<![CDATA[Background: Dengue Hemorrhagic Fever (DHF) remains a major public health problem in Bali; in 2024, Bali Mandara Regional Hospital recorded 519 hospitalized cases. As a referral hospital, it plays a key role in implementing the Early Warning and Response System (EWARS) for suspected dengue cases, yet its performance has not been evaluated previously. This study aimed to evaluate the implementation of EWARS for suspected dengue cases at Bali Mandara Regional Hospital. Methods: This descriptive qualitative study employed an evaluative approach based on a logic model that covered input, process, output, and 9 surveillance attributes. Data were collected from June 9–20, 2025, through in-depth interviews, observation, and document review involving 17 purposively selected informants: surveillance officers, ward heads, medical staff, and hospital management. Data were analyzed thematically and triangulated against surveillance standards. Results: All respondents handled multiple programs; 70.59% reported that guidelines or technical instructions were unavailable in their units, and all respondents reported that no formal hospital reporting SOP was available. Data analysis and dissemination were limited, conducted only upon request. Simplicity and acceptability were fairly adequate, whereas flexibility, data quality, perceived sensitivity, perceived PPV, representativeness, timeliness, and stability remained suboptimal, driven mainly by workload burden and inconsistent case definitions. Conclusion: EWARS implementation for suspected dengue cases at Bali Mandara Regional Hospital is running but constrained primarily by limited, multi-tasked human resources and the absence of a standardized reporting SOP. A surveillance focal point, a time-bound reporting SOP, and a routine data-monitoring mechanism are priority actions to strengthen early detection and response.]]>
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