Adoption and use of the 7-1-7 target for timely outbreak detection, notification and early response in the human and animal sectors in humanitarian crisis-affected South Sudan: A mixed-methods study during 2025

<ns3:p>Background Globally, the 7-1-7 target (detect within 7 days, notify within 1 day, respond within 7 days) was introduced to improve outbreak response. South Sudan adopted the 7-1-7 framework in August 2023. This study aimed to describe the process and challenges of adopting the 7-1-7 framework, assess the performance of outbreaks in the animal and human sector against the 7-1-7 target, and explore the challenges for 7-1-7 adoption in humanitarian settings. Methods This mixed-methods study comprised a checklist-based assessment of 7-1-7 adoption at national and subnational levels, extraction of dates and bottlenecks from the 7-1-7 consolidated spreadsheet for outbreaks that occurred before (2013-July 2023) and after (August 2023-July 2025) 7-1-7 adoption, and in-depth interviews and focus group discussions among key stakeholders to explore the challenges in 7-1-7 adoption. Results 7-1-7 was successfully adopted at the national level and in four of ten states and three administrative areas, facilitated by strong leadership, and project funding and technical support from the 7-1-7 Alliance. Due to lack of funds, 7-1-7 was not adopted nation-wide. Data for applying the 7-1-7 framework was available in 9/25 (36%) and 9/9 (100%) outbreaks that occurred before and after adoption, respectively. None of the five outbreaks from the animal sector had complete data for assessing the target. Of 18 outbreaks assessed, 44% met all targets with 50%, 91% and 56% achieving detection, notification and response targets, respectively. Delayed health seeking, poor internet connectivity, and inadequate resources were bottlenecks for timely detection, notification, and response, respectively. Non-functional health facilities and competing priorities were major barriers to adopting the 7-1-7 framework in humanitarian settings. Conclusion South Sudan successfully adopted 7-1-7 at the national-level. Sustainable funding is required to expand 7-1-7 to all states, including humanitarian settings, establish a surveillance information system for the animal sector and improve timely outbreak response.</ns3:p>