A review on health system-based surveillance for acute flaccid paralysis: technological advancements, challenges, and outlooks.

BACKGROUND: Poliomyelitis is a severe viral infection that can lead to permanent paralysis or death, primarily affecting children under 15 years of age. Acute Flaccid Paralysis (AFP) surveillance is essential for global polio eradication efforts, enabling the rapid detection, reporting, and investigation of suspected cases. Implementing various technological solutions has significantly advanced AFP surveillance, which is the gold standard for early polio case identification. These technologies include short message alert systems for better case reporting, the Open Data Kit (ODK) for efficient data collection and management, digital specimen tracking systems for improved sample handling, geospatial mapping tools for monitoring surveillance coverage, and awareness campaigns to engage healthcare workers and communities. Despite these advancements, there remains a notable absence of comprehensive analyses evaluating the cumulative progress, challenges, and policy implications of AFP surveillance. MAIN BODY: This study presents a targeted literature review of English-language publications from 2002 to 2024, focusing on challenges, technological advancements, and practical recommendations for AFP surveillance. Only empirically grounded, methodologically sound studies centered on AFP within health systems were included, with preference for research conducted in polio-endemic countries. Studies lacking methodological rigor or direct relevance were excluded. The review highlights how digital reporting platforms, specimen tracking, geospatial monitoring, and awareness campaigns have strengthened surveillance operations. At the same time, it identifies persisting weaknesses in surveillance methodologies and gaps in coverage, underscoring the need for further innovation and integration into health systems. CONCLUSION: By synthesizing evidence on the latest developments, this review addresses a critical gap in the literature and provides actionable recommendations to improve AFP surveillance. The findings inform both practice and policy by identifying innovative solutions and future directions, ultimately contributing to stronger global health surveillance systems and advancing polio eradication strategies.