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Livestock disease surveillance is important in early detection and control of diseases. In resource constrained settings, passive surveillance is predominately used, a system that relies heavily on the community to share information on livestock disease events for eventual response by relevant stakeholders. This study aimed to understand pastoralists’ utilization and reasons considered when choosing methods or stakeholders for reporting or responding to livestock disease occurrences in herds. The study was conducted in Marsabit county in Northern Kenya with pastoralists. Between August 2023 to August 2024, data was collected using participatory epidemiology tools including pairwise ranking and matrix scoring to profile the stakeholders and utilization of different methods with the respective reasons considered when choosing these for livestock disease reporting or response. Summary statistics from the output were presented in tables and graphs while the Kendall’s coefficient of concordance was used to show the level of agreement among various pastoralist groups/raters. The disease reporting systems in Marsabit were most influenced by livestock owners (median rank = 9), friends and traditional healers (median rank = 7) and Elders’ council and Private AHWs (median rank = 6). Disease reporting was primarily through mobile phones (median rank = 4) with their usage increasing markedly between 2001 and 2024. Livestock disease response was most frequently offered by livestock owners, friends, and agrovets/private practitioners, with median ranks of 9, 7 and 6, respectively. The response to disease events in herds was mostly by pastoralists themselves, using synthetic drugs (median = 8) and this practice had increased overtime from before the 1980s to 2024. The pastoralists’ decisions to report a disease event were largely influenced by accessibility of the stakeholder or method of reporting, perceived technical knowledge of recipient, cost friendliness and affordability of the services, while ability to provide quick response, credit facilities for services, having technical knowledge and affordability were important reasons for their choice of the process of disease response. This study highlights the central role livestock owners’ play in disease reporting and response in underserved pastoralist areas of northern Kenya, with a limited role played by government animal health services providers. The results suggest that veterinary services delivery systems should be reviewed with input from community stakeholders to improve surveillance and disease reporting. This integration would enhance livestock disease surveillance and protect pastoralists’ livelihoods.