Setting up the Integrated Disease
Surveillance Programme (IDSP) at district
level
Integrated Disease Surveillance Programme (IDSP)
district surveillance officers (DSO) course
Preliminary questions to the group
• Were you involved in setting up surveillance
your district?
• If yes, what difficulties did you face?
• What would you like to learn about setting
up surveillance?
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Outline of the session
1.
2.
3.
4.
Warm up session
Initiating surveillance
The district surveillance unit
Initiating passive surveillance
3
Warm up session: A Bhutanese village
close to the state of West Bengal, India
• Number of blood slides collected for malaria
monitored over time
• Data analyzed for 2001-4
4
Warm up
Number of blood slides tested for malaria
in Phuentsholing, Bhutan, 2001-2004
600
Number of slides tested for malaria
500
400
2004
300
2003
200
2002
100
2001
0
5
Weeks
Warm up
What happened in 2004?
• Observe the data
 What do you see?
• Interpret the information
 What action will you take?
6
Warm up
Fever cases in Phuentsholing, 2004
• What is to be seen?
 Peak in the number of blood smears requests in
2004
 Peak is in excess to what was usually seen in this
season
• What to do?
 The increase in the number of fever cases
suggests an outbreak that needs to be
investigated
 Although not designed for this, this imperfect
surveillance system captured an outbreak of
Dengue
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Warm up
What happened in 2003?
• Observe the data
 What do you see?
• Interpret the information
 What action will you take?
8
Warm up
Fever cases in Phuentsholing, 2003
• What is to be seen?
 Smaller peak in the number of blood smears requests at the
end of 2003
 Peak seem in excess to what was usually seen in this
season, but this is less obvious
• What to do?
 The increase in the number of fever cases suggests an
outbreak that needs to be investigated
 In fact there was an outbreak of Plasmodium falciparum
malaria
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Warm up
600
Number of slides tested for malaria in
Phuentsholing, Bhutan, 2001-2004
The 2004 Dengue
outbreak was detected
Number of slides tested for malaria
500
400
2004
300
A 2003 falciparum
outbreak was missed
2003
200
2002
100
2001
0
10
Weeks
Warm up
Take home message from
this example
• All the data is there
 Only a lively surveillance system that collects, compiles,
transmits and analyzes the data can lead to useful public
health decisions
• The better the system works, the better it will react
 If the system is weak, it will only react to large signals
(e.g., the 2004 Dengue outbreak)
 If the system is strong, it will also react to more subtle
signals
(e.g., the 2003 Plasmodium falciparum outbreak that had
been missed)
• Make surveillance operational and lively in your
district!
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Warm up
The essence of surveillance
• What is the disease?
 How many get them?
• Time, place and person
 Who get the disease?
 Where they get them?
 When they get them?
• Why they get them?
• What needs to be done as public health
response?
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Info for action
A functional vision of surveillance
1. Collect and
transmit
4. Make
decisions
data
All levels use
information
to make
decisions
2. Analyze
data
3. Feedback
information
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Info for action
Questions to address to set up
a surveillance system
1. What is the objective of the programme served by
the surveillance system?
2. What kind of decisions need to be made?
3. What information will be needed?
4. What indicators will be needed?
5. What data will be needed?
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Info for action
Questions to address to set up
a surveillance system: Cholera example
1. What is the objective of the programme served by
the surveillance system?
•
Detect cholera outbreak early
2. What kind of decisions need to be made?

Investigations and control
3. What information will be needed?

Sudden rise in incidence
4. What indicators will be needed?

Baseline incidence rates to detect unusual rates
5. What data will be needed?

Number of new cases per week
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Info for action
Information for action
The surveillance system is thought and
operated from the point of view of the
decisions that need to be taken
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Info for action
District surveillance committee
CMO
(Co. Chair)
Representative
Water Board
District Program Manager
Polio, Malaria, TB, HIV - AIDS
Superintendent
Of Police
Chief District PH
Laboratory
IMA
Representative
District Data Manager
(IDSP)
Chairperson*
District surveillance committee
NGO
Representative
Representative
Pollution Board
Superintendent
of hospitals
District Training Officer
(IDSP)
District Panchayat
Chairperson
* District collector or
district magistrate
District Surveillance Officer
17 (Member Secretary)
Medical College
Representative
if any
DSU
District surveillance unit
Chief medical and health officer
Response team
District surveillance
officer
Administrative
assistant
Accountant
Data entry
operators (2)
•Epidemiologist
•Microbiologist
•Clinicians
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DSU
District epidemic investigating team (DEIT)
Microbiologist
Epidemiologist
(Nodal officer)*
District
administration
nominee
Clinician
(Pediatrician/
Physician)
Support Staff:
Entomologist**
Health assistants
Laboratory technician
* Selected from programme officers other than district surveillance officer, based on disease
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** Only when vector borne disease is suspected
DSU
Information flow of the weekly
surveillance system
Sub-centres
Programme
officers
S.S.U.
P.H.C.s
C.H.C.s
Dist. hosp.
D.S.U.
Pvt. practitioners
Nursing homes
Private hospitals
Med. col.
P.H. lab.
C.S.U.
Private labs.
Other Hospitals:
ESI, Municipal
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Rly., Army etc.
Corporate
hospitals
DSU
Functions of the district surveillance unit
• Managerial
 Implement and monitor all project activities
 Coordinate with laboratories, medical colleges, non
governmental organizations and private sector
 Organize training and communication activities
 Organize district surveillance committee meetings
• Data handling
 Centralize data
 Analyze data
 Send regular feedback
• Outbreak response
 Constitute rapid response teams
 Investigate
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DSU
Interactive session: What functions of
the district surveillance unit are in place
in your district?
• Review the functions of the surveillance unit
at the district level one by one
• All participants in the class take turn to say
if this specific function is operational in their
district
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DSU
Interactive session: What functions of
the district surveillance unit are in place
in your district?
• Managerial
 Is the unit implementing / monitoring all project activities ?
 Do laboratories, medical colleges, non governmental organizations
and private sector report in your district?
 Was IDSP training completed as per recommendations?
 When did your district surveillance committee meet last time?
• Data handling
 Does the district centralize data?
 Does the district analyze data by time, place and person?
 Do you send regular feedback containing data?
• Outbreak response
 Do you have a rapid response team?
 When was the last time the district Investigated an outbreak?
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DSU
Key elements of a surveillance system
that need to be in place
• Regular and timely collection of data
 Case definition, forms, reporting units
• Compilation of data
 Aggregation of cases
• Analysis of data
 Calculation of rates, time place and person analysis
 Graphs and tables
• Interpretation of data
 Conclusions
• Feedback of information
 Recommendations
• Action
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Starting up!
The role of the district within the
surveillance system
Reporting
units
District
Feedback
Compilation
Action
Analysis
State
Data are compiled before they are passed on
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Starting up!
Interactive session:
How would you address obstacles to
passive reporting in a district
1. What are the obstacles to data collection?
2. What are the obstacles to data compilation?
3. What are the obstacles to data
transmission?
4. What are the obstacles to data analysis?
5. What are the obstacles to review by
committee
6. What are the obstacles to using surveillance
information to make decisions?
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Starting up!
Interactive session:
How would you address obstacles to
passive reporting in a district
• Break down in 6 groups
• Each group select one of the key function of
the surveillance system
• Participants list the most important
obstacles to this function in their district
• Participants identify solutions to the
obstacles identified
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Starting up!
Example: Data collection
• Obstacles
 Medical officers do not write the diagnosis in the
registers
• Solution
 Phase in IDSP register with diagnoses
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Starting up!
Obstacles and possible solutions to initiate passive
reporting (Fill with feedback from the groups)
Activities
Locks
Keys
Collection
•…
•…
Compilation
•…
•…
Transmission
•…
•…
Analysis
•…
•..
•…
•…
Review
Action
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Starting up!
Take home message
1. Give life to your surveillance system
2. Design surveillance to make decisions
3. Implement the functions of the district
surveillance unit
4. Identify and lift obstacles to initiation of
passive surveillance
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Additional reading
• Section 1 of IDSP operations manual
• Module 2 and 4 of training manual
• Annexure 4 and 5 IDSP guidelines
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