One of the major limitations cited by participants has been the delayed implementation of IDSR in Rwanda. Without a functional IDSR strategy in place, health staff reported that the role of laboratory is not well understood in its context of a broader public health surveillance network. While there is a strategic plan with defined goals for IDSR in place, implementation of the plan has yet to be fully implemented. At the time of this review, the surveillance and reporting system was using multiple forms from a variety of implementing partners resulting in a duplication of effort and resources.