<p>The main gaps identified during system evaluation were weak supportive supervision, poor feedback, lack of budget allocation for PHEM activities, logistics, training, resources gaps, water, electric supply, and poor data management. The surveillance system of the district was useful, simple, flexible, and sensitive but, not stable, complete, timely, and representative, to detect outbreaks and early response. Hence, District Health Office should give attention to PHEM activities such as preparing an Emergency plan with budget, resource mobilization, capacity building, supportive supervision, and feedback, strengthened reporting system, and proper data management.</p>