Integrated Disease

Surveillance Project
BYPankaj Joshi (66)
Parvind Singh (67)
Pooja Negi (68)
Priya Khanijo (69)
Rahul Kumar Singh
(70)

INTRODUCTION
Disease burden of the people of India
is one of
the highest in the world.
Triple burden in infectious diseases.
Firstly, we have those infectious
diseases for which specific
preventive measures are yet not
available and secondly, we have
infectious diseases because of
insufficient public health measures.

 Disease prevention and control

planning depends upon the
frequency,distribution and
determinants of disease that can be
made available through surveillance.

SURVEY
An investigation in which an
information is
systematically collected but in which
the
experimental method is not used.

SURVEILLANCE
Defined as the continous scrutiny of
the factors that determine the
occurrence and distribution of
disease and other conditions of ill
health.
Sero-surveillance : Identifies patterns
of current and past infection and
based on blood or sera.

 Sentinel surveillance:A method of

identifying the missing cases and
thereby supplementing the notified
cases.
It includes strict sampling procedures
in limited sites with specific
population groups.These specific
groups are STD clinic attenders and
injecting drug users.

Objectives
To provide information about new
and changing trends in the health
status of a
population.eg.morbidity,mortality,nut
ritional status etc.
To provide feedback which may be
expected to modify the policy and
system.
To provide timely warning of public
health disasters.

MONITORING
Refers to the continous oversight of
activities to ensure that they are
proceeding according to plan.
Therefore, monitoring becomes one
specific and essential part of broader
concept embraced by surveillance.

INTEGRATED DISEASE
SURVEILLANCE PROJECT(IDSP)
Launched with World Bank assistance
in november 2004.
Decentralized state based project.
5 year project from 2004-2009.
Project was extended for 2 years in
march 2010

 From april 2010 to march 2012, world bank

funds were available for central surveillance
unit at NCDC and 9 identified statesUttarakhand,Gujarat,Tamilnadu,Maharashtr
a,Punjab,Rajasthan,Andhra Pradesh ,West
Bengal and Karnataka.
Rest 26 states/UTs were funded from
domestic budget.Programme continous
during 12th plan under NRHM with outlay of
Rs.640crore from domestic budget only.

Comparison of estimated budget and expenditure in recent years

70
60
50
40
30
20
10
0

est budget
expenditure

Overall objectives
To establish a decentralized
system of disease surveillance
Improve the efficiency of the
existing surveillance activities of
disease control programs for use
in health planning, management
and evaluating disease control
strategies
13

Specific Objectives
To integrate, coordinate and
decentralize surveillance activities
Undertake surveillance for limited
number of health conditions and risk
factors
To establish system for quality data
collection, reporting, analysis and
feedback using IT
To improve laboratory support for
disease surveillance
To develop human resource for disease
surveillance
To involve all stake holders including
those in private sector and
communities

14

Project Activities
Decentralizing and integrating
surveillance mechanisms
Up gradation of laboratories
Information technology and
communication
Human resources and development
Operational activities and response
Monitoring and evaluation

15

DISEASES UNDER IDSP

1.REGULAR PERIODIC
2.SENTINEL
3.REGULAR
4.ADDITIONAL
SURVEILLANCE
STATE PRIORITIES
SURVEILLANCE

Diseases and Conditions

Covered Under IDSP
1. REGULAR SURVEILLANCE
VECTOR BORNE DISEASES Malaria
WATER BORNE DISEASES Cholera ,
typhoid
RESPIRATORY DISEASES - Tuberculosis
VACCINE PREVENTABLE DISEASES
Measles

DISEASES UNDER ERADICATION -

 OTHER CONDITIONS Road traffic

accidents

OTHER INTERNATIONAL
COMMITMENTS - Plague , yellow fever
UNSUAL CLINIC SYNDROME
meningoencephalitis , respiratory diseases ,
hemorrhagic fever , jaundice and other
undiagnosed conditions.

 2.SENTINEL SURVEILLANCE
STDs/BLOOD BORNE DISEASES
HIV/HBV/HCV

OTHER CONDITIONS Water quality

,outdoor air quality (large urban areas ).

 3.REGULAR PERIODIC SURVEILLANCE

NON COMMUNICABLE RISK FACTORS

Anthropometry , physical activity , blood
pressure , tobacco , nutrition , blindness
and any other unusual condition of
emergency.

 4.ADDITIONAL STATE PRIORITIES

Each state may identify up to 5 additional
conditions for surveillance.

ORGANISATION STRUCTURE

CENTRE RESPONSIBILITIES
Developmentofguidelines,
laboratory &computermanuals,
andtrainingmaterials .
Training of State Rapid Response
Teams
Strengthening & networking of
National and Regional laboratories .
Establishing rapid communication
network .
Technical review, co-ordination,
monitoring and evaluation .

STATE RESPONSIBILITIES
Strengthening
ofepidemiologicalcapabilities
atstateanddistrict
levelbytraining ofdistrict and
healthpersonnelat theperiphery
Modernization and computerization
of state & district Epidemiology cell .
Strengthening of state / district
laboratories .
Improving sub-district mobility and
communication .

WEEKLY REPORTS
Week Starting
Week ending
Outbreak
Number
Nature

News paper cutting

Report of epidemiological investigation
Name & Signature of Nodal Officer of
District

WARNING SIGNS OF IMPENDING

OUTBREAK
Clustering of cases or death in time or space.
Unusual increase in cases or death.
Even a single case of measles, cholera,
plague, dengue or JE.
Acute febrile illness if unknown aetiology.
Unusual isolates.
Shifting in age distribution of cases.
High vector density.
Natural disaster.

Strength of IDSP
Functional integration of
surveillance components of
vertical programs.
Reporting of suspect, probable
and confirmed cases- Syndromic
reporting from periphery.
Strong IT component of data
analysis.
Trigger level for gradated
response.

 Standard formats, Operation &

Training Manuals
Standard formats for reporting.
Operation manuals for health
workers, medical officers,
laboratories technicians and District/
State surveillance Teams.
Standard user friendly training
manuals.

 Involvement Of Private Sectors

Enhance coverage.
Establish sound data base and connectivity.
Additional resources- Private Laboratory
services.
Participate in prevention & control of
outbreak prone communicable diseases.
Establish feedback mechanism.
To involve private sector in NCD surveillance.

Key Performance
Indicators
Number and percentage of districts
providing monthly surveillance
reports on time -by state and
overall
Number and percentage of
responses to disease-specific
triggers on time - by state and
overall

 Number and percentage of responses to

disease-specific triggers assessed to
be adequate- by state and overall
Number and percentage of laboratories
providing adequate quality of informationby state and center.
Number of districts in which private
providers are contributing to disease
information.

 Number of reports derived from

private health care providers.
Number of reports derived from
private laboratories.
Number and % of states in which
surveillance information relating to
various vertical disease control
programs have been integrated.

 Number and % of project districts

and states publishing annual
surveillance reports.
Publication by CSU (central
surveillance unit) of consolidated
annual surveillance report.

NEW INITIATIVE UNDER

IDSP
Alerts through IDSP
call center e-learning
Media Scanning Cell

 Alerts through IDSP call center Call center operational with 1075 toll free number
since February 2008.
Call received from beginning till 30 th June, 2012 :
2,77,395 (35,866 calls related to H1N1).
Outbreak reported in 2008 553
2009 799
2010 990
2011 1675
2013 1893 (till 8th Dec)

e-learning:
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
Currently e-leaning modules are being
prepared.

Media Scanning Cell

Objective :
To provide the supplemental
information about outbreaks.
Method:
National and local newspaper
,internet surfing, TV channel
screening for news item on disease
occurrence.

Benefits Of Media
Scanning
Increase the sensitivity &
strengthen the surveillance system.
Provide early warning of
occurrence of clusters of diseases.
A total of 2537 media alerts were
reported from July 2008 to Nov 2013
(majority of alerts were related to
diarrheal diseases, food poisoning
and vector born diseases).

IDSP Reporting

Form
Form
S
P
Form L

 SUSPECTED CASES by health

Form workers
S These are from Sub centers
PROBABLE CASES by Doctors
Form
At PHC,CHC,Hospitals
P
LAB confirmed cases
Form
These are from laboratories
L

 Frequency of reporting Weekly

TWO major Involvements of Project

1.Invovement of Private Sector :Under Strategic alliance through

professional association i.e. Indian
Medical Association
.They provided linkages through Web or
transmission by Emails ,Fax, Telephones
. Partnership

2. Involvement of Medical
colleges:-Each MEDICAL COLLEGE is
integrated to this project.
Their role is to provide services like
.Reference Laboratories
.Quality assurance
.Training
.Epidemic investigation
.Non communicable Diseases surveillance

Important services in IDSP

24X7 Call service

---- Call centre

were established in FEB 2008.
It was extensively used during H1N1
Pandemic in 2009 and Dengue outbreak
in 2010.
More than 2.70 lakh calls were received till
June 2012
*For alert for disease outbreak or epidemic
TOLL FREE NO ---1075

DISTRICT LAB--- there are around

50 identified district lab

*Contractual Microbiologist
*Annual grant of Rs2 lakh per annum
per lab for reagents & Consumables .
*Addition ,12 labs for Influenza
Surveillance in country.

IDSP &
UTTARAKHAND

 So IDSP was launched in November

2004 by GOVT. OF INDIA .
In Uttarakhand the IDSP was
launched on 5th July 2005 with world
bank assistance.
The objective was same as that of
main project.
State & District surveillance units
have been established .

 District surveillance officers are appointed .

3 Contractual staff at district level has been
appointed The Data Manager .
EDUSAT equipments have installed in 12
districts & 1 medical college in Haldwani.
Computers, internet & software services are
used at each DSU.
State and District public health laboratories
had been made functional.

 2 priority labs had been setup in

PAURI Garhwal & ALMORA.
Private sector is involved.
weekly reports are received from
reporting units .

Analysis & Use of Data

At the PHC/CHC level simple analysis of
syndromic surveillance & data analysis of
Fever,Diarrhea&Jaundice cases will be
carried using Charts and Graphs.
All Medical Officers will be trained in IDSP.
Feedback will be provided to PHC Medical
Officers during monthly meeting.

LABORATORIES
MICROBIOLOGY
REFERRAL LAB

LINKED
DISTRICTS

1. Himalayan institute of
Medical science , Jolly Grant

Dehradun,Uttarkashi,Haridwar
&Tehri Garhwal

2. Medical college Haldwani

Champawat,Pithoragarh,Nainit
al,
Bageshwar,Udham singh nagar

3. VCSGGMS&RI , Srinagar
Garhwal
4. District Priority Lab , Pauri
5. District Priority Lab ,Almora

Chamoli, Rudraprayag
Pauri Garhwal
Almora

THANK YOU