2. Introduction
Triple burden of infectious disease
Worldwide : no specific preventive measure
Due to insufficient Public Health Measure
Prevalence of vectors & ecological determinants
ID - More easily preventable than NCD
Prevention & Control needs Surveillance
To detect EWS of impending outbreaks & help allocate
health resources efficiently
3. IDSP
Decentralized project
GoI in Nov 2004 ; World Bank funded
3 Phases : Extended for 2 years in March 2010
WB funds only for 9 states & CSU
Domestic budget
Continue during 12th Plan under NRHM
4. Objectives
Establish a decentralized system of disease surveillance
so that timely & effective public health action can be
initiated
Improve the efficiency of disease control programs &
facilitate sharing of relevant information with various
stakeholders so as to detect disease trends over time &
evaluate control strategies
6. Integration
All National Disease Control Programmes
Health & Non Health sectors (Police, PCBs, Water supply)
Including NCD & CD
Laboratory information
Private sector & NGO
Academic Institution & Medical Colleges
IEC activities
Training
Formation of committees to oversee integration
7. Disease
Identification of priority diseases : Target disease
Malaria
ADD(Cholera)
Typhoid
Tuberculosis
Measles
Polio
Plague
HIV, HBV, HCV
Unusual Syndromes
Accidents
Water Quality
Outdoor Air Quality
NCD Risk factors
State Specific Diseases
8. Surveillance
Information:- Who got the dis?
How many?
From where?
Why only them?
What needs to be done as a Public
. Health response?
9. Surveillance
Strengthening hospital based surveillance
Components
Prerequisites
Classification in IDSP
Syndromic / presumptive / confirmed diagnosis
Core condition under surveillance
10. Disease Surveillance Under IDSP
1. Regular Surveillance
Vector Borne Disease : Malaria , Dengue ,JE , Filaria etc.
Water Borne Disease : ADD (Cholera)
: Typhoid
Respiratory Diseases : Tuberculosis
VPDs :Measles
Diseases under eradication : Polio
Other Conditions : Road Traffic Accidents
Other International commitments : Plague
Unusual clinical syndromes : Meningoencephalitis /
DHF /other undiagnosed conditions
11. 2. Sentinel Surveillance
STD/Blood borne : HIV/HBV, HCV
Other Conditions : Water Quality / Outdoor Air Quality
3. Regular periodic Community Survey
NCD Risk Factors : Anthropometry, Physical activity, Blood
Pressure, Tobacco, Nutrition, Blindness
4. Additional State Priorities
Each state may identify up to five additional conditions for
Surveillance.
12. Syndromic surveillance
Fever<7 days (alone, with rash, with altered
sensorium/convulsions, bleeding skin/gums
Fever>7 days
Cough>3 weeks
AFP
Diarrhea
Jaundice
Unusual events causing death/hospitalization
13. Project components
CSU integrated with NICD (NCDC)
SSU & DSU in all states & districts
Strengthening Public Health Laboratories
Training of SSU/DSU/RRT (over in all states & UT)
IT & Networking & HRD
14. Project
Early detection of outbreaks
Early institution of containment measures
Reduction in morbidity & mortality
Minimize economic loss
A limited health condition & risk factor surveilled
To involve all stakeholders private & public
15. Project phasing
Phase – I (2004-05): Tamil Nadu, Kerala, Karnataka, Andhra
Pradesh, Maharashtra, Madhya
Pradesh, Uttaranchal, Himachal Pradesh & Mizoram (nine
states)
Phase – II (2005-06): Chattisgarh
, Goa, Gujarat, Rajasthan, West
Bengal, Manipur, Meghalaya, Odisha, Tripura, Chandigarh, Po
ndicherry, Delhi
Phase – III (2006-07): Uttar Pradesh, Bihar, Jammu &
Kashmir, Jharkhand, Punjab, Arunachal
Pradesh, Assam, Nagaland, Sikkim, A & N Island, D & N
Haveli, Daman & Diu, Lakshwadeep.
16. Formats & manuals
Standard Case Definitions
Standard Formats for reporting
Operations manual for Health Workers, Medical
Officers, Laboratory Technicians and District/State
Surveillance Teams
Standard user friendly training manuals
17. Organizational Structure
National Surveillance Committee
Central Surveillance Unit
State Surveillance Committee
State Surveillance Unit
District Surveillance Committee
District Surveillance Unit
18. District Surveillance Committee
Chairperson*
District Surveillance Committee
District Surveillance Officer
(Member Secretary)
CMO
(Co. Chair)
Representative
Water Board
Superintendent
Of Police
IMA
Representative
NGO
Representative
District Panchayat
Chairperson
Chief District PH
Laboratory
Medical College
Representative
if any
Representative
Pollution Board
District Training Officer
(IDSP)
District Data Manager
(IDSP)
District Program Manager
Polio, Malaria, TB, HIV - AIDS
* District Collector or District Magistrate
22. Performance Indicators
• Number & % of districts providing monthly surveillance reports
on time – by state and overall *
• Number & % of responses to disease specific triggers on time *
• # assessed to be adequate *
• # laboratories providing adequate quality of information *
23. Performance Indicators
• Number of districts : private sector contribution C/H/L
• Number and % of states integrating various programs
• Number and % of districts & states publishing annual
surveillance reports
• Publication by CSU of consolidated annual surveillance report
24. IDSP Reporting
Form S (Suspect Cases) by Health Workers (sub centres )
Form P (Probable Cases) by Doctors (PHC, CHC, Hospital)
Form L (Lab Confirmed Cases) from Laboratories
Frequency of reporting weekly (Monday to Sunday)
Data compilation/analysis and response should be at all
levels.
Presently at State/District/Block level 12- 15 Outbreaks
reported every week
25.
26.
27.
28.
29. Reporting units
Sub-centre-health worker/ANM : All syndromic cases
from PHC , clinic, hospital in the area
PHC/CHC MO : Probable cases , where it cannot be
confirmed by lab & those confirmed by lab (mp , afb )
Sentinel private practitioners , district hospitals
,municipal hospitals, medical colleges , sentinel
hospital , NGOs : MO report as probable case of
interest
30. New Initiatives under IDSP
Alerts through IDSP call center : 1075 toll free
February 2008
Call received as on 8th October 2008 : 18,872
No of Health Alerts : 60
31. e-learning
To enhance skills of health personnel.
Proposed components:
Discussion Forums
Online Survey & Assessment
Feedback
FAQs
Currently e-learning modules are being
prepared
32. Media Scanning Cell
Objective:
Supplemental information about outbreaks
Method:
National and local newspapers ,Internet surfing, TV
channel etc screening for news item on disease
occurrence
Benefits
Increases the sensitivity & strengthen the surveillance
system
Provide early warning of occurrence of clusters of
diseases
33. Strengths of IDSP
Functional integration of surveillance components of
vertical programmes
Reporting of suspect, probable and confirmed cases
Strong IT component for data analysis
Newer initiatives
Trigger levels for gradated response
Action component in the reporting formats
Streamlined flow of funds to the districts
34. Lessons learnt
NSPCD
No budget for NSPCD nodal
cell
No integration
No budget for retraining
Feedback inadequate
Weak IT component
Weak state ownership
(selected districts)
Slow financial flow
Weak M & E, supervision
Weak Advocacy
IDSP
IDSP cell in Ministry with
budget
Integration
Budget for retraining
Adequate feedback planned
Strong IT component
Strong state ownership (all
districts)
Fast financial flow
Strong M & E, supervision
Advocacy at all levels
35. National Issues
Political considerations based on Centre-state relations
Central assistance proportionate to political affiliations
Media attention an important consideration for response
Time constraints-inadequate time given for outbreak
investigation
Hesitancy for international assistance either in Outbreak
Investigation or Lab support (plague)
36. National Issues cont’d
Public health & private sector almost 40:60
Accountability of private sector on reporting
Quackery in the name of alternate medicine
‘Overworked’ clinicians so poor records
Lack of ownership by states of central vertical programmes
37. State issues
State RRT not utilized to full potential
Regional labs strengthened but diagnosis not enhanced &
increasing dependence on Centre
Insufficient epidemiological analysis
No clear IEC strategy
Transfer/retirements of trained staff
38. State issues cont’d
Shortage of staff so multi-tasking for state and district
Fund issues
Lack of competent staff : Epidemiologist & Microbiologists
Short trainings incapable
Separate DGHS & DME : integrating Medical colleges
39. District issues
Some districts yet to act together : epidemic preparedness
Periphery needs improvement
Surveillance failure : media reports first
Weekly reports incomplete and irregular (under reporting)
Monthly reports also irregular
Communication ‘failure’
CMO-CMS-DSO lack of co-ordination
40. District issues cont’d
Overworked peripheral staff
Multiple formats for different programmes
RRT has specialists from DH & MC so problem in rapid
mobilization
Concept of Nil reporting & routine reporting difficult for the
peripheral staff to understand
41. District lab issues
Few established & functioning satisfactorily
Too Many labs spoil the agenda
Public health lab : water
Hospitals : NCDs and clinicals
College : majority of the diseases
Surveillance lab : few diseases
District blood bank : ELISA
Peripheral : Microscopy only
42. References
J.Kishore’s National Health Programmes of India 10th
Edition . century publications
Park’s Textbook of Preventive and Social Medicine , K.
Park 22nd Edition . Bhanot Publishers
Health Policies and Programmes in India , Dr. D. K.
Taneja . 11th Edition . Doctors Publications
IDSP website
NRHM website
NCDC website