idsp

1. IDSP – Integrated Disease Surveillance Programme
Dr. Dharmendra Gahwai
( MD- Community Medicine, DAE )
DD/State Epidemiologist (IDSP)
Directorate of Health Services
Raipur (C.G.)

2. Surveillance

3. 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.”

4. Surveillance is –
“Information for Action”

5. 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

6. 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

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

9. • 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.

10. 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.

11. 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

12. • IDSP was formally launched in Chhattisgarh on
19th of November 2005.

13. 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.

14. 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

15. 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

16. 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.

17. 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-encephalitis
Respiratory distress
Hemorrhagic fever
Other undiagnosed condition

18. 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
Anthropometry
Physical activity
Blood pressure
Tobacco, blood pressure
Nutrition
Blindness
Additional state priorities Up to five diseases

19. State-Specific Diseases
Chhattisgarh
1. Leprosy
2. Viral Hepatitis
3. Neonatorum Tetanus
4. Diphtheria

20. 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

21. 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.

22. 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.

23. Information flow of the weekly
surveillance system
Sub-centres
P.H.C.s
C.H.C.s
Dist. hosp.
Programme
officers
Pvt. practitioners
D.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

24. Flow of information

25. 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

27. IDSP Organisation Structure

28. 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

29. 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

30. 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

31. ICMR
National
Programs
CBHI
NCDC
CSU
Outbreak investigation
and rapid response
Non-communicable
diseases
surveillance
MIS and report
Programme monitoring
NVBDCP RNTCP RCH NACP
W.H.O. E.M.R.
Linkages of the central surveillance unit at the
central level

32. 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

33. 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

34. 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

38. 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 Laboratory
•Labs of District Hospital
•Private Hospitals & Private Labs.
I/c
Microbiologist/Pathologists
Form L3 •Labs in Medical Colleges, other
tertiary institutions,
Reference Labs.
Head, Microbiologist
Department
Laboratory Reporting

39. 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.

40. Surveillance Action
Pre-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

41. 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

42. New Initiatives - 1
E-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

43. 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

44. Thank You