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h Over the last 30 years more than 30 new diseases have

emerged and some of the old diseases like TB, Malaria,
Plague etc started re-emerging with wide geographical rapid
spread.
h It is so common in developing countries due to many reasons.
h In India, recent outbreaks of Plague in Surat (1994),
resurgence of Malaria in 1995 and Dengue haemorrhagic
syndrome in Delhi (1996) caused much concern to the
Government Of India.
h It caused much morbidity and mortality with significant
á!!" 
hThough many reasons are there for all
these, weak Surveillance system in the
country was one of the major factors.

hIn order to strengthen the Surveillance

system, in the year 1997-98, MOHFW,GOI,
launched National surveillance Programme
for Communicable Diseases (NSPCD), so
that early warning signals of diseases could
be recognized and appropriate public health
action taken timely to control and prevent
the further spread.


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Mnteric infections including Typhoid Plague

%'á#%**( á%('á(

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h To further strengthen the programme a project (2005-
2012) was drafted with the help of World Bank with
major modifications in the programme.

h As a result IDSP was launched in the country.


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h The Integrated Disease Surveillance Programme,
(IDSP), launched by Government of India, Ministry of
Health & Family Welfare (MOHFW) in November 2004,
and supported by World Bank.

h It is a decentralized, integrated, State based

Surveillance Program intended to detect á%'.,%)
()%'(of impending outbreaks and help initiate an
effective and timely response.

h In Belgaum district IDSP was implemented in 2005

Major Objective:
Marly detection of Marly Warning Signals of an impending
outbreak and help initiate an effective response in a timely
manner.

Major components:
h Integration and Decentralization of Surveillance activities

h Strengthening of Public Health Laboratories

h Human Resource Development - Training of SSO, DSO, RRT,

other medical and paramedical staff

h Use of Information Technology for collection, collation,

compilation, analysis & dissemination of data
 What is Surveillance?
Surveillance is a French word meaning ´watch with
attention, suspicion and authorityµ
Mpidemiological surveillance is defined as ´the
ongoing and systematic collection,
compilation, analysis and
interpretation of health data in the
process of describing and monitoring
a health eventµ (CDC)

Simplest definition of Surveillance is data collection for

action.

Surveillance may also be defined as ´regular and

systematic collection of data on the disease incidence for
the purpose of appropriate actionµ.
INTMGRATION ?

h CMDs with NCDs

h State and Centre
h HFW and Private clinics/Hospitals/Medical
colleges/NGOs
h National programmes
h Police, PCBs, Water supply
h IMC activities
h Training
h Formation of committees to oversee integration
/0  m m  m 

h Clustering of cases/deaths in time/place
h Unusual increase in cases/deaths
h Mven a single case of measles, AFP, cholera,
plague, dengue and JM
h Acute febrile illness of unknown etiology
h Shifting in age distribution of cases
h High vector density
h Natural disasters
 USMS?
1. Incidence/Prevalence
2. Geographical distribution of a disease------- TPP/CDC
3. Monitoring disease trend over a long period
4. Prediction of diseases-by previous outbreaks
5. Planning, Mvaluation of public health intervention and
programmes.
6. Detect the factors/conditions responsible for occurrence/spread
7. With the help of excellent lab diagnostic facilities, we can
detect the diseases early and control/prevent the spread of
disease.
8. With the help of uniform standard ´case definitionµ we can
detect the diseases and initiate early control/prevent the
spread of disease as well.
 Surveillance methods
1) Routine reporting system
2) Active and passive surveillance
3) Sentinel reporting system
4) Surveys and special studies
5) Case and outbreak investigations

ráá#.!'%&!%*!.'á%
A DYNAMIC VISION OF SURVMILLANCM

Collect and
Make
transmit
decisions
@

All levels use
information
to make
decisions

Feedback Analyze

 data

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 What are the
diseases?
DISMASMS UNDMR THM
SURVMILLANCM PROJMCT

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:
Vector Borne Disease 1) Malaria
Water Borne Disease 2) ADDs (Cholera) and 3)
Typhoid
Respiratory Diseases £


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Diseases under eradication  

Other Conditions  






 
Other International   
commitments
Unusual clinical syndromes 9)Menigoencephalitis/Respiratory
(Causing death / hospitalization)
Distress Hemorrhagic fevers, other
undiagnosed conditions
 [ 
 



Úexually transmitted 10) HIV/HBV, HCV11

diseases/Blood borne

Other Conditions : 11) Water Quality

(Large Urban centers) 12) Outdoor Air Quality
( In Metropolitan cities)
[ (iii) w
 

 


CD Risk Factors : 13) Anthropometry,

Physical activity, Blood
Pressure, Tobacco,
utrition, Blindness
[ $$*!%'*%*á!*á(  Mach state
may identify up to five additional
conditions for surveillance.

[ !*á: GOI may include in a public health

emergency any other unusual health
condition.
[ Project funds could be used for such
emergencies
LABORATORY ROLM
IN IDSP
LAB ROLM IN THM SUCCMSS OF
SURVMILLANCM
h )*(%"#'á
h
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h )*6%**.
h
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h )*'%&-!*á$(á%(á
Different levels of laboratories under
IDSP
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RRT CONSISTS OF
DSO
Mpidemiologist
Physician
Paediatrician
Microbiologist
Mntomologist
Laboratory technician

Health worker
A driver with a vehicle
 TYPMS OF CASM DMFINITIONS IN USM

Case Criteria Users

definition

Úyndromic Clinical pattern Paramedical personnel and

(suspect) members of community
ƠÚ forms
Presumptive Typical history and Medical officers of primary
(Probable) clinical examination and community health
ƠP forms centres

Confirmed Clinical diagnosis by Medical officer and

ƠL1/L2 forms a medical officer and Laboratory staff
positive laboratory Y   
identification
IDSP ² INDIA : STRUCTURM
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DATA FLOW AND FMMDBACK: LMVML BY
LMVML

Centre

State

Data District
Feedback

Primary / Community
health centre

Community
 INFORMATION FLOW OF THM WMMKLY
SURVMILLANCM SYSTMM

Sub-centres
Programme
officers 

P.H.C.s



C.H.C.s Pvt. practitioners

Õ

Dist. hosp. Nursing homes

Private hospitals
Med. col.
Private labs.
P.H. lab. Other Hospitals: Corporate
MSI, Municipal hospitals
Rly., Army etc.
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No budget for NSPCD nodal cell IDSP cell in Ministry with budget

No integration Integration

No budget for retraining Budget for retraining

Feedback inadequate Adequate feedback planned

Weak IT component Strong IT component

Weak state ownership (selected districts) Strong state ownership (all districts)

Slow financial flow Fast financial flow

Weak M & M, supervision Strong M & M, supervision

Poor advocacy Advocacy at all levels