Introduction to the Integrated Disease Surveillance Project
1. Introduction to the Integrated Disease
Surveillance Project
IDSP training module for state and
district surveillance officers
Module 1
2. Learning objectives
• Define surveillance and explain important terminology in
surveillance
• List all the components of the surveillance activities
• Specify the major objectives of the Integrated Disease
Surveillance Project
• List types of surveillance carried out under the
Integrated Disease Surveillance Project by different
categories of staff
• Name all reporting units in the rural and urban areas of a
district
• List all conditions under surveillance through primary
health centre/community health centresystem
3. Health goals - India
• Eradicate polio 2005
• Eliminate leprosy and yaws 2005
• Establish IDSP, NHA/Health Stats 2005
• Zero-level growth of HIV/AIDS 2007
• Eliminate Kala-Azar 2010
• Mortality by 50% - TB, malaria and other 2010
• Prevalence of blindness to 0.5% 2010
• IMR to 30/1000, MMR to 100/100,000 2010
• Eliminate lymphatic filariasis 2015
4. Public health surveillance
Surveillance is defined as the 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
5. Important information in surveillance
• Who get the disease?
• How many get them?
• Where they get them?
• When they get them?
• Why they get them?
• What needs to be done as public health
response?
6. Why do we need to do surveillance? (1/2)
• Recognize cases or cluster of cases to trigger
intervention to prevent transmission or
reduce morbidity and mortality
• Assess the public health impact of health
events or determine and measure trends
• Demonstrate the need for public health
intervention programme and resources
during public health planning
7. Why do we need to do surveillance? (2/2)
• Monitor effectiveness of prevention and
control measures and prevent outbreaks
• Identify high risk groups or geographical
areas to target interventions an guide
analytic studies
• Develop hypotheses that lead to analytic
studies about risk factors for disease
causation, propagation or progression
8. Key elements of a surveillance system
• Detection and notification of health events
• Investigation and confirmation
• Collection of data
• Analysis and interpretation of data
• Feedback and dissemination of results
• Response – Action for prevention and control
9. 1997-8: National Surveillance Programme
for Communicable Diseases (NSPCD)
• Nodal point
National Institute for Communicable Diseases
• Implementing agencies
States and union territories
• Main components
Infrastructural strengthening - Laboratories
Human resources development
Uniform and regular reporting
Monitoring and evaluation
• Operational - 101 districts (Merged in IDSP Phase-I)
10. Objectives of NSPCD
• Strengthen district and state capabilities to
promptly identify and respond to disease outbreaks
• Establish an early warning mechanism
• Laboratory strengthening and networking for rapid
confirmation of diagnosis
• Effective use of surveillance data using rapid means
for communication
• Institute appropriate and timely response for
prevention and control of outbreaks
11. Objectives of NSPCD
• Improving technical capabilities of medical and
paramedical personnel
• Up-gradation of laboratories at district, state and
regional level
• Improving communication and data processing
system
• Constitution of rapid response teams at district and
state levels for early response
• Collaboration with ICMR, WHO and other concerned
agencies/departments
12. Weaknesses in disease surveillance
• Lack of integration of private sector
• Poor laboratory capacity
• Blind spots in urban areas
• Slow, inefficient sharing of surveillance
information at district level
• Limited capacity to undertake analysis and
response at district level
• Non-inclusion of non communicable diseases
13. Surveillance strategy in the Integrated
Disease Surveillance Project (1/2)
• District level is the basic functional unit for
integrating surveillance functions
• All surveillance activities are coordinated and
streamlined
• Resources are combined to collect information from
single focal point at each level
• Several activities are combined into one integrated
activity to take advantage of similar surveillance
functions, skills, resources and target populations
14. Surveillance strategy in the Integrated
Disease Surveillance Project (2/2)
• Integrates public and private sector by
involving private practitioners and
communities
• Addresses communicable and non
communicable diseases
• Covers both rural and urban health systems
• Collaborates with private and public medical
colleges
15. Objectives of the Integrated Disease
Surveillance Project
• 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
16. Important components where additional
inputs will be provided
• Strengthening of laboratories
• Improved information management system
• Human resource development
• Developing supporting structure for
integration
17. What is integration?
• Sharing of surveillance information of disease
control programmes
• Developing effective partnership with heath and non
health sectors in surveillance
• 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
18. Classification of surveillance in IDSP
• Syndromic
Diagnosis made on the basis clinical pattern by
paramedical personnel and members of
community
• Presumptive
Diagnosis is made on typical history and clinical
examination by medical officers
• Confirmed
Clinical diagnosis by medical officer and or
positive laboratory identification
19. Conditions under regular surveillance
Type of disease Disease
Vector borne diseases •Malaria
Water borne diseases •Diarrhea (Cholera)
•Typhoid
Respiratory diseases •Tuberculosis
Vaccine preventable diseases •Measles
Disease under eradication •Polio
Other conditions •Road traffic accidents
International commitment •Plague
Unusual syndromes •Meningo-encephalitis
•Respiratory distress
•Hemorrhagic fever
20. Other conditions under surveillance
Type of surveillance Categories Conditions
Sentinel surveillance •STDs •HIV/HBV/HCV
•Other
conditions
•Water quality
•Outdoor air quality
Regular surveys •Non
communicable
disease risk
factors
•Anthropometry
•Physical activity
•Blood pressure
•Tobacco, blood pressure
•Nutrition
•Blindness
Additional state priorities •Up to five diseases
22. The limited number of conditions
under surveillance
• Limited number of core diseases
Improves quality of surveillance
Reduces workload
• Diseases of regional importance
Under surveillance in addition to the core list
• Review and modification of the list according to
needs at least once in two years
• Viral hepatitis and acute respiratory tract infection
Also under consideration at various levels
May be included subsequently
23. 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
24. Reporting units for disease surveillance
Public sector
(Exhaustive)
Private
(Sentinel)
Rural •Community health
centres
•District hospitals
•Practitioners
•Hospitals
Urban •Urban hospitals
•ESI
•Railways
•Medical colleges
•Nursing homes
•Hospitals
•Medical colleges
•Laboratories
25. Role of district surveillance officers
and medical officers
• Supervision and quality control of active surveillance
by field staff
• Passive surveillance for diseases on the list
• Supervision of compilation and transmission of
periodical reports
• Integration of sentinel private practitioners
• Emergency response to surveillance reports received
• Facilitation of outbreak investigation and response
26. Phases of implementation for the
Integrated Disease Surveillance Project
• 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
• Ph III (2006-07)
UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam,
Sikkim, A&N Island, D&N Haveli, Daman & Diu,
Lakshadweep