Surveillance of diseases

1. Health Education,
Disease Surveillance, Prevention
& Control

2. Health Education
• Definition

3. Disease Control
• Definition

4. Disease Control
• Definition

5. Public health surveillance
• It is the ongoing, systematic collection, analysis, and interpretation of health-
related data essential to planning, implementation, and evaluation of public health
practice.

6. Why Do We Use Public Health Surveillance?
• Because it can
• size of a health problem
• geographical occurrence of illness
• natural history of a disease
• detect epidemics or define a problem
• generate hypotheses
• changes in infectious agents
• changes in health practices
• facilitate emergency planning

7. Cont.
• Now a days public health services progress towards
the digitalization/computerization.
• So it is essential to integrate the data to gain meaningful information for planning
health programs.
• As a part of International Health Regulations (IHR) core capacity building, India
need to strengthen public health surveillance systems.
• Needs a comprehensive information system to monitor emerging and re-emerging
public health threats, disasters and mass events.

8. Cont.
• Public health surveillance is not only about collection, analysis, interpretation
but also the dissemination of health data for the batter planning,
implementation and evaluation of public health action.
• Thus it is essential to get a single operating picture of health profile by integrating
all the health-related information.

9. Cont. History
• 1988 Cholera outbreak in Delhi & 1994 plague outbreak in Surat
• huge morbidity and mortality, the country sustained huge economic losses
• 1995- NAAC(National Apical Advisory Committee) for national disease
surveillance and response system.
• 1997-National Surveillance Programme for Communicable Diseases
HIV Sentinel Surveillance -one of the first nationwide disease surveillance
programmes, which began in 1992 & expanded across the country in 1998.

10. Cont.
• 2004- IDSP(project) funded by world bank for 5 years.
• converted into a programme and funded under the 12th Five-year Plan (2012-17)
within the NHM.
• 26th November 2018- improve the digital capabilities of the IDSP, Integrated
Health Information Platform (IHIP) was soft launched by the MOHFW,
Government of India.
• 5th April 2021- an upgraded version of IHIP was virtually launched by Dr Harsh
Vardhan.

11. Introduction of IHIP
• It is a web-based real-time, village wise, case based electronic health information
system which will aim to provide details about epidemic-prone diseases with
Geographical Information System (GIS) for managing disease outbreaks and
related resources thus reducing the morbidity and mortality and lessening disease
burden in the populations.

12. • Single operating platform of the health data and information of India
• real-time information on human health across India
• Reduces data and information fragmentation
• 33+ health conditions
• public health surveillance in IHIP: Time , Place, Person
• Geospatial epidemiology
• provides analysis on mobile and electronic devices
• Role & hierarchy based feedback & alert mechanisms are maintained.
Cont.

13. Objectives
• Collect real time data with time, place and person distribution in respect of
diseases with outbreak potential
• Develop a surveillance system for early warning signs
• Plan preparedness as per the Disease calender with logistics
• Epidemiological investigation with RRTs
• Timely surveillance and response
• Data integration with other relevant portals

14. Two key phases for data reporting
• The process of data reporting on IHIP under IDSP consists of the following
two key phases.
verification of master data of
health facilities (including
examining of user IDs and
passwords, creation of user
profiles, health facility
directory, etc.).
one-time initial activity to set
up basic information.
 reporting disease surveillance
data (including event alerts
and outbreak)
 which is a continuous activity
carried out in a real-time
manner.
1 2

15. What are the essential differences between IDSP
portal and new IHSP?
• IHSP is designed to:
– Capture disaggregate data of persons at
all levels
– Link data from S, P, L, EWS 1
and 2 forms
– Capture real-time or daily surveillance
data
– Monitor more than 33+ health
conditions
– Provide analysis on mobile
and electronic devices
– Integrate with ongoing surveillance
programs
• IDSP was designed to:
– Capture aggregate data only
– Not to link data from S, P and
L forms
– Weekly surveillance
– Monitor 22 health
conditions
– Paper-based data collection

16. Block PHC
or Community Health Center
(Medical Doctor + helper)
Sub Center
Primary Health Center
(Auxiliary Nurse Midwife, or Male Health Worker)
Weekly household
visits to collect data
PaperForms
One consolidated “P”
form/PHC/week + “L” forms
B-PHC or CHC data
collected from PHCs
Paper forms are
converted to
electronic data
Spreadsheets
Electronic data, kept in the form
of XL sheets or on a DB / Portal
IDSP
Database Spreadsheets
PaperForms
One Consolidated “S” Form per
Sub-center per week
Email/Web Entry
Hand
deliver
Hand
deliver Laboratory Presence
District Surveillance Unit
(District Surveillance Officer,
Data Manager, Data Entry Operator)
LaboratoryPresence
State Surveillance Unit
(State Surveillance Officer,
Data Manager, Data Entry Operator)
State
(36 States/UTs)
District
(707)
Sub-district
(6267)
Village
(655075)
LaboratoryPresence
Conventional IDSP’s Data Collection Process at State-level
(718)

18. Linkages of the central surveillance unit at
the central level

20. Rationale for use of case definitions
• Uniformity in case reporting at district, state and national level.
• Use of the same criteria by reporting units to report cases.
• Compatibility with the case definitions used in WHO recommended
surveillance standard.
• Allow international information exchanges.

21. Active and Passive Reporting
Reporting
Active Passive
 Field Health
Workers
 Home Visits
 S Form
 Medical officers and
Laboratory Technicians
 Presumptive and Confirm
cases(P & L form)

22. IHIP- Home

23. Disease summary Dashboard

25. Mobile-based or Tablet-based data collection
for peripheral health workers(real-time or offline data collection abilities)

30. Real-time Lab confirmed cases of health conditions
30
18/11/2019

31. Real-time view of lab-confirmed cases of
And progression and daily/weekly monitoring of activity

32. View heatmaps and distribution of lab-confirmed cases.

33. CURRENT STATUS OF IHIP IN OUTBREAK?
• Provides Health condition alert
• Threshold set for each disease
• automated epidemic curve plot and pathogen wise distribution of cases
• hotspots can be identified from the clusters with the information obtained from
GIS tagging of individual cases.
• fastening the outbreak investigation by selecting rapid response team from the
IHIP portal via online, based on the availability of trained members in the
particular outbreak area.

34. Triggers events for Investigation.

35. Existing Structure of Public Health Surveillance
• successfully integrated: 1) NVBDCP 2)Zoonotic infections
3) Diarrheal Disease Control Program
4) VPD 5) ARI
• Not yet fully integrated: 1)NACP 2) NTEP 3)RCH
• Vertical programs run their own standalone portals:
1) SI-NACO for National AIDS Control Program (NACP)
2) Nikshay for National TB Elimination Program (NTEP) and
3) RCH Portal for the Reproductive and Child Health (RCH) program.

36. Limitations of existing Public Health Surveillance
System
1. Implementation Challenges
2. Limited Private Sector Involvement
3. Programs and Institutions work in vertical siloes
4. Human Resource and Training challenge
5. Limited use of media
6. Limited focus on Non-Communicable Diseases
7. Limited focus on Occupational Health

37. References:
• Mogan Ka1 *, Aravind Gandhi Periyasamy2 , Venkatesh U.1 , Jugal Kishore1. A situation model of
integrated health information platform in India: an anticipated review. Int J Community Med
Public Health. 2020 Mar;7(3):1197-1200.
• Integrated Health Information Program (IHIP). Available at: https://ihip.nhp.gov.in.
• Guidelines of Soft launch Integrated Health Information Platform Integrated Disesase Surveillance
Programme of Segment of November; 2018.
• Park K. Park’s Text book of preventive and social medicine. 26th Edition. Jabalpur: M/s
Banarsidas Bhanot, 2021
• Kadri AM, Kundapur R, Khan AM, Kakkar R, Sheth A, Mangrola N. editors. IAPSM’s Textbook
of Community Medicine. 2nd edition. Jaypee Brothers Medical Pub; 2021.