IDSP- Dr. Dharmendra Gahwai

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

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

8. 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 .

9. 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.

10. 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

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

12. 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.

13. 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

14. 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

15. 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.

16. 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

17. 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

18. State-Specific Diseases Chhattisgarh Leprosy Viral Hepatitis Neonatorum Tetanus Diphtheria

19. 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

20. 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.

21. Types of Weekly Reports under IDSP Syndromic Surveillance report in “S” form, collected by Health Workers, at Village level and submitted at CHC. Presumptive Surveillance report in “P” form, generated by Medical Officers, collected by Pharmacist/ Health Workers, Lab Surveillance report generated by Lab Technicians, at CHC and District Hospital Labs. Compiled reports are entered online on IDSP portal by BADAs at block level. Reports are analyzed at District & State level, Reported to higher level, feed back to lower levels . Outbreak & Early Warning Signals report at District and State level.

22. 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

23. Flow of information

24. 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

25. IDSP Organisation Structure

26. 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

27. 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 Representative Representative Department of Environment State Surveillance Officer (Member Secretary) State Training Officer State Data Manager IDSP State surveillance committee * State health secretary

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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.

35. 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

36. Strengths of IDSP - 1 Functional integration of surveillance components of vertical programmes Reporting of suspect, probable and confirmed cases (Standard case Definition) Strong IT component for data analysis Trigger levels for graded response Action component in the reporting formats. Streamlined flow of funds to the districts Standard Formats, Operations & Training Manuals Involvement of Private Sector

37. 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

38. 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

39. Thank You