Surveillance and monitoring are important public health activities. Surveillance involves the ongoing collection and analysis of health data to plan, implement, and evaluate public health programs. It can be used to monitor disease trends, assess prevention programs, and recognize disease outbreaks. There are different levels of surveillance from individual to international. Types include active, passive, sentinel, behavioral, and nutritional surveillance. India has integrated disease surveillance programs to monitor communicable and non-communicable diseases across public and private sectors. Monitoring tracks program implementation and identifies solutions to improve performance using routine data collection. The health management information system is a web-based tool used in India to monitor health services and programs.

1. SURVEILLANCE
AND
MONITORING

2. CONTENTS

3. Introduction
SURVEILLANCE
• French word sur meaning over
• Veiller TO WATCH
• Best weapon to avert epidemics

4. Health surveillance
• Definition: The ongoing systematic collection, analysis and interpretation
of health data essential for planning, implementing and evaluating public
health activities.
• Include: - Compulsory notification regarding specific diseases,
- Specific disease registries (population-based or hospital-based)
- Continuous or repeated population survey
- Aggregate data that show trends of consumption patterns and
economic activity.

5. Uses of
Surveillance
Monitor
Monitor effectiveness and evaluate the
impact of prevention and control measures,
intervention strategies and health policy
changes
Measure Measure the causal factor of the disease
Assess
Assess the public health impact of events
and assess trends
Recognize Recognize isolated and clustered cases

6. Uses of surveillance
• Plan and provide care
• Strengthen commitment
• Mobilise communities
• Advocate for sufficient
resources

7. Levels of surveillance
• Individual surveillance: for all infected cases till they become non-
infectious, highly fatal diseases
• Local population surveillance: malaria, sexual practices in a defined
population
• National population surveillance: POLIO
• International Surveillance: conducted routinely by WHO
• Diseases under international surveillance

8. Types:
1) Active surveillance
2) Passive surveillance
3) Sentinel surveillance
4) Behavioural surveillance
5) Nutritional surveillance

11. Active surveillance
• Highly contagious, fatal or in the process
of elimination or eradication of disease
• Criteria established for reporting disease,
risk factors or health event
• Regular outreach to potential reporters, to
stimulate the reporting of specific
diseases or injuries.

12. Active surveillance
• Means of validating the
representative nature of passive
reports and providing a more
complete reporting of health events.
• Eg: Domiciliary fortnightly visits
for malaria cases in NVBDCP
• Project Nikshay for active TB
surveillance

13. Passive
surveillance

14. Passive surveillance
• Criteria are established for reporting
• Health practitioners are notified of the
requirements, and they report events as
they come to their attention
• Not a huge burden to the reporter
• Vulnerable to incompleteness

15. Behavioural surveillance
• Ongoing systematic collection, analysis and interpretation of
behavioural data relevant to understanding trends in the transmission
of HIV and STIs.
Knowledge Attitude
Behaviour

16. Nutritional surveillance
• Tool for identifying existing system for collecting existing system
for collecting information on the current and future magnitude,
distribution and causes of malnutrition in populations
• In order to assist govt and international agencies in policy
formulation, program planning, management and evaluation
• Eg: Short-term – excess intake of salt
Long-term – less intake of fruits and vegetables
HTN
COLON CANCER

17. Increased salt intake

19. Sentinel surveillance
• Unlinked anonymous testing of persons
for diseases under surveillance
• When we suspect missing cases or
diseases of high-level social stigma

21. Surveillance in practice
SYNDROMIC SURVEILLANCE: conducted by field
workers based on predefined symptoms. ( suspected cases)
PRESUMPTIVE SURVEILLANCE : all suspected cases are
sent to the doctor for confirmation based on signs and
symptoms
LABORATORY SURVEILLANCE: probable cases sent to
lab for diagnosis and then known as confirmed

22. Sources of data
• Mortality and morbidity reports
• Hospital records
• Laboratory diagnosis
• Outbreak reports
• Vaccine utilisation
• Sickness absence records
• Biological changes in agents,
vectors and reservoirs
• Blood banks
• Any element of the causal chain of
disease

23. Factors that influence the
effectiveness of surveillance data
• Fewer no. Of conditions
• Little information per case
• Small burden of reporter
• High interest of decision-makers in
surveillance data
• Clear and supported goals for surveillance
• Reporting strategy for serious but common
conditions
• High usefulness of data locally
• High usefulness of data to decision-makers
for prevention action

24. Surveillance in India
•
•
•

25. Integrated disease surveillance
•
•
•
•
•
•

26. The IDSP amalgamates both public and private sectors by involving private
participation and integrates surveillance of communicable and non - communicable
diseases which includes -:
 Describing health problem
 Monitoring trends
 Estimating health burden
 Evaluating programmes for prevention and control

27. Disease under surveillance include-
● Malaria
● Acute diarrhoeal diseases
● Typhoid
● Tuberculosis
● Measles
● Polio
● Meningoencephalitis, respiratory distress, haemorrhagic fever and other undiagnosed
conditions

28. ● Infections under sentinel surveillance (HIV, HBV and HCV)
● Water and outdoor air quality for large urban centres.
● Regular periodic surveys will be undertaken for risk factors of non-
communicable diseases (anthropometry, physical activity , blood
pressure, tobacco and diet) by outsourcing to an agency.

29. Monitoring
● Monitoring is the process of observing whether an activity or service is
occurring as planned.
● It implies systematic and purposeful observation, aiming to identify any
diversion from the planned course of action.
● It is a routine tracking of program using input, process, output and
outcome data collected on a regular and ongoing basis. This helps
identify the need for more formal evaluation of activities and find timely
solutions to the problems.

31. Health management information system
● Web-based monitoring system developed by the Ministry of Health and Family
Welfare under the National Health Mission.
● Its purpose is to monitor the performance of programs and services provided through
the large network of health facilities across rural and urban areas by the use of
information technology and provide timely feedback to improve the performance.

36. Training management
information system
DYNAMIC DATABASE
● Real-time training
● Registration
● Certificate generation
● Post-training evaluation
● Post-training deployment of NRHM staff
• Single window
• Two types of database
STATIC DATABASE
● Training guidelines
● Training manuals
● Course content
● Circulars

38. References
• Basic Epidemiology, Bonita page no. 127, 129-130,
• IAPSM textbook of Community Medicine, page no 154, 303, 365,
793, 884, 529