1. Evolution /Development of Surveillance Systems
( )
Dr Shashi Khare, Consultant ( Micro)
National Centre for Disease Control
New Delhi ,INDIA

2. India: Fact Sheet States : 35 (28 states & 7 UTs) Districts : 623
Villages :
Towns : 5161
Total Population: 1.17 billion
Total Area : 32,87,2631

3. Health transition in India
COMMUNICABLE DISEASE EPIDEMICS
1950s onwards
RAPID DEVELOPMENT
(Scientific, urbanization & industrialization
At present
TRIPLE BURDEN
Unfinished agenda of Communicable Diseases
Emerging NCDs
(Lifestyle diseases)
Poor Public Health System
Inequities
Social, economic & political factors 3

4. Prologue Federal structure of governance Health is a State subject
Prior to 1998, no centralized surveillance system
States maintain its own list of notifiable diseases
Supplemented by independent surveillance systems of various National health programmes (TB, Malaria, Leprosy)
Central Bureau of Health Intelligence - National nodal agency for collection & documentation of health data

5. National Surveillance Programme for Communicable Diseases (NSPCD)
Initiated in following recommendations of various High-powered committees
Central Sector Health Scheme
NICD as the nodal agency
States/UTs as implementing agency
Implemented in 101 districts spread over 28 States & 7 Union Territory’s, in a phased manner.

6. Districts covered under NSPCD

7. NSPCD - Broad Objective
Strengthen surveillance system & improve capabilities of district & state:
to identify & respond to outbreaks due to epidemic- prone diseases

8. Specific Objectives Establish early warning mechanism
Effective use of surveillance data using rapid means for communication
Institute appropriate & timely response for prevention & control of outbreaks
Laboratory networking & strengthening for surveillance & rapid confirmation of diagnosis

9. NSPCD - Strategies Establish multi-disciplinary State/ Dist. RRTs
Develop trained manpower
Strengthen infrastructure incl. laboratories
Develop rapid communication network
Uniform & regular reporting
Monitoring & evaluation
Enhance awareness through IEC

10. Feedback Mechanism under NSPCD

11. Achievements
Improved quality of detection, investigation and response to outbreaks
Rapid Response Teams (RRTs) with requisite knowledge & skills in place
Technical material on outbreaks investigation, surveillance & specific diseases, guidelines for RRT & manual on computer & laboratory procedures developed, made available in field
Labs contributing in outbreak investigation

12. Achievements contd..
Training in computer application for data processing and communication
Feedback through “Outbreak News” & “CD Alert”, frequent s/post
Improved capability of laboratories for etiological diagnosis
NICD Website (includes NSPCD networking)

13. Independent Appraisal of NSPCD
Limited reach
Improve data analysis for recognizing early warning signals
Communication weak link
Focus on urban areas
Involve Pvt. Sector
Establish int. & ext. QA system 13

14. Integrated Disease Surveillance Project
Integrated Disease Surveillance Project (IDSP) was launched in November 2004.
To cover the entire nation in a phased manner
Decentralized, State based Surveillance Program.
Intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner.

15. IDSP-Major Components
Integrating and decentralization of surveillance activities;
Strengthening of public health laboratories;
Human Resource Development – Training of State and District Surveillance Officers,, Rapid Response Team, other medical and paramedical staff;
Use of Information Technology for collection, collation, compilation, analysis and dissemination of data

16. Institutional Framework
NCDC –Nodal Agency
Surveillance Committees at National, State and District levels
Surveillance Units at Central, State and District level.
Linkages established with all State Head Quarters, District Head Quarters and all Government Medical Colleges under IDSP.

17. IDSP : Structure Central Surveillance Unit (CSU)
State Surveillance Unit (SSU)
(35 States/UTs)
District Surveillance Unit (DSU)
( 611 Districts)
Peripheral Reporting Unit (PRU)
Surveillance Unit

18. Linkages at Central Level
Outbreak Investigation
& Rapid Response
W.H.O.
E.M.R.
NCD Surveillance
MIS & Report
RCH
NACO
NVBDCP
RNTCP
Programme Monitoring 18

19. Central Surveillance Unit
Project Director
National Project Officer
NCDC Officers
Contractual Staff
Consultants
Supporting Staff

20. Route for action on alert
IDSP outbreak monitoring cell alerts Block MOH
Alert from 1075
Block RRT initiate verification
Notify nearest health unit and initiate verification
Block PHC begins medical relief measures
Block RRT completes investigation and documentation
Response for outbreak containment
BMOH alerts DSO/SSO
Alert from local loop to BMOH telephone

21. Outbreak Investigating Team - State/District
Microbiologist
Clinician
(Pediatrician/
Physician)
* Selected from Programme Officers other than SSO/DSO, based on disease
** Only when vector borne disease is suspected 21

22. Data Management – Tools & Methods
No. of outbreaks
in 2008 (n=553) &
2009 (till 45th wk) (n=733)
Weekly Data (Monday to Sunday) – no. of cases of epidemic prone diseases
Form S (Suspect Cases): Health Workers (Sub Centers)
Form P (Probable Cases): Doctors (PHC, CHC, Hospitals)
Form L (Lab Confirmed Cases): Laboratories
2. Weekly Outbreak Report (Monday – Sunday) : even NIL report is mandatory
Through standard format 22

23. Data Management – Tools & Methods (2)
3. SOS reporting for disease outbreaks (also for IHR compliance):
(i) EWS Format
(ii) Supplemental Information thru:
IDSP Toll free Number 1075
Media Scanning & Verification Cell
Data Transmission through Data Centers in ICT Network
IDSP Portal (
Data Compilation / analysis and response at all levels; Presently at district/state level 23

24. Information Flow D.S.U. C.S.U. Weekly Surveillance System S.S.U.
Sub-Centers
Programme
Officers
S.S.U.
P.H.C.s
C.H.C.s
D.S.U.
Pvt. Practitioners
Dist. Hosp.
Nursing Homes
Private Hospitals
Med.Col.
Private Labs.
P.H.Lab.
Corporate
Hospitals

25. Communication Network
Satellite Broadband Hybrid Network.
800 sites on a broadband network
400 sites will have dual connectivity with satellite and broadband.
Enhanced Speedy Data Transfer, Video Conferencing, Discussions, Training, Communication and in future e-learning for outbreaks and program monitoring

26. Information & Communication Technology (ICT) Components
Network
Data Centers
Training Centers
Video Conferencing System
Manpower
Software / IDSP Portal (
24 X 7 Call Center
IDSP portal being used for uploading weekly SPL data, outbreak and FMR

27. Alerts through IDSP Call Centre
Call Centre operational with 1075 toll free number since February 2008
Call received as on 17th January 2010: 1,40,962
No. of Health Alerts : 133
Influenza A H1N1 Calls : 36,918 (from May 2009)
Led to detection of 9 outbreaks [Acute Diarrhoeal Disease (4), Chickenpox(3), Dengue (1) and Malaria (1)]

28. Video Conferencing (VC) Facility
VC being used for:
Outbreak, Investigation, Verification and Documentation
Project Reviewing / Monitoring for different aspects
Training of Data Managers & Data Entry Operators
A total of 400 VC sessions conducted from Jan- 19th Nov 09

29. Lab Network for Influenza Surveillance
AI Lab network is established . These labs. Are also doing testing for influenza A H1N1.
Training of microbiologists and lab technicians completed.
All labs are quality checked
IGMC Shimla
JIPMER
Pondicherry
SGPGI
Lucknow
NCDC, Delhi
Haffkines
Mumbai
NIV,Pune
CRI Kasauli
NIMHANS
Bangalore
IPM
Hyderabad
BJ Medical College
Ahmedabad
Manipal Medical College
ICMR Lab : NIV, Pune, AIIMS, Delhi ,
PGI, Chandigarh,
CMC Vellore, RMRC Dibrugarh,
NICED Kolkatta ,Patel Chest Delhi,
KIPM, Chennai
Other labs: Jaipur,Trivandrum,Surat
(Total 44 labs. 26 under govt. & 18 pvt.sector)

30. Model of Referral Lab Network
State Referral Lab
SSU/DSU/ State Lab Consultant/ State Lab Coordinator
District
BEED
Nashik
MaahabubnagarL
OgoleL
SOUTH GOA
MAHESANA
Sabarkantha
KARNAL
PANCHKULA
KANGRA
MANDI
CHITRADURGA
TUMKUR
BAGALKOT
KANNUR
WAYANAD
PATHANAMTHITTA
LUNGLEI
KOHIMA
SIKAR
AJMER
Cuddalore
ERODE
Ramanthapuram
THANJAVUR
Malda
HARDWAR
Ghiziabad
BELGAUM
Lucknow
Srinagar
Bhopal
Chattisgarh
Ranchi
Dehradun
Almora
Chandigarh
Dadar nagar Haveli
Naharlagun
Sikkim
Curachandpur
DelhiA
Megalaya
Mohali
Koraput
Kolashib
Dimapur
Berhampore 30 30

31. Surveillance & Health regulations
Draft of a new “Public Health Emergencies Act” is under process that covers:
-Epidemic-prone diseases, health consequences of Disasters & Bio-terrorism
-Makes provision for empowering Central/ State Governments to declare condition as PH Emergency & take appropriate measures
Draft modified IHR to review the core capacity for public health response

32. IDSP-Role in Current Response for AI/PI
Institutional and operational framework available at Centre/ State/ District levels utilized
Substantial human Resource for public health available now as compared to a decade earlier.
Trained RRTs at District level
Real time Information flow
Electronic Data records
Enhanced lab capacity (44 labs testing H1N1)

33. Thank You

34. Thank you Dedicated to the people of India…
who have the right to get the benefits of an efficient surveillance system in the country
Thank you