Adoption and use of the 7-1-7 timeliness metrics for detection, notification, and early response actions to public health events: an observational study in Liberia, January 2024– June 2025

Background In July 2021, a new global target of 7-1-7 was proposed to improve early detection, notification and rapid control of public health threats. Liberia adopted 7-1-7 metrics in September 2023, with the framework embedded in the health and data monitoring systems by January 2024. The study aimed to document factors that influenced 7-1-7 adoption and assess how well the health systems performed for 7-1-7 metrics between January 2024 and June 2025. Methods This observational study included a prospective, cross-sectional survey for 7-1-7 adoption using primary data and a retrospectively collected cohort review for 7-1-7 performance using secondary data. Five national and 105 subnational staff were interviewed using a semi-structured questionnaire on 7-1-7 adoption, while research assistants extracted 7-1-7 performance data along with recorded bottlenecks and enablers from the 7-1-7 data consolidation spreadsheet. Results Key factors in successful adoption of 7-1-7 involved having a 7-1-7 champion, a dedicated coordination team, strong and committed leadership and effective stakeholder engagement at both national and subnational levels. Of 138 public health events, 134 (97%) were recorded against 7-1-7 targets. Mpox constituted 81 (61%) of these events. The median (range) times to detection, notification and completion of early response actions were 6 days (0-69), 0 days (0-6) and 7 days (1-129) respectively. The 7-day detection target was met in 97 (71%) events, the 1-day notification target in 131 (98%) and the 7-day response target in 79 (59%). Overall, 58 (43%) events met all three targets. Key systematic barriers to implementation (bottlenecks) were: inadequately trained health-care workers and poor community engagement for detection; electronic surveillance issues and poor network coverage for notification; and inadequate resources, logistics and delayed laboratory reporting for early response actions. Strong coordination among public health units was a key facilitator for implementation (enabler). Conclusions The 7-1-7 metrics are measurable, achievable and highlight performance bottlenecks and enablers for improvement and increased investments.