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Integrated Disease Surveillance Project
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.
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Introduction to the Integrated Disease Surveillance Project by Dr. Sandeep Das, highlighting the role of AIIMS.
Definition of surveillance in epidemiology; systematic collection and dissemination of data.
Key questions answered by surveillance: disease demographics, incidence, origins, timelines, causes, and required actions.
Timely actions through effective surveillance can prevent potential cases in outbreak scenarios.
Key components of surveillance systems: detection, data collection, analysis, feedback, and responses.
Overview of historical health programs in India and identification of gaps in integration and data usage.
Introduction to NSPCD launched in 1997-98, covering 101 districts, focusing on outbreak reporting.
IDSP: decentralized, state-based surveillance program initiated in 2004, funded by the World Bank.
Details on IDSP's rollout across various states by phases from 2004 to 2007.
Goals of IDSP including establishing a decentralized system and integrating existing surveillance efforts.
List of diseases monitored through regular surveillance, including communicable and non-communicable diseases.
Categories of surveillance: sentinel, regular periodic surveys, and monitoring various health conditions.
Key components integral to IDSP's approach: decentralization, IT use, lab strengthening, and workforce development.
Definitions of different surveillance classifications: syndromic, presumptive, and confirmed.
Who conducts syndromic surveillance and the diseases categorized under this method.
Process of presumptive surveillance conducted by medical officers, including laboratory confirmation.
Overview of reporting forms for health workers concerning suspect, probable, and lab-confirmed cases.
Levels of laboratory responsibility and requirements for reporting cases at various lab types.
Hierarchical structure of IDSP with Central, State, and District Surveillance Units.
Responsibilities of the National Surveillance Unit in planning, monitoring, and coordinating surveillance activities.
Roles and responsibilities of the State Surveillance Unit including data analysis and rapid response coordination.
Duties of the District Surveillance Unit in data collection, project monitoring, and training coordination.
Comparison of public health sector roles in rural versus urban areas, including different health facilities.
Detailed flow of information relating to weekly surveillance activities from district to central units.
Key performance indicators for evaluating the timeliness and adequacy of surveillance reporting and responses.
Networking relationships of the Central Surveillance Unit with various health programs and organizations.
Different levels of surveillance triggers to respond to outbreaks, specifying local, regional, and state-level actions.
Conditions identifying potential outbreaks including clustering of cases, unusual case increases, and more.
Introduction to IHIP, a web-based system for real-time data reporting and health management.
Goals and objectives of the SHOC for managing disease outbreaks and enhancing response mechanisms.
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Integrated Disease Surveillance Project
- 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 weneed 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 timelyaction in controlling an outbreak through effective surveillance action Potential cases prevented Response 1st case
- 5. Key elements ofa 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 majorhealth 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 thegaps? ➔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 Programmefor 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.
- 10. IDSP ➔ IDSPis 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. ➔ PhaseI (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 ➔ Toestablish 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 diseasesDisease 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 SurveillanceCategories 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 inIDSP ➔ 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 Levelof 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 StateSurveillance 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.
- 28. State Surveillance Unit 1. Collation andanalysis 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.
- 30. District Surveillance Unit • Collation andanalysis 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 UrbanAreas 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 ofWeekly 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 performanceindicators ❖ 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 ofreports 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 thecentral 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 triggerlevel 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 ofan 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 InformationPlatform ● 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: ○ “Toprovide 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.