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

1. INTEGRATED
DISEASE
SURVEILLANCE
PROGRAMME
- Critical Review
Dr. Gaurav Kamboj

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. 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. 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. Importance of timely action in controlling an
outbreak through effective surveillance action

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. 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. Phasing of Integrated Disease Surveillance Project
Phase II (05-06)
Phase-I (04-05)
Phase III (06-07)

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. 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. 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. 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. 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. State Specific Diseases for Haryana
 Meningococcal Meningitis
 Dengue
 Viral Hepatitis
 J.E

15. NCD Surveillance

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. Organizational Structure
National Surveillance Committee
Central Surveillance Unit
State Surveillance Committee
State Surveillance Unit
District Surveillance Committee
District Surveillance Unit

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. 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. 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. 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. 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. 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. District surveillance
officer
Accountant
Administrative
assistant
Data entry
operators (2)
Response team
•Epidemiologist
•Microbiologist
•Clinicians
Chief medical and health officer
District surveillance unit

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

27. 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

28. RAPID RESPONSE TEAM - ROHTAK

29. 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

30. 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

31. NOT BEING USED

34. 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

35. In the year 2008-09, two Districts priority labs
i.e. Hisar & Panchkula and One State Lab i.e.
Karnal have been upgraded
Haryana

37. Line listing of
cases is
inappropriate

39. Syndromic surveillance

40. 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

52. Trigger Events

55. 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

56. 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

57. • 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

58. 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

59. 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.

60. 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.

62. Last outbreak in Distt. Rohtak
Diarrhoea in Vill. Gilohar Kalan in
2013
Cause- Unavailability of Potable
drinking water

63. 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

67. 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

69. 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.

70. 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.

71. 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.

72. 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 *

75. 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

76. CONCLUSION- CRITICAL REVIEW
(IDSP)

77. 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

78. • 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

79. 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

80. 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

81. 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.

82. • 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

83. • 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

84. • 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

85. 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

86. “Unless you are looking for it,
you will not find it”