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Indian Journal of Community Medicine

Vol. 31, No. 4 (2006-10 - 2006-12)


Editorial: Integrated Disease Surveillance – A Key Step to Improve Public Health in India

J.S. Thakur

Disease surveillance has long been recognized as an important tool for measuring the disease burden, studying morbidity and mortality trends and early detection of outbreaks for instituting effective control measures in a timely manner. Though the health infrastructure in our country has grown immensely over the years, disease surveillance system did not get the desired attention. The outbreaks of plague (1994, 2002), malaria (1995), dengue hemorrhagic fever (1996) and recent chikungunya fever (2006) in different parts of the country further highlighted the weaknesses in the surveillance system. This brought urgency for its strengthening so that early warning signals of outbreaks are detected and appropriate preventive and control measures are applied timely to minimize the impact of the outbreak. Following plague outbreak in 1994, Government of India constituted a number of high-powered committees like Technical Advisory Committee on Plague (1994), Committee to formulate a comprehensive National Programme on Sanitation and Environment Hygiene on the lines of Technology Mission (1995) and Expert Committee on Public Health System (1996). All these committees recommended strengthening of disease surveillance activities across the country. Thereafter, the Government of India constituted a National Apical Advisory Committee (NAAC) under the chairmanship of Union Health Secretary in 1999 to look into this aspect.

On the recommendation of the NAAC, Government of India launched National Surveillance Programme for Communicable Diseases (NSPCD) as a pilot project in 1997- 98 with the overall goal of improving the health status of the people and was in operation in 101 districts. A review of the programme indicated that in the districts in which it has been made fully operational, there is defi nite improvement in the capacity for an early detection of outbreaks and response in a time bound basis thereby justifying further expansion. Integrated Disease Surveillance Project (IDSP) was formally launched by Union Minister of Health and Family Welfare on 8t” November 2004. Integrated Disease Surveillance Project is a decentralized, state based surveillance programme. It is intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner. It is also expected to provide essential data to monitor progress of on-going disease control programme and help allocate health resources more efficiently.

The IDSP proposes a comprehensive strategy for improving diseases surveillance and response through an integrated approach with rational use of resources for disease control and prevention. Data collected under IDSP would also provide a rational basis for decision-making and implementing public health interventions. Specifi c objectives of the IDSP are 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 challenges in the urban and rural areas. The other objective is to integrate existing surveillance activities to extent possible without having a negative impact on their activities so as to avoid duplication and facilitate sharing of information across all disease control programmes and other stakeholders, so that valid data are available for decision making at district, state and national levels.

The key features of Integrated Disease Surveillance are that the district level is the focus for integrating surveillance functions. All surveillance activities are coordinated and streamlined. Rather than using scarce resources to maintain vertical activities, resources are combined to collect information form a single focal point at each level. Several activities are combined into one integral activity to take advantage of similar surveillance functions, skills, resources and target populations. The IDSP integrates both public and private sector by involving the private participation. The IDSP integrates communicable and non-communicable diseases. Common to both of them are their purpose in describing the health problem, monitoring trends, estimating the health burden and evaluating programmes for prevention and control. Integration of both rural and urban health systems as rapid urbanization has resulted in the health services not keeping pace with the growing needs of the urban populace. The gaps in receiving health information from the urban areas needs to be bridged urgently. Integration with the medical colleges (both private and public) would also qualitatively improve the disease surveillance especially through better coverage.

Diseases under surveillance include core diseases, i.e. Malaria, Acute diarrheal disease (Cholera), typhoid, tuberculosis, measles and polio, other conditions (Road Traffic Accidents), International commitments (Plague, Yellow fever) and unusual clinical syndromes causing death/ hospitalization (Meningo-encephalitis/ respiratory distress, hemorrhagic fevers , other undiagnosed conditions). The diseases under sentinel surveillance include HIV, HBV and HCV. The other conditions include water and outdoor air quality for large urban centers. Regular periodic surveys will be undertaken for NCD risk factors (Anthropometry, Physical Activity, Blood Pressure, Tobacco, Diet etc.) by outsourcing to an agency. In addition each State can include up to 5 diseases prevalent in the state.

The project would cover the entire country in a phased manner; The nine states/UTs were covered in the Phase-I commenced from the year 2004-05 and 14 states during the Phase – II commencing from year 2005-06. The last Phase – III has commenced for the rest of the states from year 2006-07.

Four major components of the project are integrating and decentralizing surveillance activities, strenghening public health laboratories, using information technology optimally and enhancing human resource development. Administrative structure will include surveillance unit at central, state and district level. There is a good scope for coordination mechanism at national and state level with provision for coordination committees at different levels.

The surveillance is considered as a backbone of public health. IDSP is indeed a key step for strengthening surveillance in the country. It will not only improve the local capacity of the health system for early detection and control of outbreaks but will also improve the functioning of ongoing health programmes. The implementation of IDSP has started in phase I and II states. There are initial challenges like integration of surveillance activities under different vertical programmes because of different reporting system, building public private partnership and working with multiple stakeholders which are crucial for the successful implementation. However, with the experience of AFP surveillance, health system has the potential to face these challenges successfully.

J.S. Thakur
Deptt. of Community Medicine, PGIMER, Chandigarh
E-mail: [email protected]
Received: 12-9-06

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