Achievements and Challenges to Effective Disease Surveillance in Primary and Secondary Health Facilities in Cross River State

Background In recent years, cases of priority diseases such as Lassa fever, Cerebrospinal meningitis, Cholera and most recently Monkey pox have been sporadically reported outside routine epidemiological sources in Cross River State. This has raised concerns on the effectiveness of the surveillance system in reporting sensitive health events in the past. This study therefor aims to assess the achievements of the surveillance and challenges to disease surveillance in Cross River State.  Methods The study was conducted in Cross River State, Nigeria. A descriptive cross sectional study design with mixed approach was used to assess surveillance achievement and challenges in Primary and Secondary health facilities of the State. Respondents included the Epidemiologist, surveillance officers and head clinicians. Key informant interviews were conducted to explore the in-depth challenges of implementation and operationalization of surveillance system as well as the achievements of the system in the past. Audiotaped interviews were transcribed verbatim and inductively analyzed into themes describing their perceptions and acceptance.  Results The findings show that only 46.2% of PHCs and 19.0% SHFs had provided early warning for epidemics in the past, preventing outbreaks of Cholera, Monkey Pox and Lassa fever, Cerebrospinal Meningitis and Guinea worm infections, indicating a low level of effectiveness. The major challenges identified were poor funding of the surveillance system and inadequate infrastructure. Other challenges were lack of human resources, mobility and transportation challenges and poor integration of digital facilities into surveillance activities.  Conclusion/ Recommendation The surveillance system has shown low level of effectiveness in some respects, major challenges still exist that impede optimum functionality of the system. Addressing these challenge will optimize system functionality and effectiveness.