The document describes India's Integrated Disease Surveillance Project (IDSP), which aims to establish a decentralized, district-based system for surveillance of communicable and non-communicable diseases. Key elements of IDSP include integrating existing surveillance activities, strengthening public health laboratories, using information technology, and developing human resources for surveillance and response at the district, state, and national levels. IDSP collects surveillance data on various diseases through syndromic, presumptive, and confirmed case reporting. Data flows from the district to state and national levels to allow for analysis and coordinated response.

1. Integrated Disease
Surveillance Project
Dr. Sandeep Das
Junior Resident, Center for Community Medicine,
All India Institute of Medical Sciences.

2. Surveillance (in epidemiology)
● Surveillance is defined as the ongoing
systematic collection, collation, analysis and
interpretation of data and dissemination of
information to those who need to know in
order that action be taken.
● It came from a French word “surveiller” which
means “to watch, oversee”

3. Why do we need to do surveillance?
To answer these questions:
➔ Who gets the disease?
➔ How many of them get the
disease?
➔ Where did they get it?
➔ When did they get it?
➔ Why did they get it?
➔ What needs to be done?

4. Importance of timely action in controlling an outbreak through
effective surveillance action
Potential cases
prevented
Response
1st case

5. Key elements of a surveillance system
➔ Detection and notification of
health events
➔ Investigation and confirmation
➔ Collection of data
➔ Analysis and interpretation of
data
➔ Feedback and dissemination of
results
➔ Response – Action for
prevention and control

6. ➔Since independence major health problems
in India has been addressed
➔Vertical health programmes were launched
for Malaria, Tuberculosis, Leprosy, high
maternal and child mortality rate and lately
for HIV
➔Dedicated personnel and delivery systems to
implement this programmes were allocated
Then where does the problem lie?

7. What were the gaps?
➔Number of parallel systems under various programmes
➔The data was being collected separately and used separately
➔Data was never used comprehensively at national level
➔Huge resources were being used separately and sometimes
duplication of funds also occurred
➔Limited involvement of medical colleges and private health
sector in reporting system
➔Inadequate laboratory network for early diagnosis and
epidemic investigation

8. National Surveillance Programme for Communicable
Diseases ( NSPCD)
➔ Launched in 1997-98 in 5 districts as a pilot project
➔ Extended to cover 101 districts
➔ States were the implementing agencies and Delhi was Nodal
agency
➔ It was based on
◆ Outbreak reporting
◆ Weekly reporting of epidemic prone diseases
➔ Reporting was done from districts to the center

9. IDSP

10. IDSP ➔ IDSP is a decentralized ,
state based surveillance
programme in the country
➔ Started in November 2004,
totally funded by World
Bank
➔ Launched in 3 phases

11. Phases of
implementation.
➔ Phase I (2004-05)
Madhya Pradesh, Andhra, Himachal, Karnataka,
Kerala, Maharashtra, Mizoram, Tamil Nadu &
Uttaranchal
➔ Phase II (2005-06)
Chattisgarh, Goa, Gujarat, Haryana, Orissa,
Rajasthan, West Bengal, Manipur, Meghalaya,
Tripura, Chandigarh, Pondicherry, Nagaland,
Delhi
➔ Phase III (2006-07)
UP, Bihar, J&K, Punjab, Jharkhand, Arunachal,
Assam, Sikkim, A&N
Island, D&N Haveli, Daman & Diu, Lakshadweep

12. Objectives
of IDSP
➔ To establish a decentralized district based system of
surveillance for communicable and non
communicable diseases, so that timely and effective
public health action can be initiated in response to
health changes in the urban and rural areas
➔ To integrate existing surveillance activities to avoid
duplication and felicitate sharing of information
across all disease control programmes and other
stakeholders, so that valid data is available for health
decision making in the district, state and national
levels

13. Conditions
under
regular
surveillance
Types of diseases Disease
Vector borne disease Malaria
Water borne disease Diarrhoea, Cholera, Typhoid
Respiratory disease Tuberculosis
Vaccine preventable disease Measles
Disease under eradication Polio
Other conditions Road Traffic accidents
International commitments Plague
Unusual syndromes Meningo encephalitis

14. Types of Surveillance Categories Conditions
Sentinel surveillance STDs HIV/ HBV/ HCV
Other conditions Water quality
Outdoor air quality
Regular periodic survey Non communicable
disease risk factors
Anthropometry
Physical activity
Blood pressure
Tobacco, Blood pressure
Nutrition
Blindness
Additional state priorities Up to 5 years

15. Components
➔ Integrating & decentralizing disease surveillance
response mechanisms
➔ Strengthening Public Health Laboratories
➔ Using Information Technology and Networking in
disease surveillance
➔ Human Resource Development

16. Classification of
surveillance in IDSP
➔ Syndromic
➔ Presumptive
➔ Confirmed

17. Syndromic
surveillance
Who will do ?
◆Paramedical health staff
How?
◆Based on broad categories of presentation
Diseases of interest under each syndrome
Fever with and without localizing
signs
Malaria, typhoid, JE, Dengue, Measles
Cough more than 3 weeks Tuberculosis
Acute flaccid paralysis Polio
Diarrhoea Cholera
Jaundice Hepatitis, Leptospirosis, Dengue, Malaria
Unusual syndromes Anthrax, Plague, Emerging epidemics

18. Presumptiv
e
surveillance
Who will do ?
◆MOs of PHC, CHC, medial colleges, and sentinel center
How?
◆By clinical examination
This will be supplemented by confirmation of diseases by
laboratory reporting

19. Reporting
Reporting forms
• Form “S” ( Suspect cases)
• Health workers ( Sub center)
• Form “P” ( Probable cases)
• Doctors ( PHC, CHC, Pvt Hospitals)
• Form “L” ( Lab confirmed cases)
• Laboratories

23. Laboratory Reporting
Form Level of laboratory Responsibility of reporting
Form L1 Peripheral laboratory at PHC/CHC Laboratory assistants
Technician through MOIC
Form L2 District Public health Laboratory
Labs of District Hospital
Private and other Hospitals and
private Labs
I/c Microbiologist /
Pathologists
Form L3 Labs in Medical colleges
Other tertiary institutions
Reference Labs
Head Microbiology
department

24. Organisational
structure of
IDSP
Central Surveillance
Unit
State Surveillance
Unit
District
Surveillance
Unit

25. National Surveillance Unit (NSU)
Director general
health services
National programme
Managers polio,
malaria, TB, HIV-AIDS
NGO
IMA
Representativ
e
Consultants
National
Surveillance officer
Representative
Ministry of home
Director
NIB
Director
NICD
JS (FA)
JS ( Family
welfare)
JS (Health)
Chairperson
National
Surveillance
Committee
Director
General
The Chairman of the National Surveillance Committee is Secretary of Health with
members of various departments

26. National Surveillance Unit (NSU)
1. Approves annual action plan
2. Monitor the progress
3. Seeks reimbursement from World Bank
4. Report to National Disease Surveillance Committee
5. Make the prototypes
6. Procure goods, conducts training and IEC
7. Analysis of data from states and provide feedback
8. Coordinate with NICD, ICMR
9. Periodic review meetings
10. Organize surveys for NCDS

27. State Surveillance Unit

28. State
Surveillance
Unit
1. Collation and analysis of data from district
surveillance unit (DSU)
2. Coordinate Rapid response teams and deputing
them in field
3. Monitor and review activities of DSU
4. Coordinate activities of state public health
laboratories, medical colleges, and other state level
institutions
5. Sending regular feedback to DSU
6. Trend analysis
7. Coordinate all training activities under project

29. District
Surveillance
Unit

30. District
Surveillance
Unit
• Collation and analysis of data received and
transmiiting to SSU
• Constituting rapid response team and deputing them
to the field whenever needed
• Implementation and monitoring of all project
activities
• Co-ordinating activities of the public health labs,
medical colleges, NGOs, private sector
• Sending regular feedbacks to the reporting unit
• Organizing training and IEC activities within the
district
• Organizing meetings of the district surveillance
committee

31. Rural Areas Urban Areas
Public health sector PHCs
CHCs
Sub district
District Hospital
Urban Hospitals
ESI
Railway
CGHS hospitals and dispensaries
Other hospitals
Private health
sector
Sentinel private
practitioners
Sentinel Hospitals
Private nursing homes
Sentinel hospitals
Medical Colleges
NGOs
Private Laboratories

32. Information Flow of Weekly Surveillance System
D.S.U
S.S.U
C.S.U
P.H.Cs
C.H.Cs
District
Hospital
Medical
Colleges
P.H. Labs
Other Hospitals
ESI, Municipal,
Railway, Army
Pvt Practitioner
Nursing homes
Private Hospitals
Private Labs
Corporate
Hospitals
Sub Centers Programme
officers

34. Monitoring
and
Evaluation
❖ Key performance indicators
❖ There are TEN key performance indicators
● Number and percentage of districts providing monthly
surveillance reports on time
● Number and percentage of responses to disease specific
triggers on time by state and overall
● Number of responses to disease specific triggers
assessed to be adequate- state and overall
● Number of percentage of labs providing adequate
quality of information- by state and overall
● Number of districts in which private providers are
contributing to disease information

35. Monitoring
and
Evaluation
● Numbers of reports derived from private health care
providers
● Number of reports derived from private laboratories
● Number of % of states in which surveillance information
relating to various vertical disease control programs
have been integrated
● Number and % of project districts and states publishing
annual surveillance reports within 3 months of the end
of the fiscal year
● Publication by CSU of consolidated annual surveillance
report within three months of the end of fiscal year

36. Linkages of the central surveillance unit at the central level
CSU CBHI
ICMR
NCDC
EMR
WHO
National
Programme
RNTCP
NVBDCP RCH NACP
MIS and Report
NCD Surveillance
Outbreak investigation
and rapid response

37. Surveillance action
Preset trigger level with specific response for various levels
❖Trigger Level 1- Suspected limited outbreak
➢Local response
❖Trigger Level 2- Epidemic
➢Local and regional response
❖Trigger level 3- Wide spread epidemic
➢Local, regional and state level response

38. Warning Signals of an impending outbreak
➔ Clustering of cases/deaths in Time/Place
➔ Unusual increase in cases/ deaths
➔ Even a single case of measles , AFP, Cholera,
Plague, Dengue, or JE
➔ Ac. febrile illness of unknown etiology
➔ Two or more epidemiologically linked cases of
outbreak potential
➔ Unusual isolates
➔ Shifting in age
➔ High or sudden increase in vector density
➔ Natural Disaster

39. Integrated Health Information Platform
● The Integrated Health Information Platform (IHIP) is a web-enabled near-real-time electronic
information system
● It is embedded with all applicable Government of India's e-Governance standards, Information
Technology (IT), data & metadata standards to provide state-of-the-art single operating picture
with geospatial information for managing disease outbreaks and related resources.
● Key features of Integrated Health Information Platform (IHIP)
○ Real time data reporting (along through mobile application); accessible at all levels (from
villages, states and central level)
○ Advanced data modelling & analytical tools
○ GIS enabled Graphical representation of data into integrated dashboard
○ Role & hierarchy-based feedback & alert mechanisms
○ Geo-tagging of reporting health facilities
○ Scope for data integration with other health programs

40. Strategic
Health
Operations
Centre
(SHOC)
● Goal:
○ “To provide a facility for an emergency team, to manage
information & resources for disease surveillance and outbreak
response and key decision makers to operate in the event of an
emergency situation, disease outbreak or crisis of any nature.”
● Objective:
○ Act as a command center to manage disease outbreaks, public
health emergencies or any disaster situation.
○ Strengthening disease surveillance & response using the latest
information & communication technology.
○ Strengthening disease surveillance and response.