Dr.Anjalatchi Muthukumaran
Vice Principal
Era college of Nursing
Unit-IV Epidemiology
Health Surveillance

Content of the chapter
 Introduction
 Definition
 Nursing surveillance
 Health surveillance
 Surveillance in india
 Vision 2035
 importance of surveillance
 Goal of public health surveillance
 Type of surveillance
 Surveillance process
 Summary
 Conclusion
 References

INTRODUCTION
 In the everyday life of hustle and bustle, it is
almost a lacking hour to keep a watch on health.
As being noted by many great leaders and
personalities around us “health is life”. We must
keep an eye to look for it. As it is a need of the
hour to keep our health maintained and to keep a
keen watch over it. Thus emphasizing its
“SURVEILLANCE”.
 “It is health that is real wealth and not pieces of
gold and silver.” – Mahatma Gandhi

Vision 2035 - Public Health Surveillance
in India
 Introduction
 Surveillance is an important Public Health function. It is an
essential action for disease detection, prevention, and control.
Surveillance is ‘Information for Action’.
 ‘Vision 2035: Public Health Surveillance in India’ is a
continuation of the work on health systems strengthening. It
contributes by suggesting mainstreaming of surveillance by
making individual electronic health records the basis for
surveillance. Public health surveillance (PHS) is an important
function that cuts across primary, secondary, and tertiary levels
of care.
 The vision document is a step in that direction, it articulates the
vision and highlights the building blocks. It envisions a citizen-
friendly public health system, which will involve stakeholders at
all levels, be it individual, community, health care facilities or
laboratories, all while protecting the individual’s privacy and
confidentiality.

Definition
 1963-The French defined surveillance in three
words, ‘to watch over’ .
 1968-Langmuir defined surveillance as ‘the
continued watchfulness over distribution and
trends of incidence through systematic collection,
consolidation, and evaluation of morbidity and
mortality reports and other relevant data

Definition continued
 The Centre for Disease Control, Atlanta, US
defined surveillance as ‘the ongoing systematic
collection, collation, analysis and interpretation of
data and dissemination of information to those
who need it, in order that action is taken.”

Vision
 To make India’s public health surveillance system
more responsive and predictive to enhance
preparedness for action at all levels.
 Citizen-friendly public health surveillance system
will ensure individual privacy and confidentiality,
enabled with a client feedback mechanism.
 Improved data-sharing mechanism between
Centre and states for better disease detection,
prevention, and control.
 India aims to provide regional and global
leadership in managing events that constitute a
public health emergency of international concern.

In 2035,
 India’s Public Health Surveillance will be a predictive,
responsive, integrated, and tiered system of disease
and health surveillance that is inclusive of prioritized,
emerging, and re-emerging communicable and non-
communicable diseases and conditions.
 Surveillance will be primarily based on de-identified
(anonymised) individual-level patient information that
emanates from health care facilities, laboratories, and
other sources.
 Public Health Surveillance will be governed by an
adequately resourced effective administrative and
technical structure and will ensure that it serves the
public good.
 India will provide regional and global leadership in
managing events that constitute a Public Health
Emergency of International Concern.

What is surveillance in nursing?
 The definition of surveillance proposed by the
Nursing Intervention Classification is the
purposeful and ongoing acquisition,
interpretation, and synthesis of patient data
for clinical decision making.

What is health surveillance?
 Health surveillance is a scheme of repeated
health checks which are used to identify ill
health caused by work. Health and safety law
requires health surveillance when your workers
remain exposed to health risks even after you
have put controls in place.

DEFINITION
 Surveillance is a systematic process of
collection, transmission, analysis and feedback of
public health data for decision making.
 ▫ The surveillance means supervision or close
watch especially on suspected person.
Epidemiologically surveillance means close
vigilance on occurrence and distribution of
diseases, health related problems, population of
dynamics, community behavior as well as
environmental processes resulting in increased
risk of ill health in the community

WHY IS IT IMPORTANT TO
SURVEILLANCE THE HEALTH ?
 ▫ It serves as an early warning system for
impending public health emergencies.
 ▫ It document the impact of an intervention, or
track progress towards specified goals
 ▫ Monitor and clarify the epidemiology of health
problems, to allow priorities to be set and to
inform public health policy and strategies.

What could be the goals of Public
Health Surveillance
 Predicting/Forecasting and Preparedness for
Epidemic Outbreaks for communicable and emerging
epidemics of non-communicable disease, both re-
emergence of known illnesses in different forms
(influenza, MDR-TB), or new disease outbreaks (NIPA
virus, Corona virus, etc.,) or new geographic foci of
NCD.
 • Guiding Prevention and Health Promotion
Strategies: Identify new/hidden reservoirs and
sources of infection, block chains of rapid
transmission and limit the resulting morbidity,
disability or death.
 • Responding to Outbreaks and Guiding Future
Programs of Disease control: Institute standard
protocols of a) characterising results beginning with
molecular tests, b) digitise results and ultimate action
in real-time, c) conduct genetic mapping to explore
variations in the pathogen or the susceptible host.

TYPES OF HEALTH
SURVEIILANCE
 INDIVIDUAL OR FAMILY SURVEILLANCE
 COMMUNITY OR LOCAL POPULATION
SURVEILLANC E
 NATIONAL SURVEILLANCE
 INTERNATIONAL SURVEILLANCE

Continued
 INDIVIDUAL OR FAMILY SURVEILLANCE It includes
surveillance of an infected person in a family as long
as the individual is the source of infection to others .
e.g. typhoid case and carriers
 COMMUNITY OR LOCAL POPULATION
SURVEILLANCE ▫ It includes surveillance of the
whole community for early detection and prevention &
control of a disease e.g. malaria
 NATIONAL SURVEILLANCE ▫ It includes surveillance
at the National level e.g surveillance of small pox after
its eradication.
 INTERNATIONAL SURVEILLANCE ▫ It includes
surveillance of some of the diseases which are listed
by WHO e.g malaria, influenza etc. are to be reported
information to the countries in the world to take timely
actions.

EPIDEMIOLO GICAL
SURVEILLANCE
 ▫ In many countries where particular diseases are
endemic special control eradication programmes
have been instituted. For example, National
Disease Control Programmes against malaria,
tuberculosis, leprosy etc. These programmes
have yielded considerable morbidity and mortality
data for the specific diseases

SURVEILLANCE PROCESS
1• Collection of relevant information about the
disease under surveillance
2 • Compilation and analysis of data
3 • Reporting of data and providing feedback

Gap areas identified in India’s Public
Health Surveillance
 The document identifies gap areas in India’s Public Health
Surveillance that could be addressed.
 India can create a skilled and strong health workforce
dedicated to surveillance activities.
 Non-communicable disease, reproductive and child health,
occupational and environmental health and injury could be
integrated into public health surveillance.
 Morbidity data from health information systems could be
merged with mortality data from vital statistics registration.
 An amalgamation of plant, animal, and environmental
surveillance in a One-Health approach that also includes
surveillance for anti-microbial resistance and predictive
capability for pandemics is an element suggested within
this vision document.


 Public Health Surveillance could be integrated
within India’s three-tiered health system.
 Citizen-centric and community-based
surveillance, and use of point of care devices and
self-care diagnostics could be enhanced.
 Laboratory capacity could be strengthened with
new diagnostic technologies including molecular
diagnostics, genotyping, and phenotyping. To
establish linkages across the three-tiered health
system, referral networks could be expanded for
diagnoses and care.

Building blocks envisages for the
vision
 The building blocks for this vision are an
interdependent federated system of governance
between the Centre and states, a new data-
sharing mechanism that involves the use of new
analytics, health informatics, and data science
including innovative ways of disseminating
‘information for action’.

Four building blocks are envisaged for
this vision:
 An interdependent federated system of
Governance Architecture between the Centre and
States,
 Enhanced use of new data collection and sharing
mechanisms for surveillance based on unitized,
citizen-centric comprehensive Electronic Health
Records (EHR) with a unique health identifier
(UHID). As well, existing disease surveillance
data and information from periodic surveys will
complement this information
 Enhanced use of new data analytics, data
science, artificial intelligence, and machine
learning, and
 Advanced health informatics.

Suggested Steps to move forward
 Establish a governance framework that is
inclusive of political, policy, technical, and
managerial leadership at the national and state
level.
 Identify broad disease categories that will be
included under Public Health Surveillance.
 Enhance surveillance of non-communicable
diseases and conditions in a step-wise manner.
 Prioritize diseases that can be targeted for
elimination as a public health problem, regularly.

 Improve core support functions, core functions,
and system attributes for surveillance at all levels;
national, state, district, and block.
 Establish mechanisms to streamline data sharing,
capture, analysis, and dissemination for action.
These could include the use of situation-aware
real-time signals from social media, mobile
sensor networks, and participatory surveillance
systems for eventbased epidemic intelligence.
 Encourage innovations at every step-in
surveillance activity.

References
 The full document can be accessed
at https://niti.gov.in/sites/default/files/2020-
12/PHS_13_dec_web.pdf
 Source : NITI Aayog