Integrated Disease Surveillance Project

1. Integrated Disease Surveillance Project Launched in November 2004 with World Bank Assistance Major Objective: Early detection and response to outbreaks Budget: Rs 408.36 crore (2004-09)

2. Focus States Tamil Nadu Haryana Rajasthan Gujarat Kerala Karnataka Maharashtra Goa Himachal Pradesh Uttarakhand Mizoram Nagaland Andhra Pradesh

3. Integrated Disease Surveillance Project Components: Integration and decentralization of surveillance activities Strengthening of public health laboratories Human Resource Development – Training of SSO, DSO, RRT, other medical and paramedical staff Use of Information Technology for data collection, analysis and transmission

4. State Surveillance Unit Director Health Services Administrative Assistant

5. District Surveillance Unit Chief Medical & Health Officer • DOIT • Epidemiologist • Microbiologist • Clinicians

6. Rapid Response Teams Comprise of Epidemiologist Clinician (Physician / Paediatrician) Laboratory Officer (Microbiologist / Pathologist / Sr Lab Technician) Entomologist Animal Health Expert Identified and Notified for State Hq and each District Provided 6 days comprehensive training at national level

7. InformationFlow C.S.U. Weekly Surveillance System Sub-Centres Programme Officers S.S.U. P.H.C.s • All reporting Units – identify • Passive Surveillance data from Hospitals • Data from Private Sector • Data analysis C.H.C.s D.S.U. Pvt. Practitioners Dist.Hosp. Nursing Homes Private Hospitals Med.Col. Private Labs. P.H.Lab. Other Hospitals: ESI, Municipal Rly., Army etc. Corporate Hospitals

8. Data Reporting System Form S (Suspect Cases) Health Workers (Sub Centres) Form P (Probable Cases) Doctors (PHC, CHC, Hospitals) Form L (Lab Confirmed Cases) Laboratories Frequency of reporting – weekly (Monday to Sunday) Data compilation/analysis and response At all levels Presently at district/state level

9. Feedback Weekly feedback on Coverage, Completeness, Timeliness and Analysis provided by CSU to State IDSP offices Weekly feedback to State Health Secy. also through E-mail CSU routinely analyzes the data and checks with the district/ state on actions taken whenever rising trends are detected IDSP / NICD nodal officers visit focus states and interact with the concerned officers at various levels

10. Weekly Report on Early warning Signals and Disease outbreaks in the State A new initiative by CSU for getting information on outbreaks reports from SSUs Started from week ending 9 Sep 2007 Outbreak report collected through e-mail or fax on every Monday Submission of NIL reports is required

11. Strengthening of Public Health Laboratories Focus on 50 identified labs Quality System + Biosafety Avian Influenza network Networking of Laboratories

12. Training Activities under IDSP Three Tiered Training system in IDSP ToT through 9 level Institutes Provided Training Manuals External Evaluation of ToT Monitor State Level Trainings Depute observers to assess quality of state trgs Monitor appointments of Training Consultants Need based special Training courses (FETP, EPILAB)

13. IT Network under IDSP NIC assigned the task to establish and manage IT network 800 sites being connected on Broadband (BSNL) 400 sites being connected by broadband as well as satellite connectivity (ISRO)

14. IT Network - Call Centre 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 to be established at NICD Central Outbreak Monitoring Cell will monitor the actions taken by concerned District/State Surveillance Officers Contract to M/s vCustomer Training of Agents completed Expected to be functional in February 2008

15. Current Usage of IT network Video Conferencing held frequently with State HQ/ selected District HQ Online reporting of data using IDSP software initiated 3 States Gujarat, Maharashtra, Tamilnadu being enabled as independent networks with State Teaching ends

16. NCD Risk Factor Surveillance Overall implementation of survey by ICMR Using WHO-STEPS Methodology Sampling representative at State level Periodic Survey every 3 years in each State Risk factors included: Alcohol & tobacco consumption, diet, physical inactivity, anthropometry, BP. Demographic and socio-economic variables will also be collected Survey going on in 8 Phase I states

17. Convergence with other National Health Programmes and Organizations W.H.O. National Rural Health Mission E.M.R. ICMR RCH/ NPSP NACO NVBDCP RNTCP

18. Convergence with NVBDCP MF 11 modified to capture all acute febrile illnesses which may cause outbreaks District Malaria Officer will send a copy of Report to District Surveillance Officer DSO will also share data with District Malaria Officer Modified MF-11 sent to State/Districts IDSP/NVBDCP officials District Malaria Officer will be the part of the district RRT

19. Monitoring Issues (State)

20. Expected Activities at State Level Regular Timely Reporting of Data from the Identified Reporting Units Analysis of Gathered Data for generating Early Warning Signal Responding to Early Warning Signal and investigate/confirm/document/control each Outbreak Streamlining process activities like: recruitment of support staff, training of personnel, making site ready for installation of SIT and utilizing installed SITs, Strengthening Laboratory to detect/confirm/monitor outbreaks and Financial/Procurement discipline

21. Human Resources SSO: Name & Qualification: State Surveillance Officer (SSO) Trained in IDSP What are the job responsibilities of the SSO? What proportion of time the SSO gives to IDSP and what are his other major responsibilities Incremental staff: Are there any posts vacant (state level): If yes which one/s ?

22. Monitoring issues in the stateData Reporting Whether all Reporting Units are reporting and in time Whether data reported is analyzed at every level Whether weekly data is analyzed at the District Surveillance unit and utilized for detecting Early Warning Signal for Outbreaks Action initiated to ensure compliance from non-reporting units and late reporting units How many of the listed categories reporting currently

23. Monitoring issues in the stateLaboratory Whether all PHCs/Block PHCs and CHCs having Lab Technician/Assistant is reporting in L1 format of IDSP surveillance Whether the District is collecting L2 format data from the District Public Health Lab, District Hospital Lab, Malaria Lab and Blood bank and compiling/analyzing the same for Outbreak Alerts Whether and how many of the District Public Health Labs are having Microbiologists, Equipments and supplies for conducting investigations What are the additional capacities available in the Districts like Medical Colleges that may support lab investigation Whether the Outbreaks reported by the District are lab supported

24. Monitoring issues in the stateTraining % of Personnel trained for IDSP category wise –District RRT members, Medical Officers at PHC/CHCs and those at Hospitals, Health Workers and Lab Technicians If there is a backlog remaining –action plan for completing the training Whether a plan is there to train new incumbents and any new category of health personnel identified for training (like the Pharmacists/ ASHA) Whether the state has a plan to increase public health capacity with a plan to train the public health officers in formal Public Health/Field Epidemiology training

25. Monitoring issues in the stateConnectivity How many of the DSU are connected by EDUSAT or Broadband or both currently Whether the connected units are regularly being operated and by whom What are the bottlenecks hindering connectivity at other DSUs Whether the District and State units have Data Manager and Data Entry Operator and other staff in position

26. Monitoring issues in the stateProcurement & Finance Whether the procurement received under the project are taken into Government stock and being audited regularly for utilization and physical verification Whether the state is following Government and Bank guidelines for procurement Whether any procurement has been made by the state or district and a proper book keeping maintained for the same Whether the Accountant is tallying the bank passbook with his ledger Whether vouchers after payment are defaced Whether the controlling officer is countersigning the ledger regularly

27. Monitoring issues in the stateProcurement & Finance (2) Financial Monitoring Report (FMR) for the last Quarter (September 07) submitted? Whether UC for 2006-07 submitted? Whether annual report shared with CSU? Whether advances are classified separately and not included in the FMR? Whether all districts have been covered while preparing the last 2 FMR? What are major operational constraints experienced in the finance issues and what are your suggestions to address these constraints?

28. Monitoring issues in the stateResponse Whether the District and State RRTs are in position Whether the members of District and State RRTs been trained Whether District and State RRTs are actually investigating all reported outbreaks How many of the outbreaks are detected by the IDSP system before the media alerts Bottlenecks and operational issues hindering functioning of the RRTs.