3. Integrated Disease Surveillance Project
• IDSP was launched with World Bank assistance in
November 2004 to detect and respond to disease
outbreaks quickly.
• The project was extended for 2 years in March
2010. From April 2010 to March 2012, World
Bank funds were available for Central Surveillance
Unit (CSU) at NCDC.
• The Programme continues during 12th Plan
under NRHM with outlay of Rs. 640 Crore from
domestic budget only.
5. 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
7. Need for Surveillance
The Government of India realized the importance of
Disease surveillance after the Cholera outbreak in
Delhi and the Plague outbreak in Surat, which not
only had significant mortality and morbidity but also
significant economic consequences.
8. Objectives of IDSP
• Establish a decentralized system of disease
surveillance for timely and effective public health
action
• Improve the efficiency of disease surveillance for
use in health planning, management and
evaluating control strategies
9. IDSP
Based on case based reporting
• Syndromic surveillance (suspect case reporting
at PHC and below)
• Confirmed case reporting of selected priority
diseases (at district level)
• Passive reporting of Road Traffic Accidents and
Air Pollution.
10. 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
12. Project components
• Integrating & decentralizing disease
surveillance & response mechanisms
• Strengthening Public Health Laboratories
• Using Information Technology and Networking
in disease surveillance
• Human Resource Development
14. 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,
Haryana, Rajasthan, West Bengal, Manipur,
Meghalaya, Tripura, Chandigarh, Pondicherry, 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.
15. 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
16. NCD risk factor surveillance
• Monitor trends of important risk factors of
NCD in the community over a period of time
• Evolve strategies for interventions of these risk
factors so as to reduce the burden of diseases
due to NCDs
• Strengthen NCD surveillance at District level
• Integrate NCD risk factor surveillance with IDSP
17. Strengths of IDSP
• Functional integration of surveillance components
of vertical programmes
• Reporting of suspect, probable and confirmed cases
• Strong IT component for data analysis
• Trigger levels for gradated response
• Action component in the reporting formats
• Streamlined flow of funds to the districts
18. Lessons learnt
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
19. Integration
• National programmes
• NCDs
• Private sector
• Police, Pollution Control Board, Water supply
• IEC activities
• Training
• Formation of committees to oversee integration
20. Integration ?!
• What exactly do we expect in integration
• Functional integration to what degree
• Vertical programmes still continue
• NCD component invariably stand alone
• IEC, Training, Formats- consultation with these
programmes
• Fund sharing a daunting task
21. 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
22. National Issues cont’d
• Reduced attendance in public health system and
increased in private sector almost 40:60 or more
• Wide-spread quackery in the name of alternate
medicine (ayurveda, unani, homeopathy, etc)
• ‘Overworked’ clinicians so poor maintenance of
medical records like case sheets/prescription
slips/provisional diagnosis/etc
• Lack of ownership by states of central vertical
programmes
23. State issues
• State RRT not utilized to full potential
• Regional labs strengthened but lab diagnosis not
enhanced & increasing dependence on Centre
• Insufficient epidemiological analysis
• No clear IEC strategy
• Frequent transfer/retirements of trained staff so
programme invariably suffers
• Shortage of staff so multi-tasking for state and district
level functionaries.
• Fund issues and Utilization certificates
24. State issues cont’d
• Lack of competent staff especially Public Health
Professionals and Microbiologists in majority of the
states. Short trainings not likely to build the
necessary capacity.
• Clear demarcation between the Directorate of
Health Services and Directorate of Medical
Education so difficulties in integrating Medical
colleges
25. District issues
• Programme is focused on district epidemic preparedness
and response but some districts yet to get their act
together
• Reporting from periphery needs improvement. If media
first reporting then SURVEILLANCE FAILURE
• Weekly reports incomplete and irregular (and under
reporting)
• Monthly reports also irregular
• Communication ‘failure’
• CMO-CMS-DSO lack of co-ordination
26. District issues cont’d
• Overworked peripheral staff to whom all programmes are
dependent on
• Multiple formats for different programmes
• Rapid Response Teams usually composed of specialists
from District hospital/ Medical college and problem in
rapid mobilization as from different agencies
• Concept of Nil reporting/routine reporting difficult for the
peripheral staff to understand, compounded by lack of
feedback from the higher levels
27. District lab issues
• District labs few established and functioning not
satisfactorily
• Many labs in a district:
– Public health lab-testing water samples
– Hospital lab-testing for NCDs and clinical requirements
– Medical College lab-testing for majority of the diseases
– Surveillance lab-testing for few diseases
– District blood bank –with ELISA reader
– Peripheral labs-Microscopy only
Co-ordination between these labs is difficult so that overall
district lab capacity diminished
28. Reference
• Indian Public Health Standard
• National center for disease control
• www.idsp.nic.in
• IDSP Portal
• Training manual for Medical officers,
Paramedical staff & other health professionals
for Hospital based disease surveillance
