Public health surveillance systems are crucial for monitoring disease trends and public health events in developing countries like Ethiopia. The study employed a longitudinal design with mixed methods including surveys and interviews to assess system utilization and effectiveness over two years. In one region, 65% of healthcare providers reported using the surveillance system for disease reporting, indicating moderate adoption rates. Despite initial challenges in implementation and data quality, improvements are underway through ongoing training and technical support programmes. Continued investment in infrastructure development and continuous staff training is recommended to enhance system performance and sustainability. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.