# Barriers and facilitators to the implementation of integrated disease surveillance and response (IDSR) in Africa: a systematic review using the consolidated framework for implementation research (CFIR)

## TL;DR

This paper reviews factors affecting the implementation of disease surveillance systems in Africa, identifying barriers like limited resources and facilitators like better access to knowledge.

## Contribution

The study is the first to use the CFIR framework to systematically analyze IDSR implementation determinants in Africa.

## Key findings

- Key barriers include limited resources and structural constraints within health facilities.
- Facilitators involve improved access to knowledge and adequate resources in the inner setting domain.
- The CFIR framework helps identify context-specific strategies for better implementation.

## Abstract

Integrated Disease Surveillance and Response (IDSR) are crucial for strengthening public health systems in Africa but faces implementation challenges. Despite the growing utility of implementation theories, models, and frameworks in assessing the determinants of innovation implementation, no implementation research theories have examined the determinants of IDSR implementation. This systematic review aimed to identify the barriers and facilitators of IDSR implementation in Africa using a Consolidated Framework for Implementation Research (CFIR).

We systematically searched four databases, EMBASE, PUBMED, CINAHL, and Scopus, for studies on IDSR assessments in Africa published between 2010 and 2025. Data on barriers and facilitators were extracted and mapped to CFIR domains and constructs and analyzed deductively using content analysis and inductively using thematic analysis. The quality of the included studies was assessed using the Johns Hopkins Nursing Evidence Appraisal Tool. The review was reported in alignment with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Thirty-seven studies were included in this analysis. Six CFIR domains and 24 constructs explained the determinants of IDSR implementation. The key barriers identified were limited resources, inadequate access to knowledge/information, and structural constraints in the inner-setting domain. Individual domain factors, such as low motivation and capability, also emerged as crucial barriers. Facilitators included structural characteristics, improved access to knowledge, and adequate resources in the inner setting domain as well as positive innovation outcomes in the outcome domain.

The implementation of IDSR encounters complex barriers and opportunities within health facilities. Comprehensive strategies addressing both organizational and individual factors of healthcare facilities are needed. The CFIR framework, alongside the CFIR-ERIC matching tool, provides a foundation for identifying context-specific implementation strategies that lead to improved innovation performance.

PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD42024571576, identifier CRD42024571576.