1. Dr. Abhishek Tiwari

2. Introduction
 Triple burden of infectious disease
Worldwide : no specific preventive measure
Due to insufficient Public Health Measure
Prevalence of vectors & ecological determinants
 ID - More easily preventable than NCD
 Prevention & Control needs Surveillance
 To detect EWS of impending outbreaks & help allocate
health resources efficiently

3. IDSP
 Decentralized project
 GoI in Nov 2004 ; World Bank funded
 3 Phases : Extended for 2 years in March 2010
 WB funds only for 9 states & CSU
 Domestic budget
 Continue during 12th Plan under NRHM

4. Objectives
 Establish a decentralized system of disease surveillance
so that timely & effective public health action can be
initiated
 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

5. I D S P

6. Integration
 All National Disease Control Programmes
 Health & Non Health sectors (Police, PCBs, Water supply)
 Including NCD & CD
 Laboratory information
 Private sector & NGO
 Academic Institution & Medical Colleges
 IEC activities
 Training
 Formation of committees to oversee integration

7. Disease
 Identification of priority diseases : Target disease
 Malaria
 ADD(Cholera)
 Typhoid
 Tuberculosis
 Measles
 Polio
 Plague
 HIV, HBV, HCV
 Unusual Syndromes
 Accidents
 Water Quality
 Outdoor Air Quality
 NCD Risk factors
 State Specific Diseases

8. Surveillance
 Information:- Who got the dis?
How many?
From where?
Why only them?
What needs to be done as a Public
. Health response?

9. Surveillance
 Strengthening hospital based surveillance
 Components
 Prerequisites
 Classification in IDSP
 Syndromic / presumptive / confirmed diagnosis
 Core condition under surveillance

10. Disease Surveillance Under IDSP
1. Regular Surveillance
Vector Borne Disease : Malaria , Dengue ,JE , Filaria etc.
Water Borne Disease : ADD (Cholera)
: Typhoid
Respiratory Diseases : Tuberculosis
VPDs :Measles
Diseases under eradication : Polio
Other Conditions : Road Traffic Accidents
Other International commitments : Plague
Unusual clinical syndromes : Meningoencephalitis /
DHF /other undiagnosed conditions

11. 2. Sentinel Surveillance
STD/Blood borne : HIV/HBV, HCV
Other Conditions : Water Quality / Outdoor Air Quality
3. Regular periodic Community Survey
NCD Risk Factors : Anthropometry, Physical activity, Blood
Pressure, Tobacco, Nutrition, Blindness
4. Additional State Priorities
Each state may identify up to five additional conditions for
Surveillance.

12. Syndromic surveillance
 Fever<7 days (alone, with rash, with altered
sensorium/convulsions, bleeding skin/gums
 Fever>7 days
 Cough>3 weeks
 AFP
 Diarrhea
 Jaundice
 Unusual events causing death/hospitalization

13. Project components
 CSU integrated with NICD (NCDC)
 SSU & DSU in all states & districts
 Strengthening Public Health Laboratories
 Training of SSU/DSU/RRT (over in all states & UT)
 IT & Networking & HRD

14. Project
 Early detection of outbreaks
 Early institution of containment measures
 Reduction in morbidity & mortality
 Minimize economic loss
 A limited health condition & risk factor surveilled
 To involve all stakeholders private & public

15. Project phasing
Phase – I (2004-05): Tamil Nadu, Kerala, Karnataka, Andhra
Pradesh, Maharashtra, Madhya
Pradesh, Uttaranchal, Himachal Pradesh & Mizoram (nine
states)
Phase – II (2005-06): Chattisgarh
, Goa, Gujarat, Rajasthan, West
Bengal, Manipur, Meghalaya, Odisha, Tripura, Chandigarh, Po
ndicherry, 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, Lakshwadeep.

16. Formats & manuals
 Standard Case Definitions
 Standard Formats for reporting
 Operations manual for Health Workers, Medical
Officers, Laboratory Technicians and District/State
Surveillance Teams
 Standard user friendly training manuals

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

18. 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

19. STRUCTURAL FRAMEWORK
C.S.U.
S.S.U
D.S.U.
P.S.U
MED COL.
DIST HOS.
PVT. HOS.
OTHER HOS.
LABS
SUB CENTRES
PHCs/CHCs
RURAL PPs

21. Level of responses
 Trigger-1 : Response Health Workers
 Trigger-2 : Outbreak Inv. & Response
(PHCs/ CHCs)
 Trigger-3 : Outbreak Inv. & Resp. (DSU)
 Trigger-4 : Epidemic Response (SSU)
 Trigger-5 : Disaster Response (CSU)

22. Performance Indicators
• Number & % of districts providing monthly surveillance reports
on time – by state and overall *
• Number & % of responses to disease specific triggers on time *
• # assessed to be adequate *
• # laboratories providing adequate quality of information *

23. Performance Indicators
• Number of districts : private sector contribution C/H/L
• Number and % of states integrating various programs
• Number and % of districts & states publishing annual
surveillance reports
• Publication by CSU of consolidated annual surveillance report

24. IDSP Reporting
Form S (Suspect Cases) by Health Workers (sub centres )
Form P (Probable Cases) by Doctors (PHC, CHC, Hospital)
Form L (Lab Confirmed Cases) from Laboratories
Frequency of reporting weekly (Monday to Sunday)
Data compilation/analysis and response should be at all
levels.
Presently at State/District/Block level 12- 15 Outbreaks
reported every week

29. Reporting units
Sub-centre-health worker/ANM : All syndromic cases
from PHC , clinic, hospital in the area
PHC/CHC MO : Probable cases , where it cannot be
confirmed by lab & those confirmed by lab (mp , afb )
Sentinel private practitioners , district hospitals
,municipal hospitals, medical colleges , sentinel
hospital , NGOs : MO report as probable case of
interest

30. New Initiatives under IDSP
 Alerts through IDSP call center : 1075 toll free
 February 2008
 Call received as on 8th October 2008 : 18,872
 No of Health Alerts : 60

31. e-learning
 To enhance skills of health personnel.
 Proposed components:
Discussion Forums
Online Survey & Assessment
Feedback
FAQs
Currently e-learning modules are being
prepared

32. Media Scanning Cell
Objective:
 Supplemental information about outbreaks
Method:
 National and local newspapers ,Internet surfing, TV
channel etc screening for news item on disease
occurrence
Benefits
 Increases the sensitivity & strengthen the surveillance
system
 Provide early warning of occurrence of clusters of
diseases

33. Strengths of IDSP
 Functional integration of surveillance components of
vertical programmes
 Reporting of suspect, probable and confirmed cases
 Strong IT component for data analysis
 Newer initiatives
 Trigger levels for gradated response
 Action component in the reporting formats
 Streamlined flow of funds to the districts

34. Lessons learnt
NSPCD
 No budget for NSPCD nodal
cell
 No integration
 No budget for retraining
 Feedback inadequate
 Weak IT component
 Weak state ownership
(selected districts)
 Slow financial flow
 Weak M & E, supervision
 Weak Advocacy
IDSP
 IDSP cell in Ministry with
budget
 Integration
 Budget for retraining
 Adequate feedback planned
 Strong IT component
 Strong state ownership (all
districts)
 Fast financial flow
 Strong M & E, supervision
 Advocacy at all levels

35. National Issues
 Political considerations based on Centre-state relations
 Central assistance proportionate to political affiliations
 Media attention an important consideration for response
 Time constraints-inadequate time given for outbreak
investigation
 Hesitancy for international assistance either in Outbreak
Investigation or Lab support (plague)

36. National Issues cont’d
 Public health & private sector almost 40:60
 Accountability of private sector on reporting
 Quackery in the name of alternate medicine
 ‘Overworked’ clinicians so poor records
 Lack of ownership by states of central vertical programmes

37. State issues
 State RRT not utilized to full potential
 Regional labs strengthened but diagnosis not enhanced &
increasing dependence on Centre
 Insufficient epidemiological analysis
 No clear IEC strategy
 Transfer/retirements of trained staff

38. State issues cont’d
 Shortage of staff so multi-tasking for state and district
 Fund issues
 Lack of competent staff : Epidemiologist & Microbiologists
Short trainings incapable
 Separate DGHS & DME : integrating Medical colleges

39. District issues
 Some districts yet to act together : epidemic preparedness
 Periphery needs improvement
 Surveillance failure : media reports first
 Weekly reports incomplete and irregular (under reporting)
 Monthly reports also irregular
 Communication ‘failure’
 CMO-CMS-DSO lack of co-ordination

40. District issues cont’d
 Overworked peripheral staff
 Multiple formats for different programmes
 RRT has specialists from DH & MC so problem in rapid
mobilization
 Concept of Nil reporting & routine reporting difficult for the
peripheral staff to understand

41. District lab issues
 Few established & functioning satisfactorily
 Too Many labs spoil the agenda
 Public health lab : water
 Hospitals : NCDs and clinicals
 College : majority of the diseases
 Surveillance lab : few diseases
 District blood bank : ELISA
 Peripheral : Microscopy only

42. 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
 IDSP website
 NRHM website
 NCDC website