours(0-4) for notification with 51(88%) events meeting the target; 1(1-101)day for early response with 50(86%) events meeting the target. Overall, 28(48%) events met all targets. Among 168 bottlenecks identified, 86(62%) were for detection, and among the 226 enablers identified, 94(42%) were related to early responses. Key bottlenecks included delayed care-seeking, low awareness among private health workers, and lack of community knowledge. Significant enablers included strong reporting lines and rapid coordinated response mechanisms. Conclusion Cambodia has made substantial progress in adopting and implementing the 7-1-7 metrics. Delays in detection remain a key challenge; addressing this through enhanced risk communication, stronger private sector engagement, and improved surveillance capacity will strengthen Cambodia's overall outbreak preparedness.</ns3:p>