Timeliness of outbreak detection and response: an operational evaluation of the 7-1-7 framework in district Mardan, Khyber Pakhtunkhwa, Pakistan

This study had two objectives: (i) to assess the timeliness of outbreak detection, notification and response against the 7-1-7 targets, and to identify the bottlenecks and enablers at each stage; and (ii) to evaluate awareness, implementation and operational feasibility of the 7-1-7 framework within the Early Warning System (EWS) component of the Integrated Disease Surveillance and Response (IDSR) strategy in Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. The 7-1-7 target framework, developed by Resolve to Save Lives (RTSL) and later adopted by the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC), provides a performance-based metric for epidemic preparedness.

The median detection interval was 9 days (IQR 7–11), the median notification interval 2 days (IQR 1–2) and the median response interval 9 days (IQR 8–11). Two of the eight outbreaks (25%) met all three 7-1-7 targets. Detection delays were mainly attributed to centralised laboratory confirmation, and notification and response were constrained by fragmented reporting and limited connectivity. Staff motivation and mobile-based reporting were identified as key enablers. Pakistan’s EWS–IDSR demonstrates readiness to operationalize the 7-1-7 framework but needs stronger laboratory capacity, integrated digital reporting and inter-sectoral coordination. Embedding 7-1-7 indicators into national IDSR monitoring would accelerate compliance with the International Health Regulations (IHR, 2005).