IDSP

Integrated Disease Surveillance
Project (IDSP)
Ebenezer Phesao

Outline
1. Introduction
2. Background history
3. Objectives
4. Organizational set up
5. Funding
6. Project activities
7. Implementation
8. Reports
9. Monitoring and Evaluation
10. Achievements
11. Limitations
12. Conclusion

 The disease burden of the people of India is one of the
highest in the world
 India have a triple burden of infectious disease
 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

Surveillance
 Surveillance is a French word meaning “ Watch
with attention, suspicion and authority”
 Definition: “The ongoing and systematic collection,
analysis and interpretation of health data in the
process of describing and monitoring a health event”
(CDC) OR
WHO definition: “The continuous scrutiny of factors
that determine the occurrence and distribution of
disease and other condition of ill-health”
Surveillance is – “Information for Action”

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

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

Important information in disease surveillance
 Who get the diseases?
 How many get them?
 Where do they get them?
 When do they get them?
 Why do they get them?
 What needs to be done at public health
response?

Pre-requisites for effective surveillance
o Use of standard case definitions
o Ensure regularity of the reports
o Action on the reports
Types of Surveillance in IDSP:
Depending on the level of expertise and specificity, disease
surveillance in IDSP will be of following three categories:
i. Syndromic – Diagnosis made on the basis of
symptoms/clinical pattern by paramedical
personnel and members of the community
ii. Presumptive – Diagnosis made on typical history and clinical
examination by Medical Officers
iii. Confirmed – Clinical diagnosis confirmed by an appropriate
laboratory test

1. Acute Flaccid Paralysis
2. AIDS
3. Leprosy
4. Malaria: falciparum and vivax
5. Tetanus neonatorum
6. TB
 For these diseases the nation already has national
programs and some sort of surveillance is carried out
under these programs

 One very successful surveillance programme for NCDs
that already exists is the Population based Cancer
Registries
 Other than this there are surveillance systems for
blindness, iodine deficiency, iron deficiency anemia etc.
 The first multiple disease surveillance system in the
country was the NSPCD(National Surveillance
Programme for Communicable Diseases)
 It has laid the foundation for basic surveillance activities
and reporting and responding to outbreaks in the
selected district

 NSPCD(National Surveillance Programme for
Communicable Diseases) Launched in
1997 - 5 districts
1998 - 20 more districts
1999 - 20 more districts
2003 - more 101 districts
2004 to 2010 - IDSP launched
2010 - Extended for 2 more years
The IDSP proposes a comprehensive strategy for
improving disease surveillance and response through an
integrated approach

Types of integration proposed in this project:
Sharing of surveillance information of disease control
programme
Developing effective partnership with health and non-health
sectors in surveillance
Included non- communicable disease in the surveillance
system
Effective partnership of private sectors and NGOs in
surveillance activities
Bringing academic institutions and medical colleges into the
primary public health activity of disease surveillance

Goal of IDSP: To provide a rational basis for decision-making and
implementing public health interventions that are efficacious in
responding to priority diseases
Keeping this in mind the main objectives of the IDSP are:
1. To establish a decentralized system of disease surveillance
2. Improve the efficiency of the existing surveillance activities of
disease control programs for use in health planning,
management and evaluating disease control strategies

Specific Objectives:
1) To integrate, coordinate and decentralize surveillance
activities
2) Undertake surveillance for limited number of health
conditions and risk factors
3) To establish system for quality data collection,
reporting, analysis and feedback using IT
4) To improve laboratory support for disease
surveillance
5) To develop human resource for disease surveillance
6) To involve all stake holders including those in private
sector and communities

Administrative Structure
NATIONAL SURVEILLANCE COMMITTEE
CENTRAL SURVEILLANCE UNIT
STATE SURVEILLANCE COMMITTEE
STATE SURVEILLANCE UNIT
DISTRICT SURVEILLANCE COMMITTEE
DISTRICT SURVEILLANCE UNIT
 National Centre for Disease Control (NCDC) is
the Nodal Agency for IDSP

 World Bank
 From April 2010 to March 2012, World Bank funds were
available for Central Surveillance Unit (CSU) at NCDC & 9
identified states (Uttarakhand, Rajasthan, Punjab, Maharashtra,
Gujarat, Tamil Nadu, Karnataka, Andhra Pradesh and West
Bengal) and the rest 26 states/UTs were funded from domestic
budget
 The Programme is proposed to continue during 12th Plan as a
Central Sector Scheme under NRHM with outlay of Rs. 851
Crore from domestic budget only

Year Budget estimates
(Rs in crores)
Expenditure
(Rs in crores)
2004-2009 408.36
2009-10 48.50 39.95
2010-11 35.00 28.49
2012-13 63.00
Year Release(in lakhs) Expenditure(in lakhs)
2005-06 94.20
2006-07 1.25
2007-08
2008-09 1.85
Total 94.20 3.10
Balance amount 91.10 lakhs
MANIPUR

 Decentralizing and integrating surveillance mechanisms
 Up gradation of laboratories
 Information technology and communication
 Human resources and development
 Operational activities and response
 Monitoring and evaluation

Phasing of IDSP
Andhra Pradesh
Himachal Pradesh
Karnataka
Madhya Pradesh
Maharashtra
Uttrakhand
Tamil Nadu
Mizoram
Kerala
9 STATES
Chhatisgarh
Goa
Gujarat
Haryana
Rajasthan
West Bengal
Manipur
Meghalaya
Orissa
Tripura
Chandigarh
Pondicherry
Delhi
Nagaland
14 STATES/ UTs
Uttar Pradesh
Bihar
Jammu & Kashmir
Jharkhand
Punjab
Arunachal Pradesh
Assam
Sikkim
A & N Nicobar
D & N Haveli
Daman & Diu
Lakshdweep
12 STATES/ UTs
Phase- I (2004-05) Phase- II (2005-06) Phase- III (2006-07)

Diseases and Conditions Covered under IDSP
 Regular Surveillance
 Vector borne diseases
 Malaria
 Water borne diseases
 Acute diarrheal disease, cholera, typhoid
 Respiratory diseases
 Tuberculosis
 Vaccine Preventable Diseases
 Measles

Contd…
Disease under eradication
o polio
Other conditions
o Road traffic accidents
Other international commitments
o Plague, yellow fever
Unusual clinical syndromes
o Meningococcal encephalitis/respiratory
distress/hemorrhagic fevers/ other undiagnosed
conditions

Contd..
 Sentinel surveillance
 STD/Blood borne diseases
 HIV/ HBV/ HCV
 Other conditions
 Water quality, outdoor air quality( large urban area)
 Regular periodic surveys
 NCD risk factors
 Anthropometry, physical activity, blood pressure,
tobacco, nutrition and blindness
 Additional state priorities
 Each state may identify up to five additional conditions
for surveillance e.g. Dengue, Japanese Encephalitis,
Leptospirosis

IDSP Reporting
• Form S ( Suspect Cases) by health workers( sub centers)
• Form P (Probable Cases) by doctors (PHC, CHC,
Hospitals)
• Form L( lab confirmed cases) from laboratories
• Sentinel site and medical college reporting form
• EWS/Outbreak reporting form
• Frequency of reporting -weekly
• Data compilation/analysis and response at all levels

Information Flow in IDSP
Sub-Centres
P.H.C.s
C.H.C.s
Dist.Hosp.
Pvt. Practitioners
D.S.U.
P.H.Lab.
Med.Co
l.
S.S.U.
C.S.U.
Nursing Homes
Private
Hospitals
Private
Labs.

Strengthening/ Upgradation of Public Health
Laboratories
• Renovation and furnishing of laboratories
• Supply of laboratory equipments & materials
• Focus on 50 identified priority district laboratories
• Quality System + Biosafety
• Avian Influenza network
• Networking of Laboratories

The laboratory network of IDSP
 Peripheral Laboratories and Microscopic centers(L1 labs)
 District Public Health Laboratory(L2 Labs)
 Disease Based State Laboratories (L3 Labs)
 Regional Laboratories (L4 Lab)
 Disease based reference Laboratories (L5 Labs)

Training Activities under IDSP
Trainees Site Days
District and state surveillance team Regional /state 6 days
Laboratory technicians of district and
state public health laboratories
Regional/state 6 days
Data manager of DSU/SSU Regional/state 3 days
Training of laboratory assistants of
CHC/PHC
District HQ 3 days
Data entry operator District HQ 3 days
Mos, Sentinel practitioners, Mos of
sentinel hospitals
District HQ 2 days
HWs, Health assistant, Aganwadi
workers, NGO volunteers, Community
bases staff
CHC 2 days

Human Resources(till 30th June 2011)
Professional Sanctioned
post
In position Trained
Epidemiologist 646 295 269
Microbiologist 85 51 46
Entomologist 35 22 18
Total 766 368 333

IT Network under IDSP
• NIC assigned the task to establish and manage IT network
• ISRO was requested to help in establishing the network for
IDSP for distance education, data entry, data transmission,
video conferencing and out break discussion
• 776 sites (State/ district HQ and Premier institutes) being
connected on Broadband (BSNL)
• 400 sites being connected by broadband as well as satellite
connectivity (ISRO)

Current Usage of IT network
• Video Conferencing held frequently with CSU, State HQ,
selected District HQ and RRT
A weekday wise VC schedule has been started since October
2008, the details as per schedule as under:

Current Usage of IT network
• IDSP portal: It is a single-stop web portal(www.idsp.nic.in) for
data entry and analysis from the district level upwards related
to disease surveillance
• 3 States Gujarat, Maharashtra, Tamilnadu being enabled as
independent networks with State Teaching ends
• Distance learning: Educational satellite (EDUSAT) classrooms
are available at State headquarters, district headquarters,
medical colleges, premier institute and infectious disease
hospitals

Fig: Informatics flow under IDSP

IT Network - Call Centre
• Established in February 2008
• 24X7 Call Centre
• Toll free No. 1075
• Major Regional languages
• Any person would be able to give information about
outbreaks/unusual events on the toll-free number
• Call Centre will refer the information to the concerned
DSU/SSU and the Central Outbreak Monitoring Cell at NICD
• Central Outbreak Monitoring Cell will monitor the actions taken
by concerned District/State Surveillance Officers

Media Scanning Cell
• A Media Scanning and Verification Cell was established at the
NCDC in July200
• 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 new clusters of
diseases

Year All 35 States/UTs 9 WB funded States/UTs
2008 553 400 (72%)
2009 799 488 (61%)
2010 990 619 (63%)
2011
(till 26th June )
699 516 (74%)
Total no. of outbreaks reported through IDSP by the
States/UTs in 2008-2011 (till 26th June 2011)

Weekly EWS / Outbreak report submitting Status of
States/UTs in 2011 (till 25th week ending on 26th
June)
EWS/OUTBREAK REPORT
SUBMITTING STATUS
STATES / UTs
> 80% times reported
(Consistently and timely reporting)
Andhra Pradesh, Arunachal Pradesh,
Assam, Bihar, Jammu & Kashmir,
Karnataka, Kerala, Madhya Pradesh,
Manipur, Meghalaya, Orissa, Punjab,
Rajasthan, Tamil Nadu, Tripura,
Uttarakhand, West Bengal
50 - 79 % times reported Chandigarh, Daman & Diu, Goa,
Gujarat, Himachal Pradesh,
Maharashtra, Puducherry, Sikkim,
Uttar Pradesh
25 - 49 % times reported Chhattisgarh, Delhi, Haryana,
Nagaland
< 25 % times reported Lakshadweep, Mizoram, Jharkhand
Never reported Andaman & Nicobar, Dadra & Nagar
Haveli

State-wise total no. of outbreaks reported through IDSP by all States/UTs in
2008, 2009, 2010 & 2011 (till 25th wk ending June 26th 2011)
2008 2009 2010 2011
1 Karnataka 54 97 90 110 351
2 Tamil Nadu 50 113 90 49 302
3 West Bengal 49 43 89 90 271
4 Gujarat 24 49 83 101 257
5 Andhra Pradesh 72 64 75 39 250
6 Maharashtra 99 27 65 32 223
7 Uttar Pradesh 40 67 98 10 215
8 Rajasthan 8 43 84 50 185
9 Madhya Pradesh 16 65 70 24 175
10 Assam 16 30 53 39 138
11 Kerala 17 47 53 19 136
12 Orissa 17 38 19 33 107
13 Uttarakhand 27 30 25 21 103
14 Punjab 17 22 18 24 81
15 Bihar 1 6 21 25 53
16 Haryana 10 9 18 7 44
17 Himachal Pradesh 3 13 7 1 24
18 Arunachal Pradesh 6 6 6 5 23
19 Chhattisgarh 1 7 2 4 14
20 Jharkhand 0 5 4 1 10
21 Meghalaya 5 3 2 0 10
22 Tripura 1 2 2 5 10
23 Puducherry 3 2 4 0 9
24 Chandigarh 3 3 2 0 8
25 Sikkim 3 0 2 3 8
26 Delhi 3 1 0 3 7
27 Goa 2 3 0 1 6
28 Manipur 1 2 2 1 6
29 Mizoram 5 0 0 0 5
30 Jammu & Kashmir 0 0 2 2 4
31 Nagaland 0 1 2 0 3
32 Daman & Diu 0 1 1 0 2
33 Dadra and Nagar Haveli 0 0 1 0 1
34 Andaman & Nicobar 0 0 0 0 0
35 Lakshadweep 0 0 0 0 0
553 799 990 699 3041
Total
Year
Sl. No. State Total

Disease-wise total no. of outbreaks reported through IDSP by all
States in 2008, 2009, 2010 & 2011 (till 25th wk ending June 26th)
2008 2009 2010 2011
1 Acute Diarrhoeal Disease 228 332 411 220 1191
2 Food Poisoning 50 121 188 158 517
3 Measles 40 44 94 103 281
4 Chicken Pox 12 45 47 47 151
5 Malaria 43 34 37 23 137
6 Viral Hepatitis 28 30 24 46 128
7 Viral Fever 31 37 40 16 124
8 Chikungunya 25 61 25 12 123
9 Dengue 42 20 40 14 116
10 Cholera 20 34 34 22 110
11 Enteric Fever 6 10 10 4 30
12 Acute Encephalitis Syndrome 6 5 11 6 28
13 Anthrax 2 6 3 6 17
14 Leptospirosis 6 3 6 1 16
15 Acute Respiratory Illness 4 3 3 1 11
16 Dysentery 0 1 3 3 7
17 Kalazar 1 0 3 3 7
18 Meningitis 2 3 1 1 7
19 Scrub Typhus 3 1 1 2 7
20 Acute Flaccid Paralysis 1 0 0 5 6
21 Mumps 0 2 3 1 6
22 PUO 1 2 1 0 4
23 Diphtheria 1 1 1 0 3
24 Rubella 0 1 2 0 3
25 Cremian-Congo Haemorrhagic Fever 0 0 0 2 2
26 Gas Poisoning 0 1 0 1 2
27 Acute Febrile Illness 1 0 0 0 1
28 Buffalo pox 0 1 0 0 1
29 Epidemic dropsy 0 0 1 0 1
30 Kyasanur Forest Disease 0 0 0 1 1
31 Pertussis 0 0 1 0 1
32 Viral Hepatitis B 0 1 0 0 1
33 Vitamin A Overdosage 0 0 0 1 1
553 799 990 699 3041
Year
Sl. No. Disease/Illness Total
Total

IDSP status of Tripura
• SSU and DSU was set up in 2005-2006
• Total DSU is 4
• Total reporting site: 802
• Every week – 630 sub-center, 91 government/ private
laboratories and 107 PHC/CHC are reporting in S, P, L
format
• Training status:
Medical officer & doctors 420
MPS 20
MPW 658
Lab technician 90

• 3 DSU and SSU is equipped with EDUSAT
• SSU is having the facility of video conferencing with
CCU
• RGM Hospt, North Tripura – identified as District Priority
Lab
• Contractual Staff position under IDSP as on June, 2012
Designation Number
Consultant (Finance) 1
Data entry operator 4

post
In position Trained
Entomologist 1 0 0
Total 8 0 0
Human resource for Tripura

IDSP status of Manipur
• Manipur is a phase II state under IDSP
Human resource for Manipur (till 30 th June 2011)
post
In position Trained
Entomologist 1 0 0
Total 13 3 3

• Outbreak and epidemic after introduction of
IDSP in Manipur
Outbreak Place and time
Dengue Moreh in Dec 2007
Scrub Typhus Bishnupur in April 2008
malaria Churachandpur In March 2009
Malaria Moreh in April to July 2009
Malaria Touthong Khunou in June 2009
German measles Khurai, Imphal East in May
2009
Japanese encephalitis June-July 2010

• RRT in every district is in position to response to any out
break
• 7 CMOs and 2 DSOs have been trained on FETP in
2010
• An innovation EWS reporting by using SMS from
periphery to district and state surveillance was
introduced in the 2011-2012 session
• Informer will be given Rs 70 recharge card / month

• Sentinel surveillance of the Vaccine preventable
childhood infectious disease started in JNIMS in 2010-11
• District priority laboratory at District hospital
Churachandpur has been fully equipped and is ready to
function
• The daily newspaper and e-mail scanning was
introduced in the 2011-2012 financial year
• SIT equipments installed at State Headquarter, 9 DSUs
and Regional Institute of Medical Sciences, Imphal
• Manipur has 9 districts. Four out of nine DSUs are
reporting weekly data and outbreak report regularly

 Total DSU: 11
 No. of DSU equipped with EDUSAT- 10
Status: Non-functional
 New diseases detected after introduction of IDSP:
JE, Dengue, Scrub Typhus, Kala Azar
(migrant)
 IDSP Priority Lab- 2
IDSP Status in Nagaland

 No of RRT : 3
 24 X 7 call centre established after detection
of swine flu case in Nagaland
 Sentinel surveillance – not done
 Media scanning cell: 1 national and 3 local
newspaper screened everyday
 Account in Facebook as Nagaland IDSP opened
 DSU reporting: regular but completeness lacking

Human Resources for Nagaland
post
In position Trained
Entomologist 1 1 1
Total 13 11 11

1. Training of Trainers (TOT) -15
2. Orientation of District Surveillance
Officers (DSOs) done - 11
3. Medical Officers - 92
4. Lab. Tech/ Asst. - 41
5. MPWs - 431
6. Accountants(IDSP) - 11
7. DEOs - 24
8. Sensitization of Private Practitioners/ Paramilitary
done for all Districts

Training programme for 2012:
Field Epidemiological Training Programme(FETP) – target achieved
Training of Trainers(TOT) – target achieved
Training of MO and Para- medical staffs – not yet done

Key Performance Indicators
 Number and percentage of districts providing monthly
surveillance reports on time – by state and overall
 Number and percentage of responses to disease-specific
triggers on time - by state and overall
 Number and percentage of responses to disease-specific
triggers assessed to be adequate -by state and overall
 Number and percentage of laboratories providing
adequate quality of information – by state and center

Contd.
 Number of districts in which private providers are
contributing to disease information
 Number of reports derived from private health care
providers
 Number of reports derived from private laboratories
 Number and percentage of states in which surveillance
information relating to various vertical disease control
programs have been integrated

Contd.
 Number and percentage of project districts and states
publishing annual surveillance reports within three
months of the end of the fiscal year
 Publication by CSU of consolidated annual
surveillance report (print, electronic, including posting
on the websites) within three months of the end of
fiscal year

• Surveillance units have been established in all states/districts
(SSU/DSU)
• Training of State/District Surveillance Teams and Rapid
Response Teams (RRT) has been completed for all 35
States/Uts
• IT network connecting 776 sites in States/District HQ and
Premier institutes has been established with the help of National
Informatics Centre (NIC) and Indian Space Research
Organization (ISRO) for data entry, training, video conferencing
and outbreak discussion

Contd.
• On an average, 20-30 outbreaks are reported every week
by the States. 553 outbreaks were reported and responded
to by states in 2008, 799 outbreaks in 2009, 990 in 2010
and 1675 outbreaks in 2011. In 2012, 482 outbreaks have
been reported till 29th April
• A total of 1758 media alerts were reported from July 2008
to March 2012
• About 2.7 lakh calls have been received from beginning till
now, out of which more than thirty five thousand calls were
related to Influenza A H1N1
• 50 identified district laboratories are being strengthened for
diagnosis of epidemic prone diseases and a network of 12
laboratories has been developed for Influenza surveillance
in the country

Contd.
• In 9 States, a referral lab network has been established
• Recruitment of 301 Epidemiologists, 60 Microbiologists and
23 Entomologists has been completed so far

• The project was launched throughout the county but on
papers and no training of professionals and staff involved in
data collection and transmission has been completed
• The project started in 2005-06 but functional software was
shared during end of 2008, thereby leading to gaps in data
entry, data-basing and analysis
• Difficulty in ensuring the quality of training in a cascade
method
• Lack of trained epidemiologist and microbiologist

• Trained District Surveillance Officers have not been able
to use their skills due to high turnover. In addition, the
district surveillance officer has multiple responsibilities
• Involvement of Medical Colleges (In the first PIP there
was no provision for training, outbreak investigation and
contingencies etc. for Medical Colleges)
• Funds committed for medical college laboratory to act
as State Reference Laboratory were not available.

• District Laboratories do not have the
infrastructure/manpower with adequate skills for
undertaking confirmatory tests for a number of diseases
• Broadband connection installation and maintenance of
VC was centrally coordinated, as a result of which minor
defects could not be rectified locally and Data Managers
were not trained enough to rectify the defects
• At the time of disaster, SSU and State Health Control
Room operate in the same office because of which the
routine surveillance gets diluted

• Public Health which gets activated only during the time
of disaster and crisis is yet to get its due place in day to
day functioning of the health system
• Lack of monitoring and supervision at all levels
• Private sectors and semi-government organization have
not been involved in the same proportion as of their
numbers
• Number of parallel systems under various programs are
still operating and duplication of record generation has
not gone down

 Integrated Disease Surveillance Project (IDSP) is a
decentralized, state based surveillance programme in the
country
 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 programmes and
help allocate health resources more efficiently

IDSP

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