Pyrrolizidine Alkaloid Induced Liver Disease has been an emerging public health problem in the Tigray region in Ethiopia since 2002, with 1033 cases, including 314 deaths, detected as of September 2011. Disease surveillance started in 2009 to determine the magnitude and distribution of the disease, to detect and manage cases, and to inform officials for resource allocation. Despite limited resources and logistical challenges, the system operated at a high standard and met its original objectives. Maintenance of this high level of operation will be an ongoing challenge but will be critical to ensure continual disease monitoring through this system
