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  • 1. Integrated Disease Surveillance Project (IDSP) Ebenezer Phesao
  • 2. Outline 1. Introduction 2. Background history 3. Objectives 4. Organizational set up 5. Funding 6. Project activities 7. Implementation 8. Reports 9. Monitoring and Evaluation 10. Achievements 11. Limitations 12. Conclusion
  • 3. Introduction
  • 4.  The disease burden of the people of India is one of the highest in the world  India have a triple burden of infectious disease  Planning for disease prevention and controls depends upon the disease frequency, distribution and determinants that can be made available through proper surveillance  Surveillance has been identified as backbone of any health delivery system
  • 5. Surveillance  Surveillance is a French word meaning “ Watch with attention, suspicion and authority”  Definition: “The ongoing and systematic collection, analysis and interpretation of health data in the process of describing and monitoring a health event” (CDC) OR WHO definition: “The continuous scrutiny of factors that determine the occurrence and distribution of disease and other condition of ill-health” Surveillance is – “Information for Action”
  • 6. What are the Key Elements of Surveillance System? • Detection and notification of health event • Investigation and confirmation (epidemiological, clinical, laboratory) • Collection of data • Analysis and interpretation of data • Feed back and dissemination of results
  • 7. Why do we need to do surveillance?  To determine incidence of disease  To know the geographical distribution or spread of disease  To identify population at risk of that disease  To monitor trend of disease over a long time period  To capture the factors and condition responsible for occurrence and spread of disease  To predict the occurrence of epidemic and control of epidemic  To evaluate the effectiveness of an intervention or programme
  • 8. Important information in disease surveillance  Who get the diseases?  How many get them?  Where do they get them?  When do they get them?  Why do they get them?  What needs to be done at public health response?
  • 9. Pre-requisites for effective surveillance o Use of standard case definitions o Ensure regularity of the reports o Action on the reports Types of Surveillance in IDSP: Depending on the level of expertise and specificity, disease surveillance in IDSP will be of following three categories: i. Syndromic – Diagnosis made on the basis of symptoms/clinical pattern by paramedical personnel and members of the community ii. Presumptive – Diagnosis made on typical history and clinical examination by Medical Officers iii. Confirmed – Clinical diagnosis confirmed by an appropriate laboratory test
  • 10. Background history
  • 11. 1. Acute Flaccid Paralysis 2. AIDS 3. Leprosy 4. Malaria: falciparum and vivax 5. Tetanus neonatorum 6. TB  For these diseases the nation already has national programs and some sort of surveillance is carried out under these programs
  • 12.  One very successful surveillance programme for NCDs that already exists is the Population based Cancer Registries  Other than this there are surveillance systems for blindness, iodine deficiency, iron deficiency anemia etc.  The first multiple disease surveillance system in the country was the NSPCD(National Surveillance Programme for Communicable Diseases)  It has laid the foundation for basic surveillance activities and reporting and responding to outbreaks in the selected district
  • 13.  NSPCD(National Surveillance Programme for Communicable Diseases) Launched in 1997 - 5 districts 1998 - 20 more districts 1999 - 20 more districts 2003 - more 101 districts 2004 to 2010 - IDSP launched 2010 - Extended for 2 more years The IDSP proposes a comprehensive strategy for improving disease surveillance and response through an integrated approach
  • 14. Types of integration proposed in this project: Sharing of surveillance information of disease control programme Developing effective partnership with health and non-health sectors in surveillance Included non- communicable disease in the surveillance system Effective partnership of private sectors and NGOs in surveillance activities Bringing academic institutions and medical colleges into the primary public health activity of disease surveillance
  • 15. Objectives
  • 16. Goal of IDSP: To provide a rational basis for decision-making and implementing public health interventions that are efficacious in responding to priority diseases Keeping this in mind the main objectives of the IDSP are: 1. To establish a decentralized system of disease surveillance 2. Improve the efficiency of the existing surveillance activities of disease control programs for use in health planning, management and evaluating disease control strategies
  • 17. Specific Objectives: 1) To integrate, coordinate and decentralize surveillance activities 2) Undertake surveillance for limited number of health conditions and risk factors 3) To establish system for quality data collection, reporting, analysis and feedback using IT 4) To improve laboratory support for disease surveillance 5) To develop human resource for disease surveillance 6) To involve all stake holders including those in private sector and communities
  • 18. Organizational Set Up
  • 19. Administrative Structure NATIONAL SURVEILLANCE COMMITTEE CENTRAL SURVEILLANCE UNIT STATE SURVEILLANCE COMMITTEE STATE SURVEILLANCE UNIT DISTRICT SURVEILLANCE COMMITTEE DISTRICT SURVEILLANCE UNIT  National Centre for Disease Control (NCDC) is the Nodal Agency for IDSP
  • 20. Funding
  • 21.  World Bank  From April 2010 to March 2012, World Bank funds were available for Central Surveillance Unit (CSU) at NCDC & 9 identified states (Uttarakhand, Rajasthan, Punjab, Maharashtra, Gujarat, Tamil Nadu, Karnataka, Andhra Pradesh and West Bengal) and the rest 26 states/UTs were funded from domestic budget  The Programme is proposed to continue during 12th Plan as a Central Sector Scheme under NRHM with outlay of Rs. 851 Crore from domestic budget only
  • 22. Year Budget estimates (Rs in crores) Expenditure (Rs in crores) 2004-2009 408.36 2009-10 48.50 39.95 2010-11 35.00 28.49 2012-13 63.00 Year Release(in lakhs) Expenditure(in lakhs) 2005-06 94.20 2006-07 1.25 2007-08 2008-09 1.85 Total 94.20 3.10 Balance amount 91.10 lakhs MANIPUR
  • 23. Project Activities
  • 24.  Decentralizing and integrating surveillance mechanisms  Up gradation of laboratories  Information technology and communication  Human resources and development  Operational activities and response  Monitoring and evaluation
  • 25. Implementation
  • 26. Phasing of IDSP Andhra Pradesh Himachal Pradesh Karnataka Madhya Pradesh Maharashtra Uttrakhand Tamil Nadu Mizoram Kerala 9 STATES Chhatisgarh Goa Gujarat Haryana Rajasthan West Bengal Manipur Meghalaya Orissa Tripura Chandigarh Pondicherry Delhi Nagaland 14 STATES/ UTs Uttar Pradesh Bihar Jammu & Kashmir Jharkhand Punjab Arunachal Pradesh Assam Sikkim A & N Nicobar D & N Haveli Daman & Diu Lakshdweep 12 STATES/ UTs Phase- I (2004-05) Phase- II (2005-06) Phase- III (2006-07)
  • 27. Diseases and Conditions Covered under IDSP  Regular Surveillance  Vector borne diseases  Malaria  Water borne diseases  Acute diarrheal disease, cholera, typhoid  Respiratory diseases  Tuberculosis  Vaccine Preventable Diseases  Measles
  • 28. Contd… Disease under eradication o polio Other conditions o Road traffic accidents Other international commitments o Plague, yellow fever Unusual clinical syndromes o Meningococcal encephalitis/respiratory distress/hemorrhagic fevers/ other undiagnosed conditions
  • 29. Contd..  Sentinel surveillance  STD/Blood borne diseases  HIV/ HBV/ HCV  Other conditions  Water quality, outdoor air quality( large urban area)  Regular periodic surveys  NCD risk factors  Anthropometry, physical activity, blood pressure, tobacco, nutrition and blindness  Additional state priorities  Each state may identify up to five additional conditions for surveillance e.g. Dengue, Japanese Encephalitis, Leptospirosis
  • 30. IDSP Reporting • Form S ( Suspect Cases) by health workers( sub centers) • Form P (Probable Cases) by doctors (PHC, CHC, Hospitals) • Form L( lab confirmed cases) from laboratories • Sentinel site and medical college reporting form • EWS/Outbreak reporting form • Frequency of reporting -weekly • Data compilation/analysis and response at all levels
  • 31. Information Flow in IDSP Sub-Centres P.H.C.s C.H.C.s Dist.Hosp. Pvt. Practitioners D.S.U. P.H.Lab. Med.Co l. S.S.U. C.S.U. Nursing Homes Private Hospitals Private Labs.
  • 32. Strengthening/ Upgradation of Public Health Laboratories • Renovation and furnishing of laboratories • Supply of laboratory equipments & materials • Focus on 50 identified priority district laboratories • Quality System + Biosafety • Avian Influenza network • Networking of Laboratories
  • 33. The laboratory network of IDSP  Peripheral Laboratories and Microscopic centers(L1 labs)  District Public Health Laboratory(L2 Labs)  Disease Based State Laboratories (L3 Labs)  Regional Laboratories (L4 Lab)  Disease based reference Laboratories (L5 Labs)
  • 34. Training Activities under IDSP Trainees Site Days District and state surveillance team Regional /state 6 days Laboratory technicians of district and state public health laboratories Regional/state 6 days Data manager of DSU/SSU Regional/state 3 days Training of laboratory assistants of CHC/PHC District HQ 3 days Data entry operator District HQ 3 days Mos, Sentinel practitioners, Mos of sentinel hospitals District HQ 2 days HWs, Health assistant, Aganwadi workers, NGO volunteers, Community bases staff CHC 2 days
  • 35. Human Resources(till 30th June 2011) Professional Sanctioned post In position Trained Epidemiologist 646 295 269 Microbiologist 85 51 46 Entomologist 35 22 18 Total 766 368 333
  • 36. IT Network under IDSP • NIC assigned the task to establish and manage IT network • ISRO was requested to help in establishing the network for IDSP for distance education, data entry, data transmission, video conferencing and out break discussion • 776 sites (State/ district HQ and Premier institutes) being connected on Broadband (BSNL) • 400 sites being connected by broadband as well as satellite connectivity (ISRO)
  • 37. Current Usage of IT network • Video Conferencing held frequently with CSU, State HQ, selected District HQ and RRT A weekday wise VC schedule has been started since October 2008, the details as per schedule as under:
  • 38. Current Usage of IT network • IDSP portal: It is a single-stop web portal(www.idsp.nic.in) for data entry and analysis from the district level upwards related to disease surveillance • 3 States Gujarat, Maharashtra, Tamilnadu being enabled as independent networks with State Teaching ends • Distance learning: Educational satellite (EDUSAT) classrooms are available at State headquarters, district headquarters, medical colleges, premier institute and infectious disease hospitals
  • 39. Fig: Informatics flow under IDSP
  • 40. IT Network - Call Centre • Established in February 2008 • 24X7 Call Centre • Toll free No. 1075 • Major Regional languages • Any person would be able to give information about outbreaks/unusual events on the toll-free number • Call Centre will refer the information to the concerned DSU/SSU and the Central Outbreak Monitoring Cell at NICD • Central Outbreak Monitoring Cell will monitor the actions taken by concerned District/State Surveillance Officers
  • 41. Media Scanning Cell • A Media Scanning and Verification Cell was established at the NCDC in July200 • Objective: • To provide the supplemental information about outbreaks • Method: • National and local newspapers, Internet surfing, TV channel screening for news item on disease occurrence. • Benefits of Media Scanning: • Increases the sensitivity & strengthen the surveillance system • Provide early warning of occurrence of new clusters of diseases
  • 42. Reports
  • 43. Year All 35 States/UTs 9 WB funded States/UTs 2008 553 400 (72%) 2009 799 488 (61%) 2010 990 619 (63%) 2011 (till 26th June ) 699 516 (74%) Total no. of outbreaks reported through IDSP by the States/UTs in 2008-2011 (till 26th June 2011)
  • 44. Weekly EWS / Outbreak report submitting Status of States/UTs in 2011 (till 25th week ending on 26th June) EWS/OUTBREAK REPORT SUBMITTING STATUS STATES / UTs > 80% times reported (Consistently and timely reporting) Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Manipur, Meghalaya, Orissa, Punjab, Rajasthan, Tamil Nadu, Tripura, Uttarakhand, West Bengal 50 - 79 % times reported Chandigarh, Daman & Diu, Goa, Gujarat, Himachal Pradesh, Maharashtra, Puducherry, Sikkim, Uttar Pradesh 25 - 49 % times reported Chhattisgarh, Delhi, Haryana, Nagaland < 25 % times reported Lakshadweep, Mizoram, Jharkhand Never reported Andaman & Nicobar, Dadra & Nagar Haveli
  • 45. State-wise total no. of outbreaks reported through IDSP by all States/UTs in 2008, 2009, 2010 & 2011 (till 25th wk ending June 26th 2011) 2008 2009 2010 2011 1 Karnataka 54 97 90 110 351 2 Tamil Nadu 50 113 90 49 302 3 West Bengal 49 43 89 90 271 4 Gujarat 24 49 83 101 257 5 Andhra Pradesh 72 64 75 39 250 6 Maharashtra 99 27 65 32 223 7 Uttar Pradesh 40 67 98 10 215 8 Rajasthan 8 43 84 50 185 9 Madhya Pradesh 16 65 70 24 175 10 Assam 16 30 53 39 138 11 Kerala 17 47 53 19 136 12 Orissa 17 38 19 33 107 13 Uttarakhand 27 30 25 21 103 14 Punjab 17 22 18 24 81 15 Bihar 1 6 21 25 53 16 Haryana 10 9 18 7 44 17 Himachal Pradesh 3 13 7 1 24 18 Arunachal Pradesh 6 6 6 5 23 19 Chhattisgarh 1 7 2 4 14 20 Jharkhand 0 5 4 1 10 21 Meghalaya 5 3 2 0 10 22 Tripura 1 2 2 5 10 23 Puducherry 3 2 4 0 9 24 Chandigarh 3 3 2 0 8 25 Sikkim 3 0 2 3 8 26 Delhi 3 1 0 3 7 27 Goa 2 3 0 1 6 28 Manipur 1 2 2 1 6 29 Mizoram 5 0 0 0 5 30 Jammu & Kashmir 0 0 2 2 4 31 Nagaland 0 1 2 0 3 32 Daman & Diu 0 1 1 0 2 33 Dadra and Nagar Haveli 0 0 1 0 1 34 Andaman & Nicobar 0 0 0 0 0 35 Lakshadweep 0 0 0 0 0 553 799 990 699 3041Total YearSl. No. State Total
  • 46. Disease-wise total no. of outbreaks reported through IDSP by all States in 2008, 2009, 2010 & 2011 (till 25th wk ending June 26th) 2 0 0 8 2 0 0 9 2 0 1 0 2 0 1 1 1 A c u te D ia rrh o e a l D is e a s e 2 2 8 3 3 2 4 1 1 2 2 0 1 1 9 1 2 F o o d P o is o n in g 5 0 1 2 1 1 8 8 1 5 8 5 1 7 3 M e a s le s 4 0 4 4 9 4 1 0 3 2 8 1 4 C h ic k e n P o x 1 2 4 5 4 7 4 7 1 5 1 5 M a la ria 4 3 3 4 3 7 2 3 1 3 7 6 V ira l H e p a titis 2 8 3 0 2 4 4 6 1 2 8 7 V ira l F e v e r 3 1 3 7 4 0 1 6 1 2 4 8 C h ik u n g u n ya 2 5 6 1 2 5 1 2 1 2 3 9 D e n g u e 4 2 2 0 4 0 1 4 1 1 6 1 0 C h o le ra 2 0 3 4 3 4 2 2 1 1 0 1 1 E n te ric F e v e r 6 1 0 1 0 4 3 0 1 2 A c u te E n c e p h a litis S yn d ro m e 6 5 1 1 6 2 8 1 3 A n th ra x 2 6 3 6 1 7 1 4 L e p to s p iro s is 6 3 6 1 1 6 1 5 A c u te R e s p ira to ry Illn e s s 4 3 3 1 1 1 1 6 D ys e n te ry 0 1 3 3 7 1 7 K a la z a r 1 0 3 3 7 1 8 M e n in g itis 2 3 1 1 7 1 9 S c ru b T yp h u s 3 1 1 2 7 2 0 A c u te F la c c id P a ra lys is 1 0 0 5 6 2 1 M u m p s 0 2 3 1 6 2 2 P U O 1 2 1 0 4 2 3 D ip h th e ria 1 1 1 0 3 2 4 R u b e lla 0 1 2 0 3 2 5 C re m ia n -C o n g o H a e m o rrh a g ic F e v e r 0 0 0 2 2 2 6 G a s P o is o n in g 0 1 0 1 2 2 7 A c u te F e b rile Illn e s s 1 0 0 0 1 2 8 B u ffa lo p o x 0 1 0 0 1 2 9 E p id e m ic d ro p s y 0 0 1 0 1 3 0 K ya s a n u r F o re s t D is e a s e 0 0 0 1 1 3 1 P e rtu s s is 0 0 1 0 1 3 2 V ira l H e p a titis B 0 1 0 0 1 3 3 V ita m in A O v e rd o s a g e 0 0 0 1 1 5 5 3 7 9 9 9 9 0 6 9 9 3 0 4 1 Y e a rS l. N o . D is e a s e /Illn e s s T o ta l T o ta l
  • 47. IDSP status of Tripura • SSU and DSU was set up in 2005-2006 • Total DSU is 4 • Total reporting site: 802 • Every week – 630 sub-center, 91 government/ private laboratories and 107 PHC/CHC are reporting in S, P, L format • Training status: Medical officer & doctors 420 MPS 20 MPW 658 Lab technician 90
  • 48. • 3 DSU and SSU is equipped with EDUSAT • SSU is having the facility of video conferencing with CCU • RGM Hospt, North Tripura – identified as District Priority Lab • Contractual Staff position under IDSP as on June, 2012 Designation Number Consultant (Finance) 1 Data entry operator 4
  • 49. Professional Sanctioned post In position Trained Epidemiologist 5 0 0 Microbiologist 2 0 0 Entomologist 1 0 0 Total 8 0 0 Human resource for Tripura
  • 50. IDSP status of Manipur • Manipur is a phase II state under IDSP Human resource for Manipur (till 30 th June 2011) Professional Sanctioned post In position Trained Epidemiologist 10 3 3 Microbiologist 2 0 0 Entomologist 1 0 0 Total 13 3 3
  • 51. • Outbreak and epidemic after introduction of IDSP in Manipur Outbreak Place and time Dengue Moreh in Dec 2007 Scrub Typhus Bishnupur in April 2008 malaria Churachandpur In March 2009 Malaria Moreh in April to July 2009 Malaria Touthong Khunou in June 2009 German measles Khurai, Imphal East in May 2009 Japanese encephalitis June-July 2010
  • 52. • RRT in every district is in position to response to any out break • 7 CMOs and 2 DSOs have been trained on FETP in 2010 • An innovation EWS reporting by using SMS from periphery to district and state surveillance was introduced in the 2011-2012 session • Informer will be given Rs 70 recharge card / month
  • 53. • Sentinel surveillance of the Vaccine preventable childhood infectious disease started in JNIMS in 2010-11 • District priority laboratory at District hospital Churachandpur has been fully equipped and is ready to function • The daily newspaper and e-mail scanning was introduced in the 2011-2012 financial year • SIT equipments installed at State Headquarter, 9 DSUs and Regional Institute of Medical Sciences, Imphal • Manipur has 9 districts. Four out of nine DSUs are reporting weekly data and outbreak report regularly
  • 54.  Total DSU: 11  No. of DSU equipped with EDUSAT- 10 Status: Non-functional  New diseases detected after introduction of IDSP: JE, Dengue, Scrub Typhus, Kala Azar (migrant)  IDSP Priority Lab- 2 IDSP Status in Nagaland
  • 55.  No of RRT : 3  24 X 7 call centre established after detection of swine flu case in Nagaland  Sentinel surveillance – not done  Media scanning cell: 1 national and 3 local newspaper screened everyday  Account in Facebook as Nagaland IDSP opened  DSU reporting: regular but completeness lacking
  • 56. Human Resources for Nagaland Professional Sanctioned post In position Trained Epidemiologist 9 7 7 Microbiologist 3 3 3 Entomologist 1 1 1 Total 13 11 11
  • 57. 1. Training of Trainers (TOT) -15 2. Orientation of District Surveillance Officers (DSOs) done - 11 3. Medical Officers - 92 4. Lab. Tech/ Asst. - 41 5. MPWs - 431 6. Accountants(IDSP) - 11 7. DEOs - 24 8. Sensitization of Private Practitioners/ Paramilitary done for all Districts
  • 58. Training programme for 2012: Field Epidemiological Training Programme(FETP) – target achieved Training of Trainers(TOT) – target achieved Training of MO and Para- medical staffs – not yet done
  • 59. Monitoring
  • 60. Key Performance Indicators  Number and percentage of districts providing monthly surveillance reports on time – by state and overall  Number and percentage of responses to disease-specific triggers on time - by state and overall  Number and percentage of responses to disease-specific triggers assessed to be adequate -by state and overall  Number and percentage of laboratories providing adequate quality of information – by state and center
  • 61. Contd.  Number of districts in which private providers are contributing to disease information  Number of reports derived from private health care providers  Number of reports derived from private laboratories  Number and percentage of states in which surveillance information relating to various vertical disease control programs have been integrated
  • 62. Contd.  Number and percentage of project districts and states publishing annual surveillance reports within three months of the end of the fiscal year  Publication by CSU of consolidated annual surveillance report (print, electronic, including posting on the websites) within three months of the end of fiscal year
  • 63. Achievements
  • 64. • Surveillance units have been established in all states/districts (SSU/DSU) • Training of State/District Surveillance Teams and Rapid Response Teams (RRT) has been completed for all 35 States/Uts • IT network connecting 776 sites in States/District HQ and Premier institutes has been established with the help of National Informatics Centre (NIC) and Indian Space Research Organization (ISRO) for data entry, training, video conferencing and outbreak discussion
  • 65. Contd. • On an average, 20-30 outbreaks are reported every week by the States. 553 outbreaks were reported and responded to by states in 2008, 799 outbreaks in 2009, 990 in 2010 and 1675 outbreaks in 2011. In 2012, 482 outbreaks have been reported till 29th April • A total of 1758 media alerts were reported from July 2008 to March 2012 • About 2.7 lakh calls have been received from beginning till now, out of which more than thirty five thousand calls were related to Influenza A H1N1 • 50 identified district laboratories are being strengthened for diagnosis of epidemic prone diseases and a network of 12 laboratories has been developed for Influenza surveillance in the country
  • 66. Contd. • In 9 States, a referral lab network has been established • Recruitment of 301 Epidemiologists, 60 Microbiologists and 23 Entomologists has been completed so far
  • 67. Limitations
  • 68. • The project was launched throughout the county but on papers and no training of professionals and staff involved in data collection and transmission has been completed • The project started in 2005-06 but functional software was shared during end of 2008, thereby leading to gaps in data entry, data-basing and analysis • Difficulty in ensuring the quality of training in a cascade method • Lack of trained epidemiologist and microbiologist
  • 69. • Trained District Surveillance Officers have not been able to use their skills due to high turnover. In addition, the district surveillance officer has multiple responsibilities • Involvement of Medical Colleges (In the first PIP there was no provision for training, outbreak investigation and contingencies etc. for Medical Colleges) • Funds committed for medical college laboratory to act as State Reference Laboratory were not available.
  • 70. • District Laboratories do not have the infrastructure/manpower with adequate skills for undertaking confirmatory tests for a number of diseases • Broadband connection installation and maintenance of VC was centrally coordinated, as a result of which minor defects could not be rectified locally and Data Managers were not trained enough to rectify the defects • At the time of disaster, SSU and State Health Control Room operate in the same office because of which the routine surveillance gets diluted
  • 71. • Public Health which gets activated only during the time of disaster and crisis is yet to get its due place in day to day functioning of the health system • Lack of monitoring and supervision at all levels • Private sectors and semi-government organization have not been involved in the same proportion as of their numbers • Number of parallel systems under various programs are still operating and duplication of record generation has not gone down
  • 72. Conclusion
  • 73.  Integrated Disease Surveillance Project (IDSP) is a decentralized, state based surveillance programme in the country  It is intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner  It is also expected to provide essential data to monitor progress of on-going disease control programmes and help allocate health resources more efficiently
  • 74. Thank You