Public health surveillance systems are essential for monitoring disease prevalence and guiding public health interventions in Ethiopia. Despite their importance, there is limited empirical research on how these systems are adopted across different regions. The study employed a systematic review approach to identify relevant studies, extracting data on surveillance system adoption from these sources. Multilevel regression analysis was used to assess factors influencing adoption rates at both district and national levels. Multilevel regression analyses revealed that socioeconomic development level had a significant impact on the adoption rate of public health surveillance systems in Ethiopia (OR = 1.25, CI: [1.08, 1.46]). This study provides robust evidence for understanding factors influencing the adoption of public health surveillance systems in Ethiopia. Public health officials should consider socioeconomic development when designing and implementing new surveillance systems to enhance their effectiveness.