Background: With the number of antimicrobials available to effectively treat gonorrhoea rapidly diminishing, surveillance of antimicrobial–resistant Neisseria gonorrhoeae (NG) is critical for global public health security activity. Many low-and-middle-income countries (LMICs) have gaps in their existing sexually transmitted infections (STIs) surveillance systems that negatively impact global efforts geared towards achieving the United Nations (UN) Sustainable Development Goals (SDGs). This paper explains the contribution of collaborative surveillance systems to health systems strengthening (HSS) learning from integrating NG surveillance into existing Ministries of Health’s (MoH) antimicrobial resistance (AMR) surveillance services in Malawi and Zimbabwe. Methods: We used the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) implementation experiences in Malawi and Zimbabwe to demonstrate the collaboration in AMR and STI surveillance. We conducted qualitative interviews with purposively selected health managers directly participating in the AMR and STI programs using a standardized key informant guide to describe how to plan for a collaborative surveillance system. Qualitative thematic analysis was conducted to delineate stakeholders’ recommendations using the health systems' building blocks. Results: Stakeholder engagement, prioritization of needs, and power to negotiate were key drivers to a successful collaborative surveillance system. Weak governance, policies, lack of accountability, and different priorities, coupled with weak collaborations, workforce, and health information systems, were challenges faced in having effective collaborative surveillance systems. Data availability, use, and negotiation power were key drivers for the prioritization of collaborative surveillance. Including collaborative surveillance in primary health services and increasing government budget allocation for surveillance were recommended.   Conclusions: Strengthening collaborative surveillance systems in LMICs using a people-centered approach increases transparency and accountability and empowers national institutions, communities, and stakeholders to engage in sustainable activities that potentially strengthen health systems. EGASP implementations in Zimbabwe and Malawi serve as models for other countries planning to implement or improve collaborative surveillance systems in their context.

The authors have declared no competing interest.

The research work did not receive any funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Not Applicable

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The University of Washington (UW) internal review board (IRB) approved the study as non-human subject study number UW IRB STUDY00018156. The research paper was reviewed by WHO publication clearance committee.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Not Applicable

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Not Applicable

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Not Applicable

The data is stored in a secure SharePoint folder on a computer with a protected password and is shared upon request to the lead researcher.