Integrated Disease Surveillance Project
I. Background:
Government of India has launched Integrated Disease Surveillance Project (IDSP) with
support from the World Bank. Karnataka state was included in the Phase I of the project.
The Project aims at
1. Improve the information on a limited set of outbreak prone diseases from public and
private sectors
2. Enhance local response to such outbreaks
3. Established a network of dedicated and adequately staff at district Public Health
Laboratories.
II. Original objectives and scope:
This project originally sought to improve
(1) Reporting on a limited set of diseases and syndromes,
(2) Strengthening laboratory capacity to diagnose these priority diseases,
(3) Recording and transmission of the information through effective use of IT networks,
and
(4) Enhancing the ability of health system to detect outbreaks, promptly investigate and
control them.
This national initiative was to accomplish the goals by enabling the states to improve
the completeness, reliability, and timeliness of information collected at the peripheral
levels of the health care system, engage the large private health care sector in disease
reporting, conduct training of surveillance personnel, equip and staff public health
laboratories, and improve capacity of rapid response teams. Given the surveillance
challenges in India, the project was to accomplish its goals through:

Reporting a small list of priority conditions that include (a) syndromes at
community and sub center level; (b) provisionally diagnosed conditions at the out
patients and inpatients care of facilities; and (c) laboratory confirmed conditions
identified by simple laboratory tests including rapid tests. This information was
to be collected from both public and private sectors.

Enhancing the abilities of surveillance personnel to compile and analyze the
surveillance information through computerization and electronic data
transmission. Using video conferencing links for effective communication and
training.

Integrating all existing disease surveillance activities.
III. Successes and Challenges for IDSP in Karnataka
A. Successes:
 Strong political commitment shown at the highest level for improved disease
surveillance as a part of the NRHM: Regular oversight by the Commissioner
Health and Mission Director NRHM. Additional support to PH laboratories under
NRHM. Bi-weekly detailed reviews by the Principal Secretary Health.
 Network of Public Health Laboratories: Karnataka is one of the few states that
have established dedicated public health labs at district level which are headed by
a full time medical officer. These labs have approved positions of dedicated
Epidemiologists, microbiologists (non-doctor) and entomologists from the state
budget.
 Designating full time district surveillance officers and capacity building: The
State has designated the medical officers of the district public health labs as
district surveillance officers and ensured that all of them have received 2 weeks
competency based training in field epidemiology. These two measures have
significantly improved the ability of the DSOs to undertake disease surveillance.
 Data Analysis and Feedback: The State Surveillance Unit is preparing a weekly
surveillance report with graphs and this report is being shared with the senior
policy makers as well as districts.
 Outbreak investigations: The state had improved in reporting outbreaks in 127
in 2009, 167 in 2010,278 in 2011,223 in 2012, 315 in 2013and 283 in 2014 and
those were increasingly being confirmed by appropriate laboratory tests.
 Initiation of media scanning to identify outbreaks reported by media and followup with districts on actions taken.
 Warning Alerts- By weekly analyzing the trend of the diseases, State is sending
warning alerts to Districts.
B. Challenges
Management of Disease Surveillance:

Coordination with City Corporation and other local bodies for disease surveillance
has been another problem.
Reporting:
 The data in P forms (provisional diagnosis) being reported by the Primary Health
Centers is mostly probable cases
 Though district and Taluk hospitals, SCs reporting, the information is mostly from
the in-patients and also a large part of the data is syndromic, cases as many doctors at
these facilities do not write provisional diagnosis in the OPD registers.
 The state has a large number of medical colleges both in public and private sector. 8
government medical colleges are involved in the IDSP.
Outbreak Investigation:
 Despite improvements in reporting of outbreaks and most of the outbreaks are
confirmed. 44 in 2009, 58 in 2010, 103 in 2011, 152 in 2012, 117 in 2013, 187 in
2014 outbreaks are confirmed.
 Participation of Medical College Pediatrician, Microbiologist, Clinician in outbreak
investigation as part of the RRT has been lacking.
Analysis and use of data:



Mostly limited to district and state levels. Requires more decentralized analysis at
PHC level
Districts have started entering data on IDSP portal report of facing problems very
often.
The monitoring of timeliness, completeness and correctness and follow up with
concerned reporting unit is done less frequently.
IT component:




Denominator data of reporting units and their population to be entered by the DSU
into the IDSP portal is not yet complete.
VC/Interwise, although functional is not yet stabilized and is of poor quality.
Access to IDSP portal is poor due to server downtime.
IDSP portal use is limited due to inadequate training for Data Managers and Data
Entry Operators.
Urban Surveillance:
 Engagement of the Bangalore City Corporation in surveillance activities. Bangalore
City Corporation is reporting the SPL data weekly.
IV. Evolving Vision for Disease Surveillance in Karnataka:
Karnataka will have a high quality and dependable disease surveillance program which is in
compliance with the International Health Regulations (IHR-2005).
To support this vision, the State has to :
 Establish a comprehensive surveillance information system covering public and private
hospitals.
 Build capacities to analyze and use surveillance information at all levels to identify
communicable disease outbreaks early.
 Ensure that all outbreaks will have high quality investigation by multi-specialty rapid
response teams supported by laboratory confirmation.
Laboratory network:
(a) Referral Lab Network :
8 Government Medical Colleges have been identified as Referral Laboratories
for laboratory confirmation of epidemic prone diseases. To provide all districts access
to diagnostic facilities during outbreak situations, the identified 8 Referral labs were
linked to 3-4 districts.
Rs. 2 lakhs is released for each Medical College on annual
basis for procurement of kits, reagent and consumables. And a ceiling of Rs 3 lakhs
has been allocated for reimbursing for the tests performed by Referral Laboratories
on quarterly basis.
Details of Referral Lab and linked districts is as follows:
Sl. Name of Referral Lab
No.
Hassan Institute of Medical
1
Sciences.
Shimoga Institute of Medical
2
Sciences.
Vijayanagar Institute of Medical
3
Sciences, Bellary
4
Mysore Medical College.
Belgaum Institute of Medical
5
Sciences.
6
Bidar Institute of Medical Sciences
Karnataka Institute of Medical
7
Sciences, Hubli
8
Bangalore Medical College
Districts linked
Hassan, Kodagu , Dakshina Kannada
Chikmagalur , Shimoga, Davanagere
Bellary, Koppal, Raichur
Mysore , Mandya, Chamarajnagar
Bijapur , Belgaum, Bagalkote
Bidar, Gulbarga, Yadgiri
Dharwar, Uttara Kannada , Haveri,
Gadag
Bangalore(R),Bangalore(U),Kolar,
Ramanagar,Chikkaballapura, Tumkur.
(B) Priority labs:
Chitradurga & Udupi District Public Health Laboratory have been strengthened to
confirm the outbreaks and diagnosis of epidemic prone diseases and thus enabling
immediate focused containment measures. Human resource and equipments reuired
for functioning of the lab has been provided by G.O.I. Priority labs are given an
annual grant of 4 lakh for purchase of kits, reagents and consumables.
(c) Model Laboratories :IDSP has proposed the development of district Hospital labs for Sentinel Surveillance
of epidemic prone diseases. The criteria for identifying the district labs are as follows:
a) It must be integrated in the existing health system in the district.
b) Must have an established system of receiving routine clinical specimens (linked with
district hospitals or other mechanisms).
c) Be accessible and Provide service needed by the community and those managing
health care in the district.
As per the approved PIP, GOI has released a budget of Rs 107.40 Lakhs ( @ Rs 17.9lakh
/ Lab) in FY 2014-15 towards the procurement of Laboratory Equipments to strengthen six
District hospital Laboratories of Gadag, Koppal, Gulbarga, Bagalkot, Davangere and Haveri
District. These Laboratories would function as District Public Health Laboratory on Model
basis in diagnosis of Communicable diseases. The basic equipments that are being procured
are Bio safety cabinet, Autoclave (Sterilization), Hot Air Oven, Autoclave for
decontamination, Incubators, Binocular microscopes, ELISA reader and washer, Refrigerator,
Computer with printer, scanner, UPS, Deep Freezer, Centrifuge, Micro pipette, Water bath,
Weighing scale & Mixer and Needle Destroyer.
Influenza Surveillance: Karnataka has tackled H1N1 during 2009-10. However, the
threats from Influenza outbreaks are always impending. The threat to the community
especially with regard to H5N1 is expected to have more mortalities. Hence the State has to
be prepared for the eventualities in regard to finances and logistics.
Ebola Surveillance:
The State Government initiated surveillance and monitoring of
Ebola disease with the communication of advisory note from GoI and declaration of Ebola as
a Public Health Emergency of International Concern (PHEIC). As per directions from
Honourable Minister for Health, Shri U.T Khadar, a meeting was convened on 8-8-2014
under the chairmanship of Director Health and family Welfare Services and involving
Surveillance Officers of State, Bangalore urban and rural, Airport Health Officers Bangalore
International Airport, Resident doctors of the Infectious Diseases (ED) Hospital to plan the
strategies to be initiated for the surveillance and monitoring, screening of passengers from the
affected countries and quarantine the suspected patients at Rajeev Gandhi Institute of Chest
Diseases, Bangalore. Copy of meeting proceedings is attached (Annexure 1). Brief
description of the activities is as below,
1.
Human Resources: Three Medical Doctors from State Health Department /
Airport have been nominated and deputed for passive screening of passengers from
affected countries at Kempegowda International Airport, Bangalore and Mangalore
International Airport with immediate effect commencing from 8-8-2014 on 24X7.
2.
Deputy Director, State Surveillance Unit is designated as the State Nodal Officer
for Ebola Viral Disease.
3.
State has taken care of the IEC with regard to Disease symptoms in terms of
banners, flexes and pamphlets and promoting self reporting of the suspects to the
health facility. The Nodal Officer along with a team of Physician from Manipal
Hospital Bangalore and Microbiologist from KIMS Hospital Bangalore have
participated in IEC to community through Regional TV9 Media.
4.
Logistics:- 108 Ambulance has been arranged to commute the suspected cases to
Rajeev Gandhi Chest Disease Hospital from the airport.
5.
Reporting:- Daily reporting has been initiated from the APHO and the Bangalore
Urban Surveillance Officers regarding the passengers screened and their health status
in a prescribed format.
6.
Isolation wards:- Designated Isolation ward with 15 beds have been reserved for
the suspected patients at Rajiv Gandhi Chest Disease Hospital, Bangalore and
Wenlock Hospital Mangalore.
7.
All arrangements for collection of clinical samples and transportation to the
National Institute of Virology for confirmation are made..
8.
Health Education materials have been displayed at appropriate places including
International arrival and waiting area of airport.
9.
IDSP unit at Bangalore is keeping a track of all suspected / screened cases and
reporting it on daily basis.
10.
Till Date 11 suspected cases have been identified from the screening activities
amongst which one was Indian National from Tamil Nadu. The State Surveillance
Officer Tamil Nadu has been alerted to monitor the case up-to 30 days and has been
communicated to report to the concerned GoI authorities. The 6 Nigerian Nationals
reported are being monitored for 30 days and the status of the suspected cases is
submitted to GoI on daily basis. The remaining 3 Indian are travelled to Ebola
affected countries and they are from Shimoga and Gulbarga Districts. The daily health
Status report is sent to Delhi. All 10 suspected cases completed the 30days
observation period.
11.
Training: The following Staffs- (1) State Nodal Officer for Ebola , (2) Physician
(RGICD), (3) Microbiologist (State Surveillance Unit), (4) Staff Nurse (RGICD) are
trained from Karnataka for the “Training of Master trainers on Preparedness and
Response to Ebola Virus Disease(EVD)” at NIHFW New Delhi from 19th to 21st
October 2014. GOI has conducted the 2nd round of training on “Training of Rapid
Response team on Public Health Preparedness and response to Ebola Virus Disease
Outbreak ’’on 3rd to 5th November 2014 at IHM Bangalore. Totally 18 members are
trained on Ebola in the State. Their skills and Knowledge will help in containing the
outbreak.
12.
State have been received the 100 cartoons of Personal Protective Equipment
(PPE) form the GOI. PPEs are supplied to RGICD Hospital and to Wenlock Hospital,
District Surveillance Unit, Mangalore.
13.
State Crisis Management Committee has been formed and first meeting was held
on 11 November 2014 under the Chairmanship of Chief Secretary.
14.
Technical Advisory Committee has been formed and first meeting was held 18
November 2014 under Chairmanship of Director of Health Services.
15.
A team of officers had been inspected the arrangement made for Ebola at
Kempegowda International Airport, Bengaluru on 19 Nov 2014.