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INTEGRATED
DISEASE
SURVEILLANCE
PROGRAMME
- Critical Review
Dr. Gaurav Kamboj
Outline of Presentation
• What is Surveillance?
• Need for IDSP
• Introduction to IDSP
• Objectives
• Diseases and Conditi...
Surveillance in its simplest form is collection of
information for action.
Disease Surveillance is a systematic process of...
Need For IDSP?
• Because data was being COLLECTED SEPARATELY AND
USED SEPARATELY by the various program managers
• Data wa...
Importance of timely action in controlling an
outbreak through effective surveillance action
National Surveillance Programme
for Communicable Diseases
(NSPCD)
• Launched in 1997-98 in five pilot districts of the cou...
IDSP- Introduction
• IDSP is a decentralized, state based surveillance
programme in the country
• GoI in Nov 2004 ; totall...
Phasing of Integrated Disease Surveillance Project
Phase II (05-06)
Phase-I (04-05)
Phase III (06-07)
Objectives
• To establish a decentralized State based system for
communicable diseases to detect the EARLY WARNING
SIGNALS...
Integration
• All National Disease Control Programmes
• Health & Non Health sectors (Police, PCBs, Water supply)
• Includi...
Disease And Conditions Covered
Under IDSP
The disease to be included in the surveillance
program will be based on the foll...
Type of disease Disease
Vector borne diseases Malaria
Water borne diseases Diarrhoea, Cholera, Typhoid, Jaundice
Respirato...
Other conditions under
surveillance
Type of surveillance Categories Conditions
Sentinel surveillance STDs HIV/HBV/HCV
Othe...
State Specific Diseases for Haryana
 Meningococcal Meningitis
 Dengue
 Viral Hepatitis
 J.E
NCD Surveillance
Project components & Highlights
• Limited number of conditions based on state perceptions
(13core, 5 state priority condit...
Organizational Structure
National Surveillance Committee
Central Surveillance Unit
State Surveillance Committee
State Surv...
Chairperson*
National surveillance
committee
Director General
Health Services
(Co. Chair)
Director General
ICMR
PD
(IDSP)
...
Central Surveillance Unit
• NCDC, Delhi.
• National Project Officer(NCDC): Dr. Jagvir Singh,
Additional Director
• Execute...
Chairperson*
State surveillance committee
Director Health Service
Director Public
Health (Co. Chair) Director Medical Educ...
State Surveillance Unit
1. State Surveillance Officer (Joint Director)
2. Rapid Response Team Representatives
3. Consultan...
SSU- Haryana
• Director (SSO) - Dr. Kamla Singh
• Deputy Director - Dr. Aparajita Sondh (08288021859)
• State Nodal Office...
District Surveillance Committee
Chairperson*
District Surveillance Committee
District Surveillance Officer
(Member Secreta...
District surveillance
officer
Accountant
Administrative
assistant
Data entry
operators (2)
Response team
•Epidemiologist
•...
DSU- Rohtak
• Located at Civil Surgeon’s Office, Rohtak
• Distt Surveillance Officer - Dr. Ved Pal
• Epidemiologist - Dr V...
Epidemiologist
(Nodal officer)*
District
administration
nominee
Support Staff:
Entomologist**
Health assistants
Laboratory...
RAPID RESPONSE TEAM - ROHTAK
IDSP Committee – PGIMS Rohtak
• Chairperson - Dr. Ashok Chauhan (M.S.)
• Co-ordinator - Dr. R.B. Jain (Prof, Comm.
Med.)
•...
Formats And Reporting
S – FORM (Syndromic)
P – FORM (Presumptive)
L – FORM (Laboratory)
REPORTING SYSTEM –WEEKLY REPORTING...
NOT BEING USED
Form Level of Laboratory Responsibility of
Reporting
Form L1 Peripheral Laboratory at
PHC/CHC
Laboratory Assistants/
Techn...
In the year 2008-09, two Districts priority labs
i.e. Hisar & Panchkula and One State Lab i.e.
Karnal have been upgraded
H...
Line listing of
cases is
inappropriate
Syndromic surveillance
Types of case definitions in use
Case definition Criteria used Who does it
Syndromic Clinical pattern Paramedical personne...
Trigger Events
Methods Of Data Collection
• Universal
– Routine reporting ( institutional based or passive
reporting)
• Need and area spe...
S
Programme Officers
D.S.U.
S.S.U.
C.S.U.
INFORMATION FLOW
WEEKLY SURVEILLANCE SYSTEM
Other Hospitals:
ESI, Municipal
Rly....
• Reports consolidated from various deptt:
•Medicine, Gynae-Obs, Pediatrics, TB chest, Skin & VD
• Validity of reports is ...
Linkages at Central level
Outbreak Investigation
& Rapid Response
NCD Surveillance MIS & Report
Programme Monitoring
NVBDC...
Level of response
• Specified in the form of trigger:
Trigger-1 -- Local response by health worker, M.O.
Trigger-2 -- Dist...
Warning signs of an impending
outbreak
1. Clustering of cases or death in time and/ or space
2. Unusual increase in cases ...
Last outbreak in Distt. Rohtak
Diarrhoea in Vill. Gilohar Kalan in
2013
Cause- Unavailability of Potable
drinking water
Outbreaks
Majority of the reported outbreaks were of Acute Diarrhoeal
diseases, Food Poisoning, Measles etc.
0
200
400
600...
Training Centre Equipments
• ISRO has installed 330 out of 400 EDUSAT sites (6 in
Haryana)
• E-Learning Portal ( http://e-...
New Initiatives
1. Alerts through IDSP call center
Call Centre operational with 1075 (1800-11-4377)
toll free number since...
3. Media Scanning And
Verification Cell
• Established in July 2008 at NCDC, Delhi.
• Objective: To provide the supplementa...
4. Entomology Unit
• Established in December 2008
• Vector borne epidemic prone diseases (VBD) like Malaria,
JE, Dengue, C...
Performance Indicators
• Number & % of districts providing monthly surveillance
reports on time – by state and overall *
•...
Human Resource in Haryana
S.No. Position No.
Sanctioned
No. Working
1. State Surveillance Officer 1 1
2. State Nodal Offic...
CONCLUSION- CRITICAL REVIEW
(IDSP)
Strengths of IDSP
• IDSP has clear cut ownership by the Govt. with the
National Cell located in the Union Ministry of
Heal...
• Standard Formats, Operations & Training Manuals
• Compilation of disease outbreaks/alerts is done on
weekly basis and th...
National Issues
• Media attention an important consideration for
response
• ‘Overworked’ clinicians so poor records, heavy...
State issues
• State RRT not utilized to full potential
• Regional labs strengthened but diagnosis is not
enhanced & incre...
District issues
• Surveillance is done by existing personnel after
training in specific modules- reduces cost of service.
...
• Surveillance failure : media reports first
• Weekly reports incomplete, irregular (UNDER
REPORTING)
• Monthly reports al...
• All activities being undertaken presently under
IDSP are proposed to continue by NCDC under
NRHM in the 12th Five-Year P...
• Given the huge area and population in India, effective
surveillance of diseases faces many challenges and a
lot of impro...
References
• J.Kishore’s National Health Programmes of India 10th
Edition . century publications
• Park’s Textbook of Prev...
“Unless you are looking for it,
you will not find it”
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
IDSP- Integrated Disease Surveillance Programme
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IDSP- Integrated Disease Surveillance Programme

Integrated Disease Surveillance Program: The strategies, components and framework of IDSP along with Critical review of the program

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IDSP- Integrated Disease Surveillance Programme

  1. 1. INTEGRATED DISEASE SURVEILLANCE PROGRAMME - Critical Review Dr. Gaurav Kamboj
  2. 2. Outline of Presentation • What is Surveillance? • Need for IDSP • Introduction to IDSP • Objectives • Diseases and Conditions under IDSP • Organisational structure • Formats and Reporting • Case definitions and Trigger events • Information flow and linkages • Newer Initiatives • Performance indicators • Conclusion- Critical Review
  3. 3. Surveillance in its simplest form is collection of information for action. Disease Surveillance is a systematic process of reporting of various diseases of public health importance, as & when & where they occur, to a designated agency responsible for taking effective interventional steps. Its success depends on 3Rs: Recognition- quality of diagnosis, case definitions Reporting- timely and complete Response- analysis and effective feedback What is Public Health Surveillance ?
  4. 4. Need For IDSP? • Because data was being COLLECTED SEPARATELY AND USED SEPARATELY by the various program managers • Data was never used comprehensively at national level • Huge resources were being used separately and sometimes DUPLICATION OF FUNDS also occurred • The epidemiological impact of the outbreak control measures can be expected to be significant only if these measures are APPLIED IN TIME.
  5. 5. Importance of timely action in controlling an outbreak through effective surveillance action
  6. 6. National Surveillance Programme for Communicable Diseases (NSPCD) • Launched in 1997-98 in five pilot districts of the country • Extended to cover 101 Districts in all 35 states and UTs in the country • States were the implementing agencies and NICD(now NCDC) Delhi was the Nodal agency • Based on outbreak reporting (as and when outbreaks occur) with weekly reporting of epidemic prone diseases directly from Districts (including nil reporting) to the Centre.
  7. 7. IDSP- Introduction • IDSP is a decentralized, state based surveillance programme in the country • GoI in Nov 2004 ; totally funded by World Bank • Launched 3 Phases • Haryana- Launched on 1.4.2005 (2nd phase) • Extended for 2 years in March 2010- WB funded only for 9 states & CSU, Rest funded by Domestic budget • Continued during 12th Plan under NRHM with total domestic funding of Rs. 640.40 Crore
  8. 8. Phasing of Integrated Disease Surveillance Project Phase II (05-06) Phase-I (04-05) Phase III (06-07)
  9. 9. Objectives • To establish a decentralized State based system for communicable diseases to detect the EARLY WARNING SIGNALS, so that the timely and effective public health actions can be initiated • To improve the efficiency of disease control programs & facilitate sharing of relevant information with various stakeholders so as to detect disease trends over time & evaluate control strategies
  10. 10. Integration • All National Disease Control Programmes • Health & Non Health sectors (Police, PCBs, Water supply) • Including NCD & CD • Laboratory information • Private sector & NGOs • Academic Institution & Medical Colleges • IEC activities • Training No allaince 13 Pvt Practitioners + 10 Pvt Labs Monthly meeting with IMA, NIMA Red cross society, Senior citizen association, Rotary club
  11. 11. Disease And Conditions Covered Under IDSP The disease to be included in the surveillance program will be based on the following criteria: • Does the disease condition have high health impact? (morbidity, mortality, disability) {Malaria, NCD risk factors, Road Traffic Accidents (RTA)}. • Does it have significant epidemic potential? (Cholera, Measles). • Is it a target of a specific national, regional or international disease control programme? (HIV, TB, Polio). • Will the information collected lead to significant public health action?
  12. 12. Type of disease Disease Vector borne diseases Malaria Water borne diseases Diarrhoea, Cholera, Typhoid, Jaundice Respiratory diseases Tuberculosis, ARI Vaccine preventable diseases Measles Disease under eradication Polio Other conditions Road traffic accidents International commitment Plague, Yellow fever Unusual syndromes (Causing death/hospitalization) Meningoencephalitis/ Respiratory distress Hemorrhagic fever Other undiagnosed condition Disease And Conditions Covered Under IDSP
  13. 13. Other conditions under surveillance Type of surveillance Categories Conditions Sentinel surveillance STDs HIV/HBV/HCV Other conditions Water quality Outdoor air quality Regular periodic surveys Non-communicable disease risk factors (ICMR) Anthropometry Physical activity Blood pressure Tobacco Nutrition Blindness Additional state priorities Up to five diseases
  14. 14. State Specific Diseases for Haryana  Meningococcal Meningitis  Dengue  Viral Hepatitis  J.E
  15. 15. NCD Surveillance
  16. 16. Project components & Highlights • Limited number of conditions based on state perceptions (13core, 5 state priority conditions) for which pubic health response is available. • CSU integrated with National Center for Disease Control (NCDC) • SSU & DSU in all states & districts • Strengthening Public Health Laboratories (microbiologist, grant of 2 lakh/yr) • Training of SSU/DSU/RRT (over in all states & UT) • IT & Networking & Human Resource Development • IDSP Portal and Self learning e-module- 2weeks course
  17. 17. Organizational Structure National Surveillance Committee Central Surveillance Unit State Surveillance Committee State Surveillance Unit District Surveillance Committee District Surveillance Unit
  18. 18. Chairperson* National surveillance committee Director General Health Services (Co. Chair) Director General ICMR PD (IDSP) JS (Family Welfare) Director NICD Director NIB National Program Managers Polio, Malaria, TB, HIV - AIDS Consultants (IndiaCLEN / WHO / Medical College /others) NGO IMA Representative Representative Ministry of Home Representative Ministry of Environment National Surveillance Officer (Member Secretary) * Secretary health and secretary family welfare National surveillance committee The committee will be responsible for major policy decisions in: implementing IDSP, coordination with other ministries, departments and organizations and review progress in implementation of IDSP.
  19. 19. Central Surveillance Unit • NCDC, Delhi. • National Project Officer(NCDC): Dr. Jagvir Singh, Additional Director • Executes the approved annual plan of action for IDSP and monitor progress in states. • Conduct central level training and review meetings with SSOs. • Analyze data received from states and provide feed back on trends observed. • Form and supervise the movement of RAPID RESPONSE TEAM at the central level to supplement efforts of states during disaster or epidemics of a very large magnitude
  20. 20. Chairperson* State surveillance committee Director Health Service Director Public Health (Co. Chair) Director Medical Education Representative Water Board NGO Medical Colleges State Coordinator Representative Department of Home State Program Managers Polio, Malaria, TB, HIV - AIDS Head, State Public Health Lab IMA RepresentativeRepresentative Department of Environment State Surveillance Officer (Member Secretary) State Training Officer State Data Manager IDSP State surveillance committee * State health secretary
  21. 21. State Surveillance Unit 1. State Surveillance Officer (Joint Director) 2. Rapid Response Team Representatives 3. Consultant (Training & Technical) 4. Consultant (Procurement & Finance) 5. Data Manager 6. Data Entry Operators This unit will be responsible for : The collation and analysis of all data being received from the districts and transmitting the same to the Central Surveillance Unit.
  22. 22. SSU- Haryana • Director (SSO) - Dr. Kamla Singh • Deputy Director - Dr. Aparajita Sondh (08288021859) • State Nodal Officer - Dr. Jyoti Kaushal (09876500239) • St. Consultant Training - Dr. Ravinder Singh (09463912215) • State Epidemiologist - Ms. Neha Narula (09872810014) • State Microbiologist - Mr. Sombir (09815195544) • Data manager - Mr. Sandeep Thakur (09501971141) Reporting Units- 3231 (Public – 3108, Pvt – 123)
  23. 23. 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
  24. 24. District surveillance officer Accountant Administrative assistant Data entry operators (2) Response team •Epidemiologist •Microbiologist •Clinicians Chief medical and health officer District surveillance unit
  25. 25. DSU- Rohtak • Located at Civil Surgeon’s Office, Rohtak • Distt Surveillance Officer - Dr. Ved Pal • Epidemiologist - Dr Vivek Mor • Data manager - Vacant • Data operator - Smt. Rekha Reports from all reporting units (Public- 189, Pvt- 23) is received by Tuesday, Compiled and send SSU till Wednesday and Entered into IDSP portal by Thursday
  26. 26. Epidemiologist (Nodal officer)* District administration nominee Support Staff: Entomologist** Health assistants Laboratory technician Clinician (Pediatrician/ Physician) Microbiologist ** Only when vector borne disease is suspected District epidemic investigating team (DEIT) (=Rapid Response Team) No participation Not below the rank of Tehsildar
  27. 27. RAPID RESPONSE TEAM - ROHTAK
  28. 28. IDSP Committee – PGIMS Rohtak • Chairperson - Dr. Ashok Chauhan (M.S.) • Co-ordinator - Dr. R.B. Jain (Prof, Comm. Med.) • Members – Dr. Pardeep Khanna (Sr. Prof. and HOD, Comm. Med.) – Dr. J.S. Malik (Sr. Prof. and Head-II, Comm. Med.) – Head Microbiology, Medicine, Paeds, Gynae, T.B. Chest • Meet once in 3 months • Last meeting was about 5 months back
  29. 29. Formats And Reporting S – FORM (Syndromic) P – FORM (Presumptive) L – FORM (Laboratory) REPORTING SYSTEM –WEEKLY REPORTING (Mon- Sun) DAILY REPORTING IN CASE OUTBREAK HAS BEEN IDENTIFIED
  30. 30. NOT BEING USED
  31. 31. Form Level of Laboratory Responsibility of Reporting Form L1 Peripheral Laboratory at PHC/CHC Laboratory Assistants/ Technician through MO I/C Form L2 District Public Health Lab, Labs of District Hospital, Private and other Hospitals & Private Labs. I/c Microbiologist/ Pathologists Form L3 Labs in Medical Colleges, other tertiary institutions, state reference labs Reference Labs. Head, Microbiologist Department Laboratory Reporting
  32. 32. In the year 2008-09, two Districts priority labs i.e. Hisar & Panchkula and One State Lab i.e. Karnal have been upgraded Haryana
  33. 33. Line listing of cases is inappropriate
  34. 34. Syndromic surveillance
  35. 35. Types of case definitions in use Case definition Criteria used Who does it Syndromic Clinical pattern Paramedical personnel and members of community Presumptive Typical history and clinical examination Medical officers of PHC/CHC Confirmed Clinical diagnosis by a medical officer and positive laboratory identification Medical officer and Laboratory staff
  36. 36. Trigger Events
  37. 37. Methods Of Data Collection • Universal – Routine reporting ( institutional based or passive reporting) • Need and area specific: – Sentinel surveillance – Active surveillance (active search for cases) – Vector surveillance – Laboratory surveillance – Sample surveys – Outbreak investigations
  38. 38. S Programme Officers D.S.U. S.S.U. C.S.U. INFORMATION FLOW WEEKLY SURVEILLANCE SYSTEM Other Hospitals: ESI, Municipal Rly., Army etc Sub-Centres P.H.C.s C.H.C.s Dist. Hosp. Med. Col. P.H. Lab Pvt. Practitioners Nursing Homes Private Hospitals Private Labs Corporate Hospitals IDSP Portal : The IDSP portal is one stop portal which has facilities for data entry, view reports, outbreak reporting data, analysis, training modules and resources related to disease surveillance. All district are connected through Broad Band PGIMS Rohtak MAMC, Agroha
  39. 39. • Reports consolidated from various deptt: •Medicine, Gynae-Obs, Pediatrics, TB chest, Skin & VD • Validity of reports is doubtful seeing such a low no. of cases being reported • Reports of ONLY indoor cases is sent • No OPD reporting of presumptive cases from institution • Over-worked staff, Multi-tasking •No in-built mechanism of reporting
  40. 40. Linkages at Central level Outbreak Investigation & Rapid Response NCD Surveillance MIS & Report Programme Monitoring NVBDCP RNTCP RCH NACO W.H.O. E.M.R. CSU NCDC National Programs CBHI ICMR EMR-Emergency Medical Relief CBHI-Central Bureau of Health Intelligence
  41. 41. Level of response • Specified in the form of trigger: Trigger-1 -- Local response by health worker, M.O. Trigger-2 -- District level response by DSO, RRT Trigger-3 -- State level response to an established outbreak Trigger-4 -- National level response Trigger-5 -- International level response to an established outbreak.
  42. 42. Warning signs of an impending outbreak 1. Clustering of cases or death in time and/ or space 2. Unusual increase in cases or death 3. Even a single case of measles, AFP, cholera, plague, dengue or JE 4. Acute febrile illness of unknown etiology 5. Occurrence of two or more epidemiologically linked cases of meningitis, measles 6. Unusual isolate 7. Shifting in age distribution of cases 8. High vector density 9. Natural disasters.
  43. 43. Last outbreak in Distt. Rohtak Diarrhoea in Vill. Gilohar Kalan in 2013 Cause- Unavailability of Potable drinking water
  44. 44. Outbreaks Majority of the reported outbreaks were of Acute Diarrhoeal diseases, Food Poisoning, Measles etc. 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2008 2009 2010 2011 2012 2013 553 799 990 1675 1584 1964 No.ofoutbreaks Year
  45. 45. Training Centre Equipments • ISRO has installed 330 out of 400 EDUSAT sites (6 in Haryana) • E-Learning Portal ( http://e-learning.nic.in/Ims ), 2 weeks course, which has facility in managing virtual life classrooms for training (state/area specific discussion on disease surveillance activities), e-learning and interactive electronic discussion (chat rooms, boards, mailing lists) Information And Communication Network Installed in PGIMS, Rohtak with Dr. Dhruv Chaudhary Not used at all Don’t know how to operate
  46. 46. New Initiatives 1. Alerts through IDSP call center Call Centre operational with 1075 (1800-11-4377) toll free number since February 2008 2,77,395 lakhs calls have been received from beginning till 30th June, 2012 2. Community Based Surveillance Active involvement of community institutions and volunteers such as the PRI, VHSC, Mahila Mandals, Self Help Groups(SHG), Youth Clubs, School, NGOs, Traditional/ Private Health Care Providers Pilot project in 3 states viz., Maharashtra, Orissa and Karnataka.
  47. 47. 3. Media Scanning And Verification Cell • Established in July 2008 at NCDC, Delhi. • Objective: To provide the supplemental information about outbreaks • Method: National & local newspapers, Internet, TV channel screening for news items on disease occurrence. • Benefits of Media Scanning: – Increases the sensitivity & strengthen the surveillance system – Provide early warning of occurrence of clusters of diseases • 8-12 media alerts are being detected and verified per week. • A total of 2537 health alerts have been detected till November 2013 since its establishment.
  48. 48. 4. Entomology Unit • Established in December 2008 • Vector borne epidemic prone diseases (VBD) like Malaria, JE, Dengue, Chikungunya, Kala-azar, and Plague are of major public health concern. • Other diseases like KFD, tick typhus and other tick and mite borne diseases are being reported in the areas where they were not reported earlier. • Objectives- – Regular dissemination of data – Technical support – Entomological surveillance – Monitor and evaluate the timeliness and quality of IRS, ITN and distribution of larvivorous fishes.
  49. 49. Performance Indicators • Number & % of districts providing monthly surveillance reports on time – by state and overall * • Number & % of responses to disease specific triggers on time * • Number of districts : private sector contribution C/H/L • Number and % of districts & states publishing annual surveillance reports • Publication by CSU of consolidated annual surveillance report # assessed to be adequate *
  50. 50. Human Resource in Haryana S.No. Position No. Sanctioned No. Working 1. State Surveillance Officer 1 1 2. State Nodal Officer 1 1 3. DSO 20 20 4. Data Manager 21 16 5. Data Entry Operators 21 19 6. Epidemiologist 21 18 7. Microbiologist 3 2 8. Entomologist 1 0 9. RRTs Working in all districts
  51. 51. CONCLUSION- CRITICAL REVIEW (IDSP)
  52. 52. Strengths of IDSP • IDSP has clear cut ownership by the Govt. with the National Cell located in the Union Ministry of Health and Family Welfare • Functional integration of surveillance components of vertical programmes • Reporting of suspect, probable and confirmed cases (Standard case Definition and Trigger levels for graded response) • Strong IT component for data analysis
  53. 53. • Standard Formats, Operations & Training Manuals • Compilation of disease outbreaks/alerts is done on weekly basis and the weekly outbreak report generated by the CSU is shared with all key stakeholders every week including the Prime Minister’s Office. • Involvement of Private Sector- yields a better assessment of disease trends as major part of the population is dependent on them Strengths of IDSP
  54. 54. National Issues • Media attention an important consideration for response • ‘Overworked’ clinicians so poor records, heavy workload in the periphery causing a gap in the validity of data. • Poor routine flow of funds • Integration with Medical colleges is poor due to the jurisdiction differences between Directorate of Health and Directorate of Medical Education. • Multiple formats for different programmes
  55. 55. State issues • State RRT not utilized to full potential • Regional labs strengthened but diagnosis is not enhanced & increasing dependence on Centre thus causing delay in response. • Transfer/retirements of trained staff • Shortage of staff so multi-tasking for state and district • Lack of competent staff : Epidemiologist & Microbiologists, Short trainings incapable
  56. 56. District issues • Surveillance is done by existing personnel after training in specific modules- reduces cost of service. • But its disadvantage is that data collected is only from institutions (Sub-centres, PHCs, CHCs, District Hospitals and Tertiary care centres) and not from field surveys • This data does not include cases who do not seek health care thus indicating its limitations regarding quality. • District level reporting is not up to the mark due to lack of infrastructure, communication failure and lack of commitment.
  57. 57. • Surveillance failure : media reports first • Weekly reports incomplete, irregular (UNDER REPORTING) • Monthly reports also irregular • Peripheral and district labs are still not well equipped • Disease Surveillance Laboratories generate hazardous waste if not managed properly, carries the risk of infection for waste handlers and to the larger community • RRT has specialists from DH & MC so problem in rapid mobilization District issues
  58. 58. • All activities being undertaken presently under IDSP are proposed to continue by NCDC under NRHM in the 12th Five-Year Plan with objectives: – To strengthen/maintain a decentralized laboratory based IT-enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained RRTs. – To establish a functional mechanism for inter- sectoral co-ordination to tackle the zoonotic diseases Proposal for 2012-2017
  59. 59. • Given the huge area and population in India, effective surveillance of diseases faces many challenges and a lot of improvement is required to reach an optimal level of surveillance. • As IDSP has been implemented in stages with a small set of priorities with a decentralized approach, incorporating equal involvement of peripheral health care centres and laboratories, targeting cumulative data rather than individual data of cases, success can be achieved with passage of time. CONCLUSION
  60. 60. References • J.Kishore’s National Health Programmes of India 10th Edition . century publications • Park’s Textbook of Preventive and Social Medicine , K. Park 22nd Edition . Bhanot Publishers • Health Policies and Programmes in India , Dr. D. K. Taneja . 11th Edition . Doctors Publications • Integrated Disease Surveillance Project: Operational Manual For District Surveillance Unit • IDSP website http://idsp.nic.in • NCDC website http://ncdc.in • IDSP Haryana website http://haryanahealth.nic.in/menudesc.aspx?page=69
  61. 61. “Unless you are looking for it, you will not find it”

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