Diseases have no borders. A disease anywhere in the world may become a health threat everywhere. It takes less than 36 hours for an outbreak to spread from a remote village to any major city in the world, therefore, the most effective – and cost effective – way to protect people from such health threats i.e measles, cholera and COVID-19 is to stop them before they spread to others and cross borders. Here comes the role of public health surveillance. Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data. An effective disease surveillance system is essential to detecting disease outbreaks quickly before they spread, cost lives and become difficult to control. Digital technologies can improve the ability to both detect and respond to disease outbreaks by sharing data swiftly thus helping us to understand how and where diseases are spreading. This information is crucial for deciding what health policies and strategies to make and follow. Significance of this research is not limited to one country but it has global health dimensions. It can help to address the critical issue of global health security by evaluating the impact of digital technologies on public health surveillance. Low and middle income countries (LMICs) including Pakistan have fragile health systems therefore the risk of spreading diseases, even beyond their borders, is high. Disease surveillance system in Pakistan has largely been outdated and paper based, frequently leading to delayed detection of measles, cholera and other communicable disease outbreaks. In 2017, Ministry of Health Pakistan, with support of World Health Organization (WHO), launched Integrated Disease Surveillance and Response (IDSR) system which uses electronic health information system (District Health Information System – DHIS-2) as a platform for rapid and near real time reporting for selected diseases. From 2017 to 2022, the new system was implemented in 52 districts of the country while remaining 104 districts are still using paper based system. The dual existence of different reporting systems presents a unique opportunity for a comparative analysis, allowing for insights into the effectiveness of the digital transition. As a doctoral researcher, I will conduct an evaluation to address the existing knowledge gap regarding the effectiveness of transitioning from traditional paper-based disease data reporting systems to new digital systems. Specifically, my research will focus on evaluating the impact of Integrated Disease Surveillance and Response (IDSR) and District Health Information System 2 (DHIS-2) initiatives in Pakistan. This evaluation aims to assess the effectiveness of new electronic infectious disease surveillance system in enhancing the country's health system capabilities. I aim to conduct a comparative analysis of the performance between DHIS-2, an electronic system, and traditional paper-based systems through cross sectional study, evaluate the effectiveness of the Integrated Disease Surveillance and Response (IDSR) framework and the District Health Information System 2 (DHIS-2) through a comprehensive assessment and explore the determinants influencing the adoption of electronic surveillance systems through a mix method study. The local research infrastructure is well-established, with the National Institutes of Health (NIH) Pakistan under Ministry of Health serving as a central data hub for disease surveillance and public health information. The presence of this infrastructure is vital for the success of the research project, as it provides access to comprehensive and up-to-date data on disease surveillance, outbreaks, and response efforts across Pakistan. The NIH website hosts weekly epidemiological IDSR reports. These reports serve as a rich source of information, forming the foundation for the research and ensuring the reliability and relevance of the data collected. Furthermore, the International Doctoral Programme in Epidemiology and Public Health at Tampere University, drawing on its expertise and research strength, will help to improve the quality and depth of the research findings. Together, these elements of the research infrastructure will contribute to the robustness of the study. The research project is feasible as IDSR implementation, led by Ministry of Health Pakistan, is already in progress with support of WHO. I have five years of practical experience, as a public health expert, in disease surveillance, monitoring and evaluation with World Health Organization, US Centers for Disease Control and Prevention (CDC), and UK Health Security Agency. My previous role as the Training Coordinator in the Integrated Disease Surveillance and Response (IDSR) project has been very relevant. Research will be implemented in phased manner starting from kick off meetings, ethical approvals to data collection, data analysis, reporting and dissemination and finalization and publications. The results of this study may help to improve global health security by examining how well digital health information systems detect and respond to diseases quickly. In Pakistan, the findings might help strengthen the healthcare system, providing useful guidance to policy makers and contributing to practical strategies for better public health monitoring. My research is in line with the European Union's recent Global Health Strategy, which is a cornerstone of the EU's external policy. Addressing and mitigating health threats, particularly pandemics, is highlighted as a key priority within this strategy. Through my research, I aim to contribute to this overarching goal by examining the effectiveness of infectious disease surveillance systems, ultimately working towards a healthier and more resilient global community.

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