Introduction to the Integrated Disease Surveillance Project

1. Introduction to the Integrated Disease Surveillance Project IDSP training module for state and district surveillance officers Module 1

2. Learning objectives • Define surveillance and explain important terminology in surveillance • List all the components of the surveillance activities • Specify the major objectives of the Integrated Disease Surveillance Project • List types of surveillance carried out under the Integrated Disease Surveillance Project by different categories of staff • Name all reporting units in the rural and urban areas of a district • List all conditions under surveillance through primary health centre/community health centresystem

3. Health goals - India • Eradicate polio 2005 • Eliminate leprosy and yaws 2005 • Establish IDSP, NHA/Health Stats 2005 • Zero-level growth of HIV/AIDS 2007 • Eliminate Kala-Azar 2010 •  Mortality by 50% - TB, malaria and other 2010 •  Prevalence of blindness to 0.5% 2010 •  IMR to 30/1000, MMR to 100/100,000 2010 • Eliminate lymphatic filariasis 2015

4. Public health surveillance 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

5. Important information in surveillance • Who get the disease? • How many get them? • Where they get them? • When they get them? • Why they get them? • What needs to be done as public health response?

6. Why do we need to do surveillance? (1/2) • Recognize cases or cluster of cases to trigger intervention to prevent transmission or reduce morbidity and mortality • Assess the public health impact of health events or determine and measure trends • Demonstrate the need for public health intervention programme and resources during public health planning

7. Why do we need to do surveillance? (2/2) • Monitor effectiveness of prevention and control measures and prevent outbreaks • Identify high risk groups or geographical areas to target interventions an guide analytic studies • Develop hypotheses that lead to analytic studies about risk factors for disease causation, propagation or progression

8. Key elements of a 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

9. 1997-8: National Surveillance Programme for Communicable Diseases (NSPCD) • Nodal point • National Institute for Communicable Diseases • Implementing agencies • States and union territories • Main components • Infrastructural strengthening - Laboratories • Human resources development • Uniform and regular reporting • Monitoring and evaluation • Operational - 101 districts (Merged in IDSP Phase-I)

10. Objectives of NSPCD • Strengthen district and state capabilities to promptly identify and respond to disease outbreaks • Establish an early warning mechanism • Laboratory strengthening and networking for rapid confirmation of diagnosis • Effective use of surveillance data using rapid means for communication • Institute appropriate and timely response for prevention and control of outbreaks

11. Objectives of NSPCD • Improving technical capabilities of medical and paramedical personnel • Up-gradation of laboratories at district, state and regional level • Improving communication and data processing system • Constitution of rapid response teams at district and state levels for early response • Collaboration with ICMR, WHO and other concerned agencies/departments

12. Weaknesses in disease surveillance • Lack of integration of private sector • Poor laboratory capacity • Blind spots in urban areas • Slow, inefficient sharing of surveillance information at district level • Limited capacity to undertake analysis and response at district level • Non-inclusion of non communicable diseases

13. Surveillance strategy in the Integrated Disease Surveillance Project (1/2) • District level is the basic functional unit for integrating surveillance functions • All surveillance activities are coordinated and streamlined • Resources are combined to collect information from single focal point at each level • Several activities are combined into one integrated activity to take advantage of similar surveillance functions, skills, resources and target populations

14. Surveillance strategy in the Integrated Disease Surveillance Project (2/2) • Integrates public and private sector by involving private practitioners and communities • Addresses communicable and non communicable diseases • Covers both rural and urban health systems • Collaborates with private and public medical colleges

15. Objectives of the Integrated Disease Surveillance Project • 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

16. Important components where additional inputs will be provided • Strengthening of laboratories • Improved information management system • Human resource development • Developing supporting structure for integration

17. What is integration? • Sharing of surveillance information of disease control programmes • Developing effective partnership with heath and non health sectors in surveillance • 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

18. Classification of surveillance in IDSP • Syndromic • Diagnosis made on the basis clinical pattern by paramedical personnel and members of community • Presumptive • Diagnosis is made on typical history and clinical examination by medical officers • Confirmed • Clinical diagnosis by medical officer and or positive laboratory identification

19. Conditions under regular surveillance

20. Other conditions under surveillance

21. 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

22. The limited number of conditions under surveillance • Limited number of core diseases • Improves quality of surveillance • Reduces workload • Diseases of regional importance • Under surveillance in addition to the core list • Review and modification of the list according to needs at least once in two years • Viral hepatitis and acute respiratory tract infection • Also under consideration at various levels • May be included subsequently

23. Surveillance activities at each level

24. Reporting units for disease surveillance

25. Role of district surveillance officers and medical officers • Supervision and quality control of active surveillance by field staff • Passive surveillance for diseases on the list • Supervision of compilation and transmission of periodical reports • Integration of sentinel private practitioners • Emergency response to surveillance reports received • Facilitation of outbreak investigation and response

26. Phases of implementation for the Integrated Disease Surveillance Project • 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 • Ph III (2006-07) • UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N Island, D&N Haveli, Daman & Diu, Lakshadweep