IDSP – Integrated Disease Surveillance Programme

Dr. Dharmendra Gahwai ( MD- Community Medicine, DAE )

DD/State Epidemiologist (IDSP)Directorate of Health Services

Raipur (C.G.)

Surveillance

Surveillance

• Surveillance is a French word meaning -

“ Watch with attention, suspicion and authority”

• Surveillance is defined as –

“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.”

Surveillance is –

“Information for Action”

Why do we need to do surveillance?

• To determine incidence of disease

• To know the geographical distribution or spread of disease

• To identify population at risk of that disease

• To monitor trend of disease over a long time period

• To capture the factors and condition responsible for occurrence and spread

of disease

• To predict the occurrence of epidemic and control of epidemic• To evaluate the effectiveness of an intervention or programme

What are the Key Elements of Surveillance System?

• Detection and notification of health event

• Investigation and confirmation (epidemiological, clinical, laboratory)

• Collection of data

• Analysis and interpretation of data

• Feed back and dissemination of results

Health Care System................Public Health Authority

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

• India have dual burden of Infectious Disease and NCD.

• Planning for disease prevention and controls depends upon the disease

frequency, distribution and determinants that can be made available through

proper surveillance.

• Surveillance has been identified as backbone of any health delivery system.

History

• NSPCD(National Surveillance Programme for Communicable Diseases) Launched in

• 1997 - 5 districts

• 1998 - 20 more districts

• 1999 - 20 more districts

• 2003 - more 101 districts

Nov. 2004 - IDSP launched

(up to 2010)

• 2010 - Extended for 2 more years

2012- Integrated Disease Surveillance Programme

The IDSP proposes a comprehensive strategy for improving disease surveillance and response through an integrated

approach.

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

• IDSP was formally launched in Chhattisgarh on

19th of November 2005.

Mission

• To strengthen the disease surveillance in the country by

establishing a decentralized State based surveillance system

for epidemic prone diseases to detect the early warning

signals, so that timely and effective public health actions can

be initiated in response to health challenges in the country at

the Districts, State and National level.

Objectives

• To establish a decentralized district based system of surveillance for

communicable and non-communicable diseases, so that timely and

effective public health actions can be initiated in response to health

changes in the urban and rural areas.

• To integrate existing surveillance activities to avoid duplication and

facilitate sharing of information across all disease control programmes and

other stake holders, so that valid data is available for health decision

making in the district, state and national levels

Components

• Integration and decentralization of surveillance activities

through establishment of surveillance units at Centre, State and District

level.

• Human Resource Development – Training of State Surveillance Officers,

District Surveillance Officers, Rapid Response Team and other Medical

and Paramedical staff on principles of disease surveillance.

• Information Communication Technology - for collection, collation,

compilation, analysis and dissemination of data.

• Strengthening of public health laboratories

What is integration?

• Sharing of surveillance information of various disease control

programmes.

• Developing effective partnership with heath and non health sectors in

surveillance. (Inter-sectoral Coordination).

• Including communicable and non communicable diseases in the

surveillance system.

• Working with the private sector and non governmental organization .

• Bringing academic institutions and medical colleges into disease

surveillance.

Conditions under regular surveillance

Type of disease Disease

Vector borne diseases Malaria

Water borne diseases Diarrhoea, Cholera, Typhoid

Respiratory diseases Tuberculosis

Vaccine preventable diseases Measles

Disease under eradication Polio

Other conditions Road traffic accidents

International commitment Plague

Unusual syndromes (Causing death/hospitalization)

Meningo-encephalitisRespiratory distressHemorrhagic feverOther undiagnosed condition

Other conditions under surveillance

Type of surveillance Categories Conditions

Sentinel surveillance STDs HIV/HBV/HCV

Other conditions

Water qualityOutdoor air quality

Regular periodic surveys

Non-communicable disease risk factors

AnthropometryPhysical activityBlood pressureTobacco, blood pressure

Nutrition

Blindness

Additional state priorities Up to five diseases

State-Specific DiseasesChhattisgarh

1. Leprosy

2. Viral Hepatitis

3. Neonatorum Tetanus

4. Diphtheria

State-specific diseases

• Madhya Pradesh, Uttaranchal – Diphtheria, neonatal tetanus, leprosy

• Maharashtra – Diphtheria, neonatal tetanus, leptospirosis

• Andhra Pradesh – Filariasis

• Karnataka – Filariasis, KFD & HGS, leptospirosis

• Tamil Nadu – Leprosy, leptospirosis

• Kerala – Leptospirosis

• Mizoram – Cancer, substance abuse, acid peptic disease, pneumonia

Classification of surveillance in IDSP

• Syndromic

– Diagnosis made on the basis of clinical pattern by paramedical

personnel and members of community .

– By Health Workers, at Village/ SHC level on the basis of symptoms.

• Presumptive

– Diagnosis is made on typical history and clinical examination by

medical officers. (Health Facilities- PHC/CHC/DH etc. )

• Confirmed/Laboratory

– Clinical diagnosis confirmed by appropriate laboratory identification.

– at CHC, District Hospital and Medical Colleges Labs for confirmation.

Types of Weekly Reports under IDSP

1. Syndromic Surveillance report in “S” form, collected by Health Workers,

at Village level and submitted at CHC.

2. Presumptive Surveillance report in “P” form, generated by Medical

Officers, collected by Pharmacist/ Health Workers,

3. Lab Surveillance report generated by Lab Technicians, at CHC and

District Hospital Labs.

4. Compiled reports are entered online on IDSP portal by BADAs at block

level.

5. Reports are analyzed at District & State level, Reported to higher

level, feed back to lower levels.

6. Outbreak & Early Warning Signals report at District and State level.

Information flow of the weekly surveillance system

Sub-centres

P.H.C.s

C.H.C.s

Dist. hosp.

Programmeofficers

Pvt. practitionersD.S.U.

P.H. lab.

Med. col.

Other Hospitals: ESI, Municipal Rly., Army etc.

S.S.U.C.S.U.

Nursing homes

Private hospitals

Private labs.

Corporate hospitals

Flow of information

Activities Periphery District State

Detection and notification of cases

+++ ++ -

Consolidation of data + +++ +++

Analysis and interpretation + +++ +++

Investigation and confirmation +++ +++ +

Feedback + +++ ++

Dissemination + ++ ++

Action ++ +++ +

Surveillance activities at each level

IDSP Organisation Structure

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

Chairperson* State surveillance committee

Director Health Service

Director Public Health (Co. Chair) Director Medical Education

RepresentativeWater Board

NGO

Medical CollegesState Coordinator

RepresentativeDepartment of Home

State Program ManagersPolio, 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

Chairperson*National surveillance committee

Director General Health Services(Co. Chair)

Director General ICMR

PD (IDSP)

JS (Family Welfare)

Director NICD

Director NIB

National Program ManagersPolio, Malaria, TB, HIV - AIDS

Consultants(IndiaCLEN / WHO / Medical College /others)

NGO

IMA Representative

RepresentativeMinistry of Home

RepresentativeMinistry of Environment National Surveillance Officer

(Member Secretary)

* Secretary health and secretary family welfare

National surveillance committee

ICMR

NationalPrograms

CBHI

NCDC

CSU

Outbreak investigation and rapid response

Non-communicable diseases

surveillanceMIS and report

Programme monitoring

NVBDCP RNTCP RCH NACP

W.H.O. E.M.R.

Linkages of the central surveillance unit at the central level

Organization Structures at State Level

State Surveillance Unit IDSP is under State Surveillance officer

S.No. POST SANCTIONED

1 State Epidemiologist 1

2 State Microbiologist 1

3 State Veterinary Consultant 1

4 State Entomologist 1

4 Finance Consultant 1

5 Training Consultant 1

6 Data Manager 1

7 Data Entry Operator 1

Organization Structures at District Level

District Surveillance Units IDSP under District Surveillance officers

S.No. POST SANCTIONED

1 District Epidemiologist 27

3 Data Manager 27

4 Data Entry Operator 27

Reporting Forms

• Form ‘S’ (Suspect Cases)

• Health Workers (Sub Centre)

• Form ‘P’ (Probable Cases)

• Doctors (PHC, CHC, Pvt. Hospitals)

• Form ‘L’ (Lab Confirmed Cases)

• Laboratories

Form Level of Laboratory Responsibility of Reporting

Form L1 Peripheral Laboratory at PHC/CHC Laboratory Assistants/Technicianthrough MO I/c

Form L2 •District Public Health Laboratory•Labs of District Hospital•Private Hospitals & Private Labs.

I/c Microbiologist/Pathologists

Form L3 •Labs in Medical Colleges, othertertiary institutions,

Reference Labs.Head, Microbiologist Department

Laboratory Reporting

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.

• Acute febrile illness of unknown etiology.

• Two or more epidemiologically linked cases of outbreak potential.

• High or sudden increase in vector density.

• Natural Disaster.

Surveillance ActionPre-set trigger level with specific response for various levels

• Trigger Level 1 - Suspected limited outbreak– local response

• Trigger Level 2 - Epidemic– local & regional response

• Trigger Level 3 - Wide spread Epidemic– local, regional & state level response

Strengths of IDSP - 1

1. Functional integration of surveillance components of vertical programmes

2. Reporting of suspect, probable and confirmed cases (Standard case Definition)

3. Strong IT component for data analysis

4. Trigger levels for graded response

5. Action component in the reporting formats.

6. Streamlined flow of funds to the districts

7. Standard Formats, Operations & Training Manuals

8. Involvement of Private Sector

New Initiatives - 1E-learning/VC

The objective of e-learning is to enhance the skills to a wide arena of health personnel.Proposed components:– Discussion Forums– Online Survey & Assessment– Feedback– FAQs

Media Scanning and Verification Cell• Objective:– To provide the supplemental information about outbreaks

• Method:– National and local newspapers, Internet surfing, TV

channel screening for news item on disease occurrence.• Benefits of Media Scanning:– Increases the sensitivity & strengthen the surveillance

system– Provide early warning of occurrence of clusters of diseases

New Initiatives - 2

Thank You