Institutional Governance, Capacity and Coordination: Shaping Infectious Disease Surveillance at West Nile Uganda–DRC Land Border Crossings

Background: Infectious disease surveillance plays a critical role in the timely detection, reporting, and response to public health threats, particularly within transboundary settings characterized by high population mobility. Despite investments in surveillance systems, land border crossings along the West Nile Uganda–Democratic Republic of Congo (DRC) corridor continue to experience surveillance challenges associated with institutional governance, capacity limitations, and coordination weaknesses. This study examined how institutional governance, capacity, and coordination shape infectious disease surveillance at West Nile Uganda–DRC land border crossings. Methods: A qualitative exploratory study was conducted at selected gazetted and ungazetted border crossings in Koboko, Arua, Maracha, Zombo, Nebbi, and Pakwach districts. Data were collected through thirteen key informant interviews, four executive interviews, three focus group discussions, two narrative interviews, direct observations, and document review. Participants were purposively selected based on their involvement in border management and infectious disease surveillance activities. Data were analysed thematically using NVivo software following Braun and Clarke’s thematic analysis procedures. Results: Three interrelated themes emerged: institutional coordination, governance and leadership support, and institutional capacity. Coordination mechanisms were largely reactive and outbreak-driven, characterized by informal communication systems and weak cross-border information sharing. Governance structures were constrained by limited leadership engagement, centralized decision-making processes, and weak accountability mechanisms. Institutional capacity challenges included staffing shortages, inadequate infrastructure, limited workforce development opportunities, fragmented information systems, and weak integration of community-based surveillance structures. These factors collectively constrained timely disease detection, reporting, information sharing, and response across border settings. Conclusion: Infectious disease surveillance effectiveness at West Nile Uganda–DRC land border crossings is shaped by the interaction of governance arrangements, coordination mechanisms, and institutional capacity. Strengthening routine inter-agency coordination, improving cross-border information sharing, enhancing accountability systems, investing in workforce and infrastructure development, and integrating community-based surveillance structures into formal surveillance systems are essential for improving surveillance effectiveness and strengthening public health security in transboundary settings.