Setting up the Integrated Disease Surveillance Programme

(IDSP) at district level

Integrated Disease Surveillance Programme (IDSP) district surveillance

officers (DSO) course

2

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?

3

Outline of the session

1. Warm up session2. Initiating surveillance3. The district surveillance unit4. Initiating passive surveillance

4

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

Warm up

5

Number of blood slides tested for malaria in Phuentsholing,

Bhutan, 2001-2004

0

100

200

300

400

500

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Weeks

Number of slides tested for malaria

2004

2003

2002

2001

Warm up

6

What happened in 2004?

• Observe the data What do you see?

• Interpret the information What action will you take?

Warm up

7

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

Warm up

8

What happened in 2003?

• Observe the data What do you see?

• Interpret the information What action will you take?

Warm up

9

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

Warm up

10

Number of slides tested for malaria in Phuentsholing,

Bhutan, 2001-2004

0

100

200

300

400

500

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Weeks

Number of slides tested for malaria

2004

2003

2002

2001

The 2004 Dengue outbreak was detected

A 2003 falciparum outbreak was missed

Warm up

11

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!

Warm up

12

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?

Info for action

13

A functional vision of surveillance

1. Collect and transmit

data

2. Analyzedata

3. Feedbackinformati

on

4. Make decisions

All levels use information to make decisions

Info for action

14

Questions to address to set up

a surveillance system1. 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?

Info for action

15

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

Info for action

16

Information for action

The surveillance system is thought and operated from the point of view of the decisions

that need to be taken

Info for action

17

Chairperson* District surveillance committee

District Surveillance Officer (Member Secretary)

CMO(Co. Chair)

RepresentativeWater Board

Superintendent Of Police

IMA Representative

NGORepresentative

District PanchayatChairperson

Chief District PHLaboratory

Medical CollegeRepresentative

if any

RepresentativePollution Board

District Training Officer(IDSP)

District Data Manager(IDSP)

District Program ManagerPolio, Malaria, TB, HIV - AIDS

* District collector or district magistrate

District surveillance committee

Superintendent of hospitals

DSU

18

District surveillance officer

AccountantAdministrative

assistant

Data entry operators (2)

Response team•Epidemiologist•Microbiologist•Clinicians

Chief medical and health officer

District surveillance unit

DSU

19

Epidemiologist (Nodal officer)*

District administration

nominee

Support Staff:Entomologist**

Health assistantsLaboratory technician

Clinician(Pediatrician/Physician)

Microbiologist

* Selected from programme officers other than district surveillance officer, based on disease

** Only when vector borne disease is suspected

District epidemic investigating team (DEIT)

DSU

20

Information flow of the weekly

surveillance systemSub-centres

P.H.C.s

C.H.C.s

Dist. hosp.

Programmeofficers

Pvt. practitioners

D.S.U.

P.H. lab.

Med. col.

Other Hospitals: ESI, Municipal Rly., Army etc.

S.S.U.C.S.U.

Nursing homes

Private hospitals

Private labs.

Corporate hospitalsDSU

21

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

DSU

22

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

DSU

23

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?

DSU

24

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

Starting up!

25

The role of the district within the surveillance system

Compilation Analysis

Feedback

District

State

Reporting units Action

Data are compiled before they are passed on

Starting up!

26

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

committee6. What are the obstacles to using

surveillance information to make decisions?

Starting up!

27

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

Starting up!

28

Example: Data collection

• Obstacles Medical officers do not write the diagnosis in the registers

• Solution Phase in IDSP register with diagnoses

Starting up!

29

Obstacles and possible solutions to initiate passive reporting (Fill with

feedback from the groups)

Activities Locks Keys

Collection •… •…

Compilation •… •…

Transmission •… •…

Analysis •… •..

Review

Action •… •…

Starting up!

30

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

31

Additional reading

• Section 1 of IDSP operations manual

• Module 2 and 4 of training manual• Annexure 4 and 5 IDSP guidelines