Background: In India, the frontline health workers (medical ofcers and health inspectors) play an important role in conducting syndromic surveillance, analysing data, identifying disease trends based on trigger levels and responding in their catchment areas. In this context, it is useful to understand the role of the health workers in the event of an outbreak investigation and response. Method: Using an interview guide the health workers were asked questions regarding the interviewee's opinion on the training, outbreak investigation preparedness and response, the difculties faced during investigation. The health workers of primary, block and district health care levels of a district of Tamil Nadu were interviewed during March to May 2018. The interview was conducted in the language comfortable to the participant and audio recorded with prior consent. We transcribed the responses in Tamil to English verbatim with the help of the translator. Following transcription of all the records the information was analysed using the method of thematic analysis. Results: We interviewed 13 medical ofcers and 6 health inspectors from all the three tiers of the public health system. We identied key challenges during an outbreak investigation including; failure to prepare prior to an outbreak, missing cases in an outbreak, blanket measures following outbreak investigation, poor community response and non-availability of funds. However, digital initiatives were also taken by health workers to overcome these challenges. Conclusion: We conclude that though health workers faced operational challenges digital initiatives and ensuring accountability to duties helped in supporting the health system even in the face of challenges. We recommend timely training of health workers and involving the community members through volunteer programmes to ensure ownership of health issues in the community.