# Adoption and use of the 7-1-7 metrics for effective detection, notification, and early response actions to public health events: A mixed-methods study in Cambodia, January 2023 to July 2025

## TL;DR

This study evaluates how Cambodia adopted the 7-1-7 metrics to improve early detection and response to public health events, finding progress but also key challenges like delays in detection.

## Contribution

The study provides a mixed-methods evaluation of the 7-1-7 metrics adoption in Cambodia, identifying bottlenecks and enablers for outbreak response.

## Key findings

- Adoption of 7-1-7 metrics was achieved nationally and is progressing subnationally.
- Only 48% of public health events met all 7-1-7 targets, with detection delays being a major issue.
- Key bottlenecks included delayed care-seeking and low awareness among private health workers.

## Abstract

The 7-1-7 metrics with ≤7days for detection, ≤1 day for notification, ≤7 days to complete early response actions during public health outbreaks, enable early detection, notification, and rapid response. We evaluated the adoption, use of 7-1-7 metrics, and the bottlenecks and enablers for achieving the metrics in the public health sector of Cambodia.

A sequential explanatory mixed-methods design was used. A cross-sectional study using a structured checklist was employed to assess the level of adoption (26 participants) and a cohort design to assess use of 7-1-7 metrics for the public health events reported between Jan’23 and Jul’2025. A qualitative descriptive study using 6 focus group discussions and 22 key informant interviews was conducted to explore the bottlenecks and enablers in 7-1-7 adoption and implementation.

Adoption of 7-1-7 metrics was achieved at national level and is in progress at the subnational level. Health system readiness, intersectoral coordination, capacity building, budget and resources, and digital data collection were major themes that influence adoption. Among 58 events, 26 were respiratory illnesses. The median(range) time was 6(<1-149)days for detection, with 36(62%) events meeting the target; less than 24 hours(0-4) for notification with 51(88%) events meeting the target; 1(1-101)day for early response with 50(86%) events meeting the target. Overall, 28(48%) events met all targets. Among 168 bottlenecks identified, 86(62%) were for detection, and among the 226 enablers identified, 94(42%) were related to early responses. Key bottlenecks included delayed care-seeking, low awareness among private health workers, and lack of community knowledge. Significant enablers included strong reporting lines and rapid coordinated response mechanisms.

Cambodia has made substantial progress in adopting and implementing the 7-1-7 metrics. Delays in detection remain a key challenge; addressing this through enhanced risk communication, stronger private sector engagement, and improved surveillance capacity will strengthen Cambodia's overall outbreak preparedness.

Early detection, prompt notification, and timely response are essential for effective outbreak prevention and control. In partnership with the United States Centers for Disease Control and Prevention and Resolve to Save Lives, Cambodia’s Ministry of Health introduced the 7-1-7 timeliness tool in early 2023. This mixed-method study, conducted from 2023 to July 2025, evaluated the adoption and use of the 7-1-7 tool across national and subnational levels, highlighting potential barriers and facilitators. The qualitative component involved focus group discussions and interviews with Rapid Response Team members leading outbreak response efforts. During the study period, 134 public health events took place, with timeliness data available for 58 events (43%). Among these, detection, notification, and early response targets were met in 36 (62%), 51 (88%), and 50 (86%) events, respectively. All targets were achieved in 28 (48%) of the events. The median time (range) for detection was 6 days (0-149), for notification less than 24 hours (0-4), and for early responses 1 day (1-101). Bottlenecks identified included delayed care-seeking by patients, low awareness or suspicion among private health workers, limited community knowledge, unreported sick or dead poultry, and poor sharing and collaboration within the one-health framework. The 7-1-7 approach provides a clear and practical method for evaluating outbreak responses, pinpointing bottlenecks, and informing the National Action Plan for Health Security (NAPHS) to enhance the next Joint External Evaluation score. This study recommends strengthening early detection through community awareness and public and private healthcare sector engagement, strengthening logistics and coordination, offering regular training, and integrating 7-1-7 indicators into national surveillance systems to improve outbreak preparedness and response.