Evaluating the 7-1-7 target for epidemic detection, notification and response in Zambia: An operational research study, 2023-2025

<ns3:p>Background Health systems in low- and middle-income countries face challenges in detecting and responding to infectious disease outbreaks. The 7-1-7 framework sets targets for 7 days for detection, 1 day for notification, and 7 days for completion of early response. Zambia adopted this framework in 2023. Here, we report a review of the 7-1-7 adoption at national and subnational levels and its performance from May 2023 to June 2025. Methods Mixed methods design was applied. A cross-sectional study assessed progress in 7-1-7 adoption using a structured checklist to interview the national champion, provincial (n=10) and district surveillance officers (n=116). To assess performance, a cohort design was applied using secondary data extracted from the 7-1-7 consolidated spreadsheet (n=35). Results Zambia has fully adopted the 7-1-7 framework at national level. However, subnational adoption varied: all 10 provinces and half the districts (50%) had coordination teams while only about 20% had piloted 7-1-7. A total of 35 events were assessed: 74% met detection, 94% notification, and 44% early response targets, with only 42% meeting all three. The median(range) time was 2 days (0–69) for detection, 0 days (0–10) for notification, and 9 days (1–300) for completion of early response. Cholera events performed relatively better than mpox with 60% versus 33% meeting all targets. Key enablers included clinical awareness (for detection) and network connectivity (for notification). Notable bottlenecks were low index of suspicion, inadequate training, and limited resource availability. Conclusion This is Zambia’s first national analysis of the 7-1-7 framework, showing strong national adoption but uneven subnational progress. Detection and notification targets were largely met, while early response lagged due to poor coordination and reported lack of resources. This framework is a structured and objective tool to guide outbreak investigation and emergency response.</ns3:p>