INTRODUCTION:
The Integrated Disease Surveillance and Response System (IDSRS) is a cornerstone of Pakistan’s strategy to monitor and mitigate communicable diseases. We evaluated the performance of IDSRS in five districts of Khyber-Pakhtunkhwa (KP), identifying key strengths, gaps, and areas for improvement.

METHODS:
A descriptive evaluation study was conducted from January to December 2024 across Upper Chitral, Lower Chitral, Malakand, Bajaur, and Khyber. The evaluation followed updated CDC guidelines (2001, 2013), with data collected through structured interviews (n=48), facility record review, and direct observations. System attributes—including simplicity, data quality, timeliness, representativeness, sensitivity, and predictive value—were scored using a quantitative rubric.

RESULTS:
Overall performance of IDSRS was excellent in four districts. The system showed high scores across attributes: simplicity (93.3%), flexibility (91.7%), acceptability (91.7%), and stability (95.8%). However, variations in sensitivity were noted: Upper Chitral (63.4%), Bajaur (57.4%), Malakand (644.6%), Lower Chitral (144.5%), and Khyber (71.8%). PPV was uniformly 100%, reflecting strong case validation where reporting occurred. Identified gaps included low staffing, lack of mobile app functionality, and inadequate feedback loops.

CONCLUSIONS:
IDSRS is evolving into a robust system in KP, yet systemic improvements—particularly in data synchronization, intersectoral integration, and laboratory linkages—are critical for sustained performance. Policymaker investment in digital infrastructure and human resources is essential for realizing the full potential of surveillance.