The structure of surveillance data flow was from the community to the respective upper level. The structure and operational process was found to be simple (100%) and flexible (71%). The system was found to be useful as it was able to detect outbreaks and trends of cases over time, representative as cases were captured cases from all LGAs but unstable due to lack of sustainable funding and ownership by the Adamawa State Government as the system is mostly donor-driven and has been interrupted due to inadequate funds. From 2017-2020, only 60% of cases investigated had complete laboratory data and results and the NMFRI rate was less than WHO target of 2 per 100,000. 