Timeliness of outbreak detection and response: an operational evaluation of the 7-1-7 framework in district Mardan, Khyber Pakhtunkhwa, Pakistan

The 7-1-7 target framework, developed by Resolve to Save Lives (RTSL) and later adopted by the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC), provides a performance-based metric for epidemic preparedness. It sets measurable goals to detect outbreaks within seven days, notify within one day, and initiate response within seven days. This study had two objectives: (i) to assess the timeliness of outbreak detection, notification and response against the 7-1-7 targets, and to identify the bottlenecks and enablers at each stage; and (ii) to evaluate awareness, implementation and operational feasibility of the 7-1-7 framework within the Early Warning System (EWS) component of the Integrated Disease Surveillance and Response (IDSR) strategy in Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. This study used an explanatory sequential mixed-methods design, comprising a retrospective analysis of eight outbreaks (2022–2024), including dengue fever (3), measles (2), cholera/acute watery diarrhoea (2) and leishmaniasis (1), followed by 18 semi-structured in-depth interviews. Quantitative data were analysed using the 7-1-7 indicators (detection, notification, response), summarized as the median and interquartile range. The median detection interval was 9 days (IQR 7–11), the median notification interval 2 days (IQR 1–2) and the median response interval 9 days (IQR 8–11). Two of the eight outbreaks (25%) met all three 7-1-7 targets. Detection delays were mainly attributed to centralised laboratory confirmation, and notification and response were constrained by fragmented reporting and limited connectivity. Staff motivation and mobile-based reporting were identified as key enablers. Pakistan’s EWS–IDSR demonstrates readiness to operationalize the 7-1-7 framework but needs stronger laboratory capacity, integrated digital reporting and inter-sectoral coordination. Embedding 7-1-7 indicators into national IDSR monitoring would accelerate compliance with the International Health Regulations (IHR, 2005).