Building Resilient Health Systems: Experiences and Lessons from Implementing Integrated Disease Surveillance and Response (IDSR) in Northeast Nigeria Amidst Insecurity and Fragile Systems

Abstract Background Integrated Disease Surveillance and Response (IDSR) is a comprehensive strategy adopted by countries in the WHO African Region to strengthen disease surveillance and public health response across all levels of the health systems. However, Nigeria’s northeast region has had prolonged armed insurgency and complex humanitarian emergencies, resulting in widespread insecurity, fragile health systems, and disrupted health services. Despite these challenges, surveillance personnel continue to implement IDSR activities in this region. This study documents the experiences, challenges, adaptations, and lessons learned by surveillance personnel implementing IDSR in this conflict-affected setting during the post-surge phase of COVID-19 pandemic. Methods We employed a qualitative phenomenological study design to capture the experiences of surveillance personnel implementing IDSR in northeast Nigeria. Data were collected through key informant interviews (KIIs) with state-level officials and focus group discussions (FGDs) with Local Government Area (LGA) personnel and facility-based surveillance officers. Participants included state epidemiologists, disease surveillance and notification officers (DSNOs), and other health workers, selected purposively using maximum variation sampling to ensure representation across diverse roles and operational contexts. Data were transcribed and analyzed using inductive thematic analysis enhanced with NVivo software. Results Six major themes were identified: security and access constraints, human resource shortages, infrastructure and logistics limitations, data management challenges, psychosocial stress among health workers, and adaptive innovations leveraging community informants, vigilante networks, mobile reporting tools, and existing polio and COVID-19 platforms to sustain surveillance operations. Insecurity significantly restricted access to several LGAs, delayed outbreak investigation, and disrupted both reporting and response. Severe workforce shortages and high staff turnover further strained surveillance capacity. Infrastructure gaps—such as destroyed facilities, unreliable power supply, and limited transport—impeded sample collection and reporting. Data management remained largely paper-based, leading to delays and occasional loss of records. Conclusions In northeast Nigeria, IDSR is implemented in a complex environment shaped by insecurity, fragile infrastructure, and human resource constraints. However, locally driven adaptations and strong community engagement have enabled continuing surveillance. Strengthening IDSR in humanitarian settings requires investments in workforce capacity, digital reporting systems, mental health support for frontline workers, and institutionalization of community-based surveillance approaches.