Presenter - Dr. Prateek Singh

Moderator - Dr. Panna Lal

INTEGRATED DISEASE

SURVEILLANCE PROJECT (IDSP)

Plan of Presentation Introduction Surveillance- definition and elements & need of

surveillance. IDSP?Aims and objective

Core conditions

Administrative structure

DEIT

Reporting formats

Monitoring and evaluation

SWOT analysis

The burden of disease in India is one of the highest in the world.

Triple burden of infectious diseases. 1. Those infectious diseases that are

prevalent & for which preventive measures are not yet available.

2. Diseases that are prevalent because of insufficient public health measures. Industrialized nations have controlled with the efficient application of the principles of public health.

3. Diseases perpetuated by the prevalence of vectors as well as vertebrate fauna, and the ecological determinants which are specific to our geo-climatic features.

INTRODUCTION

Non-infectious diseases tend to be multi-factorial and are therefore, less amenable to control measures.

Planning for disease prevention and control depends upon the disease epidemiology, that can be made available through proper surveillance.

Defined as the ongoing systematic collection, collation, analysis and interpretation of data and dissemination of information for public health.

-Without action data collection is not surveillance.

-Activities related to case management of affected patients even though important for public health system is not surveillance activity.

SURVEILLANCE

1. Early recognition of cases or cluster of cases.

2. Assess the public health impact of health events or determine and measure trends.

3. Demonstrate the need for public health intervention programmes & resources & allocate resources during public health planning

4. Monitor effectiveness of prevention & control measures.

5. Identify high risk groups or geographical areas.

6. Develop hypothesis that lead to analytic studies about risk factors for disease causation, propagation or progression.

WHY DO WE NEED TO DO SURVEILLANCE?

Detection & notification of health event.Investigation & confirmation

(epidemiological, clinical, laboratory).Collection of data.Analysis & interpretation.Feedback and dissemination of results.Response – for prevention and control.

Key elements of surveillance system

Success of surveillance upon 3RRecognition.ReportingResponse.

De-centralized, state based surveillance programme.

Launched in November 2004 with world bank assistance.

Initially CSU located at Nirman Bhavan Shifted to NICD(now called NCDC) in

2006.Intended to detect early warning signals

of impending outbreaks & help initiate an effective response in a timely manner.

What is IDSP?

1. To establish a de-centralized district based system of surveillance for communicable and non-communicable diseases so that timely & effective public health actions can be initiated in response to health challenges in the urban & rural areas.

2. To integrate existing surveillance so as to avoid duplication and facilitate sharing of information across all disease control programmes and other stake holders so that valid data are available for decision making at district, state and national levels.

OBJECTIVES

1. Integrating & decentralizing disease surveillance & response mechanisms

2. Strengthening Public Health Laboratories

3. Using Information Technology and Networking in disease surveillance

4. Human Resource Development5. Operational activities and response6. Monitoring and evaluation.

Project components

Phase – I (2004-05): Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, Maharashtra, Madhya Pradesh, Uttaranchal, Himachal Pradesh & Mizoram (nine states);

Phase – II (2005-06): Chhattisgarh, 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, Lakshadweep.

PHASING OF IDSP COVERING THE STATES OF INDIA

Regular surveillance.Sentinel surveillance.Regular periodic surveys.

CORE CONDITIONS UNDER SURVEILLANCE IN IDSP

Vector borne disease- Malaria Water borne disease- Acute Diarrhoeal

Disease(cholera), TyphoidRespiratory disease- TuberculosisVaccine preventable diseases- MeaslesDisease under eradication- PolioOther conditions- Road Traffic Accidents, Other international commitments- Plague, Yellow

feverUnusual clinical syndromes (causing death/ hospitalisation) -

Meningoencephalitis/Respiratory Distress, Hemorrhagic fevers, other undiagnosed conditions

REGULAR SURVEILLANCE

Sexually transmitted diseases- HIV/HBV, HCV

Other conditions- Water quality, Outdoor air Quality

SENTINEL SURVEILLANCE

NCD Risk factors- Anthropometry, Physical Activity, Blood Pressure, Tobacco, Nutrition

State specific diseases- Dengue, Japanese Encephalitis,

Leptospirosis

REGULAR PERIODIC SURVEYS

IDSP function independently at the district level.

The ownership of the programme is at the state level

At national level CSU will provide technical support, and guidance along with financial support

ADMINISTRATIVE STRUCTURE

At National, State & District levels IDSP primarily has two bodies: Surveillance committee & Surveillance Unit.

The Committee would be a body for taking policy & strategic decisions, monitoring & coordinating with stakeholders.

The Unit would be responsible for implementing various activities envisaged under the Project.

Focal point of all surveillance related activities at the periphery would be the District Surveillance Unit.

DSU will receive data from both urban and rural reporting units.

Administrative structure contd.

District Surveillance Committee

Chairperson* District Surveillance Committee

District Surveillance Officer (Member Secretary)

CMO(Co. Chair)

RepresentativeWater Board

Superintendent Of Police

IMA Representative

NGORepresentative

District PanchayatChairperson

Chief District PHLaboratory

Medical CollegeRepresentative

if any

RepresentativePollution Board

District Training Officer(IDSP)

District Data Manager(IDSP)

District Program ManagerPolio, Malaria, TB, HIV - AIDS

* District Collector or District Magistrate

District surveillance officer (DSO)Data managerData entry operatorAccountantClass IV

District surveillance unit

There are 3 parallel systems of surveillance that will be established

1. Syndromic- paramedical personnel community member

2. Presumptive- medical officer3. Confirmed – lab based

Surveillance components

STRUCTURAL FRAMEWORK OF IDSP

CSU

SSU

DSU

Urban Surveillance

Rural Surveillance

District HIV/AID

District TB lab

District hospitals

ESIRailway hospWater deptCGHSCorporationHospPollutionICMR lab

Medical colleges

Urban SSPS

District malaria

Police

Rural SSPS-15

PHCSubcentersInformers

Rural medical colleges

DEIT is multifaceted team that looks into the various aspects of an outbreak.

There will be a DEIT team at each district.DEIT will investigate each and every

outbreak to reveal why the outbreak occurred, identify the high-risk groups and areas and evaluate control measures.

DISTRICT EPIDEMIC INVESTIGATING TEAM (DEIT)

1. Nodal officer2. The clinician3. The microbiologist4. District administrative nominee.(not below

the level of tahsildar)5. Any other person in the list of surveillance

consultants with DSO.6. The health assistant.

COMPOSITION OF DEIT:

Public health sector Private health sector

Rural CHCs, district hospital

Sentinel private practitioners & sentinel hospitals

Urban Urban hosp, ESI/railway/medical college hospitals

Sentinel private nursing homes, sentinel hospitals, medical colleges, private and NGO labs.

REPORTING UNITS PARTICIPATING IN REGULAR PASSIVE SURVEILLANCE UNDER IDSP:

Other sentinel sites ANC sites NACO- HIV/HBV/HCV Surveillance water board,Pollution control board,District police office for road traffic accidents.

MO of PHC will report weekly on MONDAY to CHC . Hard copy of form A & form L will also be sent from PHC to CHC once weekly.

Zero reporting is mandatory.The mode of transmission will be in any of the

following methods: -letter -fax -Telephone -Direct courier.

Role of various functionaries in regular surveillance

The designation of the person responsible for data compilation and transmission at each level is identified below:

PHC- pharmacistCHC- computer/ pharmacistSentinel private practitioners (SPPs)- Medical

officerDistrict hospital- Computer/ pharmacistMedical college- Statistical officerLaboratory- MO incharge/ lab technician.

DATA ANALYSIS SHOULD IDEALLY BE DONE AT EACH LEVEL

But the main people responsible for analysis are:

DSO- for rural areas. Corporation health officer- urban areas

ANALYSIS

No.

Reports Daily 1

Weekly

Monthly

Yearly

1 Timeliness & completeness of reports

  √ √ √

2 Description by time, place & person

√ √ √ √

3 Trends over time √ √ √ √

4 Checking for crossing of threshold levels

√ √

5 Comparison between reporting units

√

6 Comparison between public & private

√

7 Comparison between disease and lab data

√

FREQUENCY OF REPORTS AND ANALYSIS

Integrating private practitioners in surveillance. (SPPs)

Objective: 1. to identify disease outbreaks early. 2. to find out trends of disease over a

period of time.The DSO will be responsible for integrating SPPs in

each district.Selection criteria: Willingness to participate. SPPs who are likely to come across a large no. of

cases of disease of interest. Previous experience with collaboration on health

programme with the public health system.

INTERSECTORAL COORDINATION & SOCIAL MOBILIZATION

They are currently not contributing effectively to surveillance activities in the country.

The following depts. In the college will be the sites for reporting the diseases under surveillance.

Principal/ medical suprintendent(chair)Community medicineMedicine PediatricsChest and tuberculosisMicrobiologyCardiology

MEDICAL COLLEGES

In addition to data collection medical colleges can contribute to the IDSP as

Reference laboratoryQuality assuranceTrainingEpidemic investigationNCD surveillance

Health workers enjoy a good relationship with their communities and are in regular contact with village elder’s particularly ladies, pradhan panchayat members, chauwkidar, and other community members who tell them about the occurrence of disease.

All these individuals and organizations are identified as community stakeholders

SOCIAL MOBILIZATION AND COMMUNITY PARTICIPATION

Rural areasPanchayat and its members; school teachers;

community based organisations e.g mahila mandals & youth clubs; NGOs; elected representatives from the area; private rural practioners.

Urban areasMunicipal councilors; representatives of professional

bodies e.g. IAP, IMA, API; NGOs; chemists organizations; leading private practitioners & owners of hospitals and nursing homes.

List of stake holders

Following risk factors will be measured under IDSP :1. Tobacco 2. Alcohol3. Raised BP4. Obesity5. Diet6. Physical activity7. Diabetes Mellitus8. High serum cholesterol In addition demographic(sex, urban/rural

residence), socio-economic variables(education, occupation, income), past and family history of cardiovascular diseases, diabetes, and hypertension will be measured

NON COMMUNICABLE DISEASE RISK FACTOR SURVEILLANCE

A pre-tested simple questionaire has been prepared for carrying out the survey. These questionnaires has already been developed by WHO(STEPS) modified for the Indian scenario and is already in use for sentinel surveillance for cardiovascular risk factors in 10 selected industrial population all over india

SURVEY INSTRUMENT

A practical physiological consideration is that since survey requires the participant to fast overnight it would commence early in the morning and finish early in the afternoon (6:00 am to 1:00 pm). The staff can utilize the rest of the day in coding the forms, dealing with lab specimens and other documentation.

TIMING OF SURVEY

METHODS Both formally and informallyFormal methods:Newsletters.Monthly review meetings. Informal feedback .Electronic communication.

FEEDBACK

Needed for high quality of surveillance.It should be constant and supportive to

motivate the staff.INDICATORS Weekly Monthly yearly

MONITORING AND SUPERVISION

Timeliness of reports.Completeness of reports.

Apply for all levels and in both urban and rural settings

WEEKLY INDICATORS

Completeness of report for the period XXXX no. of reporting units that have been complete during the

specified period Total no. of reporting units

Timeliness of report for the period XXXNo. of reporting units that have been on time during the

specified period

Total no. of reporting units

% of outbreaks that have been detected No. of outbreaks detected by the surveillance system

Total no. of outbreaks during that period

MONTHLY/ QUARTERLY INDICATORS

Completeness of report for the yearTimeliness of report for the yearPercentage of outbreaks that have been

detectedPercentage of newsletters published

ANNUAL INDICATORS

INPUT INDICATORSo % of staff at each level trained of

reporting units at each level with functioning computers

o % of reporting units using case definitionso % of districts with functioning RRTso % of districts with functional labs.

Other indicators

o Percentage of outbreaks that have been detected

o Percentage of outbreaks have been detected within one incubation period.

o Percentage of outbreaks have been confirmedo Percentage of outbreaks have been

investigatedo Percentage of outbreaks have been

investigated within 48 hours of detectiono Percentage of outbreaks have a CFR within the

accepted norms.

OUTBREAK RESPONSE INDICATORS

o Proportion of lab specimens received in good condition.

o Proportion of lab specimens received with properly completed lab forms.

o Proportion of lab specimens results reported within seven days after receipt of specimens in the lab.

LAB PERFORMANCE INDICATORS

SWOT Analysis

Integration of different stakeholders from community.De-centralised state based approachNIC has already installed the data center equipments at

most of the sites(776/800 sites) for speedy online transmission of data.

Training center equipments (378/400 by NIC & 367/400 by ISRO) for managing live virtual classroom for training, interactive electronic discussion and monitoring of project related activities.

Training of state/district surveillance team have been completed for 28 states and UT and partially completed in 3 states

24*7 call center has been established for receiving disease alerts from all over India. toll free number 1075

STRENGTH

Indicators have been made for monitoring and evaluation of the ongoing activities

Reporting format has been designed in simple and easy way.

Broadband services is provided by BSNL which has country wide network.

STRENGTH CONT.

SHORTNESS OF TRAINED MANPOWER LIKE ENTOMOLOGIST(17/35 STATES), EPIDEMIOLOGIST.

OUT OF PROPOSED 50 LABORATORIES ONLY 26 (IN 18 STATES) LABS HAVE COMPLETED THE PROCEDURE OF PROCUREMENT.

NO INCENTIVE IS GIVEN FOR THE

WEAKNESS

INDIA IS LEADING COUNTRY IN TRAINED IT PROFESSIONALS

TAPPING THE POTENTIAL OF VAST NETWORK & COVERAGE OF MOBILE USAGE FOR RAPID TRANSFER OF DATA THROUGH sms ESPECIALLY IN POORLY ACCESIBLE AREAS .

OPPORTUNITIES

INCREMENTAL OPERATIONAL COST FOR MAINTENANCE OF EQUIPMENTS, COMPUTER HARDWARE ACCESSORIES, VEHICLES ETC.

MAJOR FUNDING IS FROM EXTERNAL SOURCES.

70% OF HEALTH CARE IS PROVIDED BY THE PVT HEALTH SECTOR.

THREAT

IDSP training manual for state and district surveillance officers, 2nd edition Feb. 2006

IDSP operational manual for district surveillance unit.

Brief note on IDSP, December 2010 issued by national centre for disease control (DGHS).

J. Kishore’s National Health Programs Of India, 9th edition.

D.K. Taneja, Health policies and programs in India, 9th edition

REFERENCES