There were 4 Components:
a. Decentralisation and integration of surveillance activities through establishment of surveillance units at district, state and central levels
b. Human Resource Development with training of State Surveillance Officers, District Surveillance Officers, Rapid Response Teams and other relevant staff
c. Use of information technology for collection, compilation, analysis and dissemination of data and
d. Enhancement of Public Health Laboratories.
The following Objectives were to be met
1. Cover limited number of diseases of public health importance which needed public health response
2. Implement multiple methods of surveillance
3. Be a proactive program with timely response at all levels i.e. Be an Early Warning and Response (EWAR) program
4. Use Information Technology to facilitate information gathering, collation, analysis and dissemination
5. Decentralise and have states take ownership and
6. Centre be responsible for coordination, quality control, policy formulation, finance management and technical assistance.
It was realised that though the healthcare infrastructure in India had grown over the years, disease surveillance had not got the required attention in the past, resulting in late detection of disease outbreaks with related morbidity and mortality. One of the main reasons for this shortcoming was the time-consuming and labour-intensive manual methods of data collection, transmission, analysis and feedback for response with paper.
Hence a countrywide Information and Communication Technology (ICT) network was established under IDSP with the help of National Informatics Centre (NIC) and Indian Space Research Organisation (ISRO). This IDSP network connects the District Surveillance Offices to the State Surveillance Offices which then connects to the Central Surveillance Office at the National Centre for Disease Control (NCDC).
The network is also presently being deployed to CHC and even PHC levels in some states. The network is used for data entry, compilation, analysis and feedback from data coming in from the sub centre level and above. It has video conferencing ability to help in meetings and training sessions. Furthermore, there is an IDSP portal ( www.idsp.nic.in ), which is a one-stop portal for data entry, reports, outbreak reporting, data analysis and training modules related to disease surveillance.
The IDSP program has three methods of surveillance
1. Indicator Based Surveillance
2. Event Based Surveillance and
3. Media Surveillance.
Briefly describing each of these: –
Indicator Based Surveillance
There are three levels where these indicators are collected: –
S form – this form is filled by the sub-center health worker and collects collated details on conditions such as Fever, Cough, Loose watery stools, Jaundice and Acute Flaccid Paralysis (AFP). These forms are submitted to the supervising primary care centre once a week and fed into the IDSP system via the District Surveillance Unit (DSU).
P form – this form is filled by the primary care providers and collects collated data on about 20 different conditions including the above plus additional conditions such as Pertussis, Diphtheria, Leptospirosis etc. This is also submitted on a weekly basis and uploaded into the IDSP system weekly via the DSU.
L form – this is the form collected from public health (and private) Labs for positive test results for specific diseases such as Dengue, Japanese encephalitis , Cholera etc. The difference in these forms are that for each positive result, further details such as the patient name, age, address, test done and lab confirmation diagnosis is also recorded. These forms also go into the IDSP network via the DSU on a weekly basis.
For more details about information on each of these forms please visit the following link
http://idsp.nic.in/index1.php?lang=1&level=1&sublinkid=5850&lid=3781
From the DSU the information gets instantaneously transmitted to the State Surveillance Unit (SSU) and then the Central Surveillance Unit (CSU) via the IDSP network. This network has been effectively working since 2010. The result is that the CSU based in the National Centre for Disease Control (NCDC), has been publishing nationwide outbreaks of these specific diseases on a week by week basis about a month later (On June 20th could see the outbreaks that occurred in the week of May 14th to May 20th) – here is the link
http://www.idsp.nic.in/index4.php?lang=1&level=0&linkid=406&lid=3689
Event Based Surveillance
Media Surveillance
In summary it is a combination of all the above three methods that bring about the Early Warning mechanism for outbreaks and potential epidemics in India. While there is much room for improvement- the IDSP program has proven the effectiveness of a nationwide IT network and in-fact can potentially be upgraded to be the Healthcare IT highway for the country.
“Dedicated to the IDSP program and public health staff of India – who do so much with so little. Often criticized, seldom appreciated, a big heartfelt thank you” – Dr. Pramod Jacob
Dr Pramod D. Jacob (MBBS, MS- Medical Informatics)County, Portland, Oregon. He went to do Healthcare IT consultancy work for states and counties in the US and India.
At present he is a Director and Chief Medical Officer of dWise Healthcare IT solutions. He was also a consultant for WHO India in the IDSP project and for PHFI for a Non Communicable Diseases Decision Support Application.
