# Barriers and Facilitators to Implementing Post-Validation Surveillance of Lymphatic Filariasis in Pacific Island Countries and Territories: A Conceptual Framework Developed from Qualitative Data

## TL;DR

This study identifies challenges and solutions for monitoring lymphatic filariasis in Pacific Island countries after they have been declared free of the disease.

## Contribution

A conceptual framework is developed to guide post-validation surveillance implementation in Pacific Island Countries and Territories.

## Key findings

- Barriers include limited awareness of surveillance requirements and competing health priorities.
- Cost and logistical challenges hinder surveillance implementation.
- Participants emphasized the need for tailored guidelines and better communication from WHO.

## Abstract

Eight Pacific Island Countries and Territories (PICTs) have been validated by the World Health Organization (WHO) as having eliminated lymphatic filariasis (LF) as a public health problem. WHO recommends that these countries implement post-validation surveillance (PVS) to ensure resurgence has not occurred. Some PICTs proactively conducted LF PVS even in the absence of specific recommendations or best-practice guidelines at the time of implementation. We aimed to explore the barriers and facilitators to implementing LF PVS in PICTs, with a view to informing context-specific strategies and regional guidelines. Key informant interviews were held between March and September 2024 with 15 participants involved in LF and/or neglected tropical disease surveillance. Transcripts were analysed thematically using a generalised deductive approach. A conceptual framework was developed to summarise themes with two main streams of barriers identified. Stream One Barriers included limited awareness of, and guidelines for, PVS requirements and competing national health priorities. Stream Two Barriers included cost, resource, and logistical barriers to conducting PVS. Participants called for clearer, contextually tailored guidelines, improved communication from WHO, and integration within existing systems. This study highlights the urgent need for operational guidance, policy advocacy, and capacity strengthening to ensure sustainable LF PVS in PICTs. Incorporating local context and leveraging existing health structures will be essential to prevent disease resurgence and maintain gains achieved through elimination programmes.