IDSP – Integrated Disease Surveillance Programme

Dr. Dharmendra Gahwai

( MD- Community Medicine, DAE )

DD/State Epidemiologist (IDSP)

Directorate of Health Services
Raipur (C.G.)
Surveillance
 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.”
 Surveillance is –

“Information for Action”

 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
 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

Health Care System................Public Health Authority
• 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.

 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.
 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
• IDSP was formally launched in Chhattisgarh on

19th of November 2005.

 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.
 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
 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

 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.
Conditions under regular surveillance
Type of disease Disease

Vector borne diseases Malaria

Water borne diseases
Respiratory diseases
Vaccine preventable diseases
Disease under eradication
Other conditions
International commitment
Unusual syndromes
(Causing death/hospitalization)
Diarrhoea, Cholera, Typhoid
Tuberculosis
Measles
Polio
Road traffic accidents
Plague
Meningo-encephalitis
Respiratory distress
Hemorrhagic fever
Other undiagnosed condition
 Other conditions under surveillance
Type of surveillance Categories Conditions

Sentinel surveillance STDs HIV/HBV/HCV

Other Water quality
conditions Outdoor air quality

Non- Anthropometry
communicable Physical activity
Regular periodic surveys disease risk Blood pressure
factors
Tobacco, blood pressure

Nutrition
Blindness
Additional state priorities Up to five diseases
 State-Specific Diseases
Chhattisgarh

1. Leprosy

2. Viral Hepatitis

3. Neonatorum Tetanus

4. Diphtheria
 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
 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.

 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.
 Information flow of the weekly
surveillance system
Sub-centres
Programme
officers C.S.U.
P.H.C.s
S.S.U.

C.H.C.s Pvt. practitioners

D.S.U.
Dist. hosp. Nursing homes

Private hospitals
Med. col.
Private labs.
P.H. lab. Other Hospitals: Corporate
ESI, Municipal hospitals
Rly., Army etc.
Flow of information
 Surveillance activities at each level
Activities Periphery District State
Detection and notification of +++ ++ -
cases
Consolidation of data + +++ +++

Analysis and interpretation + +++ +++

Investigation and confirmation +++ +++ +

Feedback + +++ ++

Dissemination + ++ ++

Action ++ +++ +
IDSP Organisation Structure
 District Surveillance Committee
CMO
(Co. Chair)
District Program Manager Representative
Polio, Malaria, TB, HIV - AIDS Water Board

Chief District PH Superintendent

Laboratory Of Police

District Data Manager

(IDSP) IMA
Chairperson* Representative
District Surveillance Committee
Representative
Pollution Board NGO
Representative

District Training Officer

(IDSP)
Medical College
Representative
District Panchayat if any
Chairperson
District Surveillance Officer
(Member Secretary)
* District Collector or District Magistrate
 State surveillance committee
Director Public
Health (Co. Chair) Director Medical Education

Director Health Service

Representative
Water Board
State Program Managers
Polio, Malaria, TB, HIV - AIDS
NGO

State Data Manager IDSP Chairperson*

State surveillance committee Medical Colleges
State Coordinator
Head, State Public
Health Lab

Representative
State Training Officer Department of Home

IMA
Representative Representative
Department of Environment State Surveillance Officer
(Member Secretary)

* State health secretary

 National surveillance committee

Director General Director General

Health Services ICMR
PD
(Co. Chair)
(IDSP)

National Program Managers

Polio, Malaria, TB, HIV - AIDS
JS
(Family Welfare)

IMA Chairperson*
Representative
National surveillance
committee Director
NICD
NGO

Director
Consultants NIB
(IndiaCLEN / WHO
/ Medical College
/others)
Representative
Ministry of Home
Representative
Ministry of Environment National Surveillance Officer
(Member Secretary)

* Secretary health and secretary family welfare

Linkages of the central surveillance unit at the
central level
Outbreak investigation
W.H.O. and rapid response E.M.R.

NCDC
Non-communicable
diseases MIS and report
surveillance

ICMR CSU CBHI

National RCH NACP

NVBDCP RNTCP Programs

Programme monitoring
 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
 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

 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
 Laboratory Reporting

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 I/c
•Labs of District Hospital Microbiologist/Pathologists
•Private Hospitals & Private Labs.

Form L3 •Labs in Medical Colleges, other Reference Labs.

tertiary institutions, Head, Microbiologist
Department
 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.
 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
 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
 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
 New Initiatives - 2
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
Thank You