JMIR Publications

ABSTRACT

Background:

Public health surveillance (PHS) systems are essential for routine disease monitoring, early outbreak detection, and emergency response. Although many studies focus on system development and implementation, less attention has been given to factors that sustain surveillance systems over time.

Objective:

This study aimed to identify factors influencing the sustainability of PHS systems in Thailand by examining stakeholder experiences across two long-standing national surveillance platforms.

Methods:

A qualitative study was conducted using evidence from the malaria surveillance system and the national notifiable disease surveillance system. Semi-structured in-depth interviews and focus group discussions were conducted with stakeholders involved in system development, implementation, operational use, management, and funding. Audio recordings were transcribed and analyzed using thematic analysis.

Results:

Thematic analysis identified seven factors influencing PHS sustainability: user needs, collaboration and partnership, human resources, infrastructure, financial sustainability, ownership, and system adaptability. Sustainability was strengthened when systems fit routine workflows, reduced duplicate work, and produced actionable outputs. The Malaria Surveillance System highlighted the need for context-adapted design in remote settings, while the national notifiable disease surveillance system emphasized interoperability and near real-time national reporting. Key challenges included limited technical capacity, infrastructure maintenance, fragmented lifecycle funding, and unclear operational ownership. Participants also emphasized the importance of moving beyond digitization toward digital transformation that improves efficiency, decision-making, and adaptability.

Conclusions:

Sustaining PHS systems requires more than technical deployment. Long-term viability depends on embedding systems within routine workflows, maintaining human and infrastructure capacity, securing lifecycle financing, establishing clear operational ownership, and enabling continuous adaptation to changing public health and technological needs.