CHAPTER - 3 INTEGRATED DISEASE SURVEILLANCE PROJECT

Transcription

1 CHAPTER - 3 INTEGRATED DISEASE SURVEILLANCE PROJECT 125

2 CHAPTER :3 INTEGRATED DISEASE SURVEILLANCE PROJECT Outline of the Chapter Page no 1 The Geographic information of the state Socio demographic information of the state Introduction of IDSP (Integrated Disease Surveillance 133 Project) in Gujarat. 3.1 Background, Specific Objectives of IDSP Project Overview of IDSP Project in Gujarat Organization Structure of IDSP in state State Surveillance Unit District Surveillance Unit Municipal Corporation and Medical Colleges Private Sectors IDSP Sub Committee Reporting Status of Contractual staff under IDSP Status of Training of Medical and Paramedical staff 145 under IDSP Training Programmes Completed in Previous years Training completed during Financial Year Annual Action plan Disease Surveillance Under IDSP Definition and Overview Importance of disease surveillance

3 5.3 Steps of disease surveillance Indicators and Vision Strategies for Surveillance Urban Surveillance Integration of various programme of IDSP Why integration? Integration with NRHM programme Integration with NVBDCP programme Integration with other programme District wise Reporting Units State Referral Network Plan Achievement Conclusion

4 Government of India launched Integrated Diseases Surveillance Project on 4 ty November 2004, with a view to establish a decentralize state based system of surveillance for communicable and non-communicablediseases and to improve the efficiency of existing surveillance system of diseases control programme. Gujarat was included in phase 2 of IDSP and it was launched in Gujarat on 8 th November Evident from the weekly surveillance data collected, complied and analyzed under IDSP shows that the mortality and morbidity due to communicable disease have drastically reduced in Gujarat state over last few years. Hence in the present chapter, the researcher has tried to provide information about Gujarat state and Integrated Diseases Surveillance Project. Information about IDSP in Gujarat has been provided about its objectives, organization structure, diseases surveillance and other important aspects. 128

5 1. The Geographic Information of the State: Gujarat is one of the leading states in India which is the northern-most maritime state on the west Coast of India, situated between 20.1 degree to 24.7 degree North Latitude and between 68.4 to 74.4 degree East Longitude. The area of State is 1,95,984 Sq.Kms. The 1600 Kms. Long coastline of Gujarat extends from Kutchh in North West to Saurashtra and South Gujarat regions. Map 3.1 MAP OF GUJARAT The present political province of Gujarat is bounded by Arabian Sea [West], Pakistan [North and North West], State of Rajasthan [North East],State of Madhya Pradesh [East] and Maharashtra [South and South East] as per the political province of Gujarat. On the Southern coast of Saurashtra, there is a Div island. On the coast of South Gujarat, we have Daman and while Dadra Nagar Haveli are on the Maharashtra border. These are centrally administered Union Territories. The North-eastern boarder of Gujarat is covered by mountain ranges in Banaskantha and 129

6 Sabarkantha district. Kutch and Saurashtra regions are largely dry and warm. A large area of Kutch as very difficult areas covered by desert land. The climate in Gujarat ranges from humid in the coastal regions to extreme in the interiors. Summers get extremely hot and winters cold in areas like the desert of Kutch The coastal regions and the eastern belt of Gujarat experience a mild pleasant climate with moderate rainfall during the monsoons. Eastern part of State has green as well as hilly area with average to heavy rainfall. 2. Socio-demographic information of the State In year 2011 the population of Gujarat is 6, 03, 83, 628 which is % rise in decade (Provision). The State of Gujarat has total population of 506 lacs (2001 census), out of this, around 52 % is represented by male and 48 % by female. There are total lacs people (62.6 %) representing from rural regions compared to only lacs (37.3 %) from urban. The overall literacy rate is 69.1 % in which male constitutes 79.6 % and female 57.8 %. The female belonging to rural regions have significantly less literacy rate (47.8 % ) then those belonging to urban regions (74.5%) Similar difference was found in case of male. There are total 26 districts in Gujarat having 226 talukas out of those, around 43 talukas are tribal. Table 3.1 Population Detail (2001) In lacs Total Male % Female % Rural % Urban % Table 3.1 Contd. 130

7 Table 3.1 Contd. SC Population Total % Male % Female % ST Population Total % Male % Female % Source : Annual report of IDSP ( Integrated Disease Surveillance Project ) Table 3.2 District wise population in Gujarat State Sr. No. District Name Total Rural Urban Percentage Decadal Growth 1 Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Table 3.2 Contd.. 131

8 Table 3.2 Contd.. Sr. No. District Name Total Rural Urban Percentage Decadal Growth 12 Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Rajkot Sabarkanthha Surat Surendranagar Vadodara Valsad Tapi Total Source : Annual report of IDSP ( Integrated Disease Surveillance Project )

9 Table 3.3 Literary Rate in State Effective Literacy Rate-Total Total 79.31% Male 87.23% Female 70.73% Effective Literacy Rate-Rural Total 73.00% Male 83.10% Female 62.41% Effective Literacy Rate-Urban Total 87.58% Male 92.44% Female 82.08% Source : Annual report of IDSP(Integrated Disease Surveillance Project ) Introduction of IDSP (Integrated Disease Surveillance Project) in Gujarat State 3.1 Background : - During Plague outbreak in 1994, with huge morbidity and mortality, the country sustained huge economic losses. Disease Surveillance was also not able to detect early warning and response was also not as per requirement to reduce the magnitude of the outbreak. Plague outbreak had shown the need to establish a dedicated disease surveillance system that has been also recommended by high power committee.1977 National Surveillance Programme for Communicable Diseases (NSPCD) piloted and Gujarat State also involved in this pilot project. 133

10 3.2 Specific Objectives of IDSP Project :- To integrateand decentralize surveillance activities. To establish systems for data collection, reporting, analysis and feedback using information technology. To improve laboratory support for disease surveillance. To develop Human resources for disease surveillance and action. To involve all stakeholders including private sector, corporate sector and communities in surveillance. General objectives of the project is to establish a decentralize state based system of surveillance for communicable and non communicable diseases, so that timely and effective public health actions can be initiated in response to health challenges in the country at state and nation level and to improve the efficiency of existing surveillance system of disease control programme and facilities sharing of relevant information with the health administration, community and other stakeholders so as to detect disease trends over time and evaluate control strategies. 3.3 Overview of IDSP Project in Gujarat State The integrated disease surveillance (IDS) system which was initiated in Kutch district after the earthquake was later expanded to cover entire state. Government of India launched Integrated Diseases Surveillance Project on 4 th November The Gujarat State is front runner in implementation of IDSP. State has successfully developed web based weekly surveillance system capable of forecasting an epidemic. Analysis of weekly surveillance data on regular basis, providing feedback to reporting units and early actions by reporting units has lead containment of diseases ultimately reducing mortality and morbidity. Before the IDSP was established, the disease surveillance data was being collected on monthly basis thus, there was no system of ongoing surveillance in the state and because of that the system of early warning signal did not exist. 134

11 The Government of India initiated a decentralized State based Integrated Disease Surveillance Project (IDSP) in the country in year in response to a long felt need expressed by various expert committees. IDSP (Phase 1) was launched by Govt. of India in Nov Gujarat state was included in phase 2 of the project and IDSP was launched in Gujarat on 8 th Nov The project would be able to detect early warning signals of impending outbreaks and help initiate an effected response in a timely manner. It is also expected to provide essential data to monitor progress of ongoing disease control programs and help allocate health resources more optimally. The mortality and morbidity due to communicable diseases have drastically reduced in Gujarat state over last few years. This is evident from the weekly surveillance data collected, compiled and analyzed under Integrated Disease Surveillance Project Implemented in the state since year 2003 Table 3.4 Phasing of IDSP Phase 1 ( ) Phase 2 ( ) Phase 3 ( ) Andhra Pradesh Chhattisgarh Uttar Pradesh Himachal Pradesh Goa Bihar Karnataka Gujarat Jammu and Kashmir Madhya Pradesh Haryana Jharkhand Maharashtra Rajasthan Punjab Uttaranchal West Bengal Arunachal Pradesh Tamil Nadu Manipur Assam Mizoram Meghalaya Sikkim Kerala Orissa AandN Nicobar Table 3.4 Contd. 135

12 Table 3.4 Contd. Phase 1 ( ) Phase 2 ( ) Phase 3 ( ) 9 States Tripura DandN Haveli Chandigarh Daman and Diu Pondicherry Lakshadweep Delhi 12 States/UTs Nagaland 14 States/UTs Source : Annual report of IDSP ( Integrated Disease Surveillance Project) Organization Structure of IDSP in State 4.1 State Surveillance Unit Active and passive surveillance is done by grass root functionaries and health facilities. No additional structure is created for surveillance system except few support persons at the district and state level. Secretary (Public Health) is overall in charge at the apex level. Commissioner (Health, Medical Services and Medical Education) guide and supervise surveillance activities at the state level. State Nodal Officer is designated as State Surveillance Officer IDSP. State Nodal Officer is designated by the State Government, a regular dedicated Govt. Officer appointed for this post. State Surveillance Unit is headed by State Nodal Officer and located at new location, Government Dispensary, Sector 3 A New Gandhinagar, under commissionerate of Health. State Nodal Officer is overall in charge of surveillance activities that monitors technical, administrative and financial activities of the project. He is assisted by contractual staff such as Epidemiologist (1) Entomologist [1] Consultant Training [1] Consultant Finance [1] Data Manager [1] Data Entry 136

13 Operator (2) Administrative Assistant [1] and Helper (Administrative assistant and Helper recruited through (NRHM). State Nodal officer is responsible for all activities and finance, State Surveillance officer, Epidemiologist and Medical Officer assists the State Nodal Officer to monitor the IDSP activities. The Data Manager is responsible to compile and manage data along with alert generation, The Data entry is managed by 2 DEOs. One Administrative Asst. and One Helper handles the clerical and administrative issues. Consultant Finance has to manage work of Finance. Consultant Training will be recruited soon. The functions of the State Surveillance unit includes: Collation and analysis of data received from district and transmitting to Central Surveillance Unit through website. Coordinating activities of rapid response teams and deputing them to the field. Monitoring and reviewing the activities of the district surveillance units including checks on validity of data, responsiveness and functioning of the laboratories. Coordinating the activities of the state public health laboratories, medical colleges and other state level institutions. Sending regular feedback to the district units on the trend analysis of data in the form of alert as well as feedback letter. Coordinating all training activities under the project. Organizing meeting of the State IDSP subcommittee. Develop State specific technical guidelines and technical support to district and corporations. 137

14 Chart 3.1 Organgram of SSU, Gujarat Secretory ( Public Health ) Commissioner ( Health ) MD NRHM Additional Director ( Health ) State Surveillance Unit State Nodal Officer ( IDSP ) and State Surveillance Officer Conultant Entomo Epidemio Micro Medical Consultant Finance-1 Logist Logist-1 Biologist Officer Training-1 Admin. Assit. Data Manager Data EntryOperator Data EntryOperator Helper Source : Annual report of IDSP ( Integrated Disease Surveillance Project)

15 Table 3.5 Integrated Diseases Surveillance Project Staff Positions SSU Gandhinagar as on 20 th March 2012 Sr. No Name Designa tion Address Telephone/Fax Number Mobile No. 1 Dr.V.S.Dhr State Sec-3/A, New Govt uwey Nodal Officer Dispensary, Gandhinagar.IDSP. 2 Dr.S.I.Patel Medical Sec-3/A, New Govt Officer Dispensary, Gandhinagar.IDSP. 3 Dr.Swaroop Purani Epidemologist 4 Mr.P.T.Jos Entomologist hi 5 Vaishali Conslun Mandiwala -tant (fin) 6 Mr.R.C. TB Mochi Supervis or 7 Mr. Ashok Admin Chauhan Assistan t 8 Er. Amit Data Rami Manager Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Table 3.5 Contd. 139

16 Sr. Name No 9 Jyotsana Dave 10 Mr.Ashwin Chaudhary 11 Mr.Banesin h Vaghela 12 Mr.Jayesh Parmar Table 3.5 Contd. Designa Address Telephone/Fax Mobile No. tion Number DEO Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. DEO Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Driver Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Helper Sec-3/A, New Govt Dispensary, Gandhinagar.IDSP. Source : Annual report of IDSP ( Integrated Disease Surveillance Project) District Surveillance Unit District Surveillance Units has been establish in all 26 districts. Chief District Health Officer, who is head of health branch, is designated as District Nodal Officer IDSP at the district level. Epidemic Medical Officer working under direct guidance and supervision of chief District Health Officer, is designated as District Surveillance Officer. He is assisted by Data Manager and Date Entry Operator Finance is looked after by Finance Assistant of NRHM. Epidemiologist is deployed, at Bhavnagar district only. Epidemic Medical Officer is the District Surveillance Officer. Data Entry is done by the existing DEOs dealing with disease surveillance activities. The data compilation, analysis, alert generation and feedback has been done by data manager who is also responsible for management of IDSP 140

17 portal in regards to district level data including Urban and Corporation area. The functions of the district surveillance unit. Collation and analysis of data received from districts and transmitting to State Surveillance Unit. To constitute rapid response teams and deputing them to the field whenever needed. Implementation and monitoring of all project activities in District including Corporation and Urban area. Coordinating with public health laboratories medical colleges, NGOs and private sectors within the District. Sending regular feedback to the reporting units on analysis of data. Coordinating training and IES activities within the district. Organizing meeting of the district IDSP subcommittee. 141

18 Chart 3.2 Organ Gram Of DSU District Surveillance Unit District Nodal Officer (CDHO) District Surveillance Officer (EMO) Epidemiologist(1) Data Manager (1) Data Manager (1) Data Entry Operator (1) Medical College Hospitals, Municipal Corporation`s Hospital, Sub- District Hospital, CHCs, PHCs, S.C, Pvt. Hospitals and Laboratories. Source : Annual report of IDSP ( Integrated Disease Surveillance Project)

19 4.3 Municipal Corporation and Medical Colleges Seven Municipal Corporation (Ahmadabad, Vadodara, Surat, Bhavnagar, Jamnagar, Junagadh and Rajkot) each having population of more than 5 lacs also carry out surveillance activities through urban health centers and private hospitals and report directly to District surveillance Officer of the same district. Six Govt. Medical Colleges and Two Municipal Medical Colleges also carry out surveillance activities. Data are collected from OPD and Wards and submitted to district surveillance Officer of the same district. 4.4 Private Sectors 105 Private reporting units are submitting weekly surveillance report. Orientation has been given to administrators and in-charge doctors of Grant-in-aid hospitals are in plan during the year 2011 to increase the number of reporting units. The SSU has planned to arrange workshops for member of Indian medical association and private laboratories in year IDSP Sub Committee The state IDSP subcommittee is a part of state health society. The district subcommittee is responsible for the regular running of the program at the district level. The district IDSP sub committee is chaired by the Chief District Health Officer. 4.6 Reporting Reporting formats developed by central surveillance unit had been continued in September The reporting formats S, P, and L as prescribed by Govt. of India have been reproduced in sufficient quantity and supplied to reporting units. After September, new P format was introduced by the CSU, the data entry in new format was started to perform immediately after its launch throughout the state. 143

20 Table 3.6 Status on availability of human resource as on 31 st December No. Category Sanctioned Filled Remarks up 1 State Surveillance - 1 RegularOfficer Additionally Officer Designated 2 State Nodal Officer - 1 Regular Officer Additionally Designated 3 District Nodal Officer - 26 Chief District Health Officer (CDHO) additionally designated 4 District Surveillance - 26 Epidemic Medical Officer Officer (DSO) additionally designated 5 Medical Officer at State 2 (State) 2 At SSu 6 Consultant training 1 0 Contractual 7 Consultant Finance 1 1 Contractual 8 Epidemiologist 26 ( 1 at State) 4 Contractual 9 Entomologist 1 1 Contractual 10 Microbiologist 3 0 Contractual 11 Data Manager State level 1 1 Contractual District level 25 Contractual Data Entry Operator State level 2 2 Contractual District level Contractual Medical college 7 6 Contractual Source : Annual report of IDSP ( Integrated Disease Surveillance Project) There are total 7214 S reporting units (syndromes surveillance), around 1780 P reporting units (surveillance based on presumptive diagnosis) and 1667 L reporting units (based on laboratory diagnosis) throughout the state. This has included district and sub district hospitals, CHCs, PHCs, 144

21 SC and private hospitals and laboratories. Active surveillance is carried out by Health Workers (Male and Female) in both urban and rural areas who collect the surveillance data at grass-root functionaries. 4.7 Status of Contractual Staff under IDSP A few contractual posts have been sanctioned in State and District Surveillance Units under Integrated Disease Surveillance Project. Posts of microbiology in 20 Districts have been sanctioned in district hospitals in Govt. setup. Including two posts of microbiology at priority labs Mahesana and Himmatnagar. One post at SSU sanctioned in project but vacant. Recruitment of microbiologists and Epidemiologists are now being done by State as GOI has decentralized the powers from 1 st July 2010 to the State. 4.8 Status of Training of Medical and Paramedical Staff under IDSP Training Programs Completed in Previous years Training of RRT: Training of around 94 Members of State and District Rapid Response Team is completed at Delhi and Pune. FETP (Field Epidemiological Training Program): The training is completed for batch-one during May 05, 2008 to May 17, 2008 in Chandigarh. The DSOs were represented from Sabarkantha, Ahmedabad, Amreli and Bhavnagar districts. The second batch trained during June 02, 2008 to June 14, 2008 in Chandigarh. The DSOs were represented from Gandhinagar, Vadodara, Surat, Navsari, Valsad, Patan and Kheda districts. The third batch, consisting the DSOs from Bharuch, Narmada, Jamnagar, Dahod, Kutch, Tapi, Medical Officer Epidemic branch, Gandhinagar; was trained during December 08, 2008 to December 12, 2008 in Chandigarh. 145

22 4.8.2 Training Completed during Financial Year Training of Medical and paramedical staffs of Medical Colleges, District hospitals and CHC have been completed. 2. Training of all Medical, Ayahs and paramedical staff who never trained before under IDSP have completed under IDSP. 3. BHO and Mande training as block health team to develop analytical skill at block level also completed. 4. FETP training for 18 officers of District and Corporation has been planned at B. J. Medical College in same financial year. Table : 3.7 Training status as on 31 st December 2012 No Category Training Days Training Load Train ed Percent age 1 Members of Rapid Response 6 Days % Team 2 Block Health Officer 3 Days % 3 Medical Officer 3 Days % 4 Paramedical supervisor and 2 Days % workers 5 Laboratory Technicians-DPHL 6 Days % 6 Laboratory Technicians-(CHC- 3 Days % PHC) 7 Medical College Doctors 2 Days % 8 Paramedical Staff of Medical 2 Days % College Hospital 9 Hospital Doctors 2 Days % 10 Hospital Paramedical Staff 2 Days % 11 Block Health Team 1 Days % 12 DM and DEO 2 Days % Source : Annual report of IDSP ( Integrated Disease Surveillance Project )

23 4.9 Annual Action Plan Integrated Disease Surveillance Project- Annul Action Plan for year had been prepared and submitted to ministry of Health and Family Welfare, Government of India as a part of NRHM action plan after approval by governing body of state health mission. Amount of Rs Laces through W.B. and Laces as NRHM additionally has been proposed for year Disease Surveillance under IDSP 5.1 Definition and Overview Surveillance is defined as the ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken Detecting disease and its distribution in time and space offers clues to the silent background phenomena of amplification and transmission of infectious agents. Surveillance is the first step in intervention and disease control which serves to direct early outbreaks of diseases. Surveillance is also essential for the early detection of emerging (new) and re- emerging (resurgent) diseases. Emerging infectious diseases encompass those diseases which are caused by new pathogens (e.g. HIV/AIDS, V. cholera O139, Hanta virus, Ebola virus, and recently Influenza A (H1N1)). The reemerging diseases are those which are mainly due to the reappearance of pathogens previously under controlled (e.g. Yesinia pests). The diseases with increasing in incidence/prevalence (e.g. malaria leptospirosis) are also included in the surveillance. The other categories of disease those need routine surveillance such as recognized diseases which are appearing in new territories ( e.g. Dengue Hemorrhagic Fever), Zoon tic diseases affecting humans (e.g. anthrax), and diseases due to pathogens showing newly acquired anti-microbiological resistance (e.g. typhoid fever). 147

24 Community: Represented by basic village level services such as trained birth attendants, village leaders, school teachers, and village health workers or similar care providers. Health Facility : Defined by each country. For example, for surveillance purpose, all institutions with outpatient and in-patient facilities are defined as a health facility 5.2 Importance of disease surveillance Communicable diseases are the most common causes of death, disability and illness in any region. While these diseases present a large threat to the well being of communities, there are well known interventions that are available for controlling and preventing them. 1. Surveillance data can guide health personnel in the decision making needed to implement the proper strategies for disease control and lead to activities for preventing future cases. 2. Surveillance is a watchful, vigilant approach to information gathering that serves to improve or maintain the health of the population. A functional disease surveillance system is essential for defining problems and taking action. Using epidemiological methods in the service of surveillance equips district and local health staff to set priorities, plan interventions, mobilize and allocate resources and predict or provide early detection of out breaks. 3. Surveillance is basically collecting the critical data about disease conditions so that action can be taken. Action may be in the form of improvement of services when gaps are identified or in the from of out breaks response when an out breaks is detected. The key output of a good surveillance system is the early detection of out breaks. 4. Depending on the goal of the disease prevention program, the surveillance activity objectives guides program managers towards 148

25 electing data that would be the most useful to collect and use for making evidenced based decisions for public health actions. 5. A disease control program may want to know what progress is being made with its prevention activities. The program collects the data of various diseases including age, sex, and different time periods. If the program s goal is to prevent out breaks, the surveillance unit can monitor the epidemiology of a particular disease so that the program can more accurately identify where the next cases might occur or the populations at highest risk. In addition, improving laboratory support for disease surveillance is essential for confirming causes of illness and early detection outbreaks. 6. Investigation and laboratory confirming provide the most precise information about where action must be taken to achieve an elimination target. Monitoring populations at highest risk for a particular disease can help to predict future outbreaks and focus prevention activities in the areas where they are most needed. Too often, however, surveillance data for communicable disease is neither reported nor analyzed. As a result, the opportunity to take action with an appropriate public health response and save lives is lost. Even in cases where adequate information is collected, it is often not available for use at the local level. The outbreaks of plague in 1994, cholera in 1995 and dengue hemorrhagic in 1996 highlighted the urgent need for disease surveillance system so that early warning signals are recognized and appropriate control measures are initiated in a timely manner. The importance of surveillance can be understood with the more recent example of pandemic Influenza A (H1N1) where routine surveillance has been playing crucial role to curb this health problem. 149

26 5.3 Steps of disease Surveillance These guidelines assume that all levels of the health system are involved in conducting surveillance activities for detecting and responding to priority diseases and conditions and include the following: 1. Identify cases: Using basic, standard case definition, Identify priority diseases and conditions. 2. Report: suspected cases or conditions to the next level. If this is an epidemic prone disease, or a disease targeted for control, elimination or eradication, investigate and respond immediately. 3. Analyze and interpret ate data: Compile the data, and analyze it for trends. Compare information with previous periods and summarize the results. 4. Investigate and confirm suspected cases and out breaks: Take action to ensure that the case or out breaks is confirmed including laboratory confirmation wherever it is feasible. Gather evidence about what may have caused the out breaks and use it to select appropriate control and prevention strategies. 5. Respond: Mobilize resources and personnel to implement the appropriate out break or public health response. 6. Provide feedback: Encourage future cooperation by communicating with levels that reported outbreaks and cases about the investigation outcome and success of response efforts. 7. Evaluate and improve the system: Assess the effectiveness of the surveillance system in terms of timeliness, quality of information, preparedness, thresholds, case management and overall performance. Take action to correct problems and make improvements. There is a role for each surveillance functions at each level of the health system. The levels are defined as follows: 150

27 Types of Surveillance in IDSP as per new systemunder GOI`s new Surveillance system. Depending upon level of expertise and specificity surveillance in IDSP are following three categories: Chart 3.3 Disease Surveillance Presumptive Confirmed Syndromic On the basis of Provisional DiagnosisDone by MO on the basis of Laboratory confirmation on the basis of symptomsclinical patterns done byhealth worker Passive Passive Active Surveillance P from L from S From Source : Annual report of IDSP ( Integrated Disease Surveillance Project) Chart 3.4 A dynamic Vision of Surveillance Make Collect and Transmit Decision Feedback Information Step 1 All levels use information to make decisions Step 2 Step 4 Step 3 Data Analyze Data Source : Annual report of IDSP ( Integrated Disease Surveillance Project )

28 5.4 Indicators and Vision: To establish state based a comprehensive surveillance information system covering public and private hospitals. To build capacities to analyze and use surveillance information at all levels to identify communicable disease out breaks early. Ensure that all out breaks will have high quality investigation by multi-specialty aroid response teams supported by laboratory confirmation. Deployment of epidemiologist at all 26 districts. Ensure functional IT systems and on-line data entry and analysis. District supported by a well performing laboratory with EQAS and State Referral Lab. Network. Training of Municipal Corporation staff to strengthen Urban Surveillance. Training of BHOs for data analysis. Table 3.8 : Indicators Component Indicators for each component 80 % of districts should have full time Surveillance Prepareness epidemiologist. 80 % of with fully it system and online data entry and use of toll free no % Develop priority labs and referral labs at least. Out break 50 % referral labs maintain EQAS atanderds. investigation and 50 % Out break detection by system with in week. response 80 % Out break/rumor must be verified. 50 % of Out break sample should reach lab. Table No. 3.8 Contd 152

29 Table No. 3.8 Contd Component Indicators for each component Analysis and use 50 % of Out break sample should reach lab. of data 80 % districts undertake weekly surveillance and data analysis. 80 % district must provide feedback to sub unit and policy makers. Source : Annual report of IDSP ( Integrated Disease Surveillance Project ) Strategies for Surveillance 1. Decentralization: Currently, the process of data entry is being performed only at district and state level; however, in near future the facility could be extend to the block level to make the process of surveillance more accurate and simple. 2. Co-ordination: All the relevant agencies should have health coordination to make the process of surveillance and outbreak investigation more accurate. 3. Capacity building of the staff: Ongoing training and education is necessaryto improve the quality of task performed by public health staff. 4. Rapid Response Teams at District and Peripheral Level: Ideal RRT should be formed and active throughout the district to improve the quality of outbreakinvestigation along with preventing and controlling measures. 5. Integration of all activities from grass root level (sub center) up to the state is most important. Integration of private and public health programs, integration of both communicable and non communicable diseases, integration of both rural and urban health system and lastly integration of both private and public medical colleges with IDSP is necessary. 153

30 6. Strengthening labs: Recently the referral lab network plan is in process for approval. 7. Strong connectivity through use of IT and 8. Rated Disease Surveillance Programme. 5.6Urban Surveillance Surveillance in urban areas is well established under Integrated Disease Surveillance Project. State Government has sanctioned urban health projects for 141 Municipalities and Towns. The contractual staff has been appointed in these urban areas. Similarly six Municipal Corporations have well established network of urban health centers. All these are covered under surveillance; however, training of manpower working in urban areas except Surat and Vadodara municipal corporation have organized during the year Integration of various programs of IDSP 6.1Why integration? Integration of the various vertical programs information flow into a single channel, currently, the same staff are reporting communicable diseases like Malaria, TB, JE, Diarrhea, Hepatitis, Typhoid etc. in all different formats. By integrating the flow of information, duplication can be minimized and workload can be reduced. Integration of data from public sector as well as private sector gives true picture of disease pattern in community. 6.2Integration with NRHM program: 1. Involvement of ASHA in disease surveillance 2. Involvement of existing human resources under NRHM 3. Provision of Additional manpower for IDSP 4. Use of flexible funds to improve disease surveillance at all levels 5. Involvement of village Sanitation Committee to detect and control outbreaks 154

31 6. Effective utilization of passive surveillance data 7. Monitoring and evaluation 6.3Integration with NVBDCP programm: 1. All acute fibril illness those can cause outbreaks are include in MF-11 and has been regularly sent to State/Districts IDSP/NVBDCP officials 2. District Malaria Officer sends copy of reports to DSO on routinely bases 3. DSO also share IDSP data as well as weekly report with District Malaria Officer on routine bases 4. District Malaria Officer is part of the district RRT 6.4Integration with other programs: NACO Sentinel data regarding HBV, HCV, and HIV is shared with IDSP NACO BB lab facilities for confirmation of HBV, HCV is coordinated with IDSP RNTCP Consulting under RNTCP help for routine disease surveillance There is good coordination of work between QA Network under RNTCP and IDSP QA Adoption of Public-Private partnership model NPSP Consultants under NPSP can help IDSP for effective polio surveillance. 155

32 7. District wise Reporting Units. Table : 3.9 District wise Reporting Units District Name Pvt. RU B L O C k CHC PHC Govt. Lab Id Hospital MC/G.H.H.C /CORPO Pvt. Hospital UHC Pvt. Lab SC Ahmedabad Amreli Anand Banaskantha Bharuch Bhavnagar Dahod Dang Gandhinagar Jamnagar Junagadh Table No. 3.9 Contd 156

33 Table No. 3.9 Contd District Name Pvt. RU B L O C k CHC PHC Govt. Lab Id Hospital MC/G.H.H.C /CORPO Pvt. Hospital UHC Pvt. Lab SC Kutch Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Rajkot Sabarkantha Surat Surendranagar Tapi Vadodara Valsad Source : Annual report of IDSP ( Integrated Disease Surveillance Project )

34 8. State Referral Network Plan Integrated Disease Surveillance Project in Gujarat plans to strengthen the public health laboratories in the state at various levels in phased manner to provide diagnostic facilities for epidemic prone diseases. In the first phase, referral lab network proposed to develop in 8 medical colleges. The two priority district reference laboratories at district Hospital Mahesana and Sabarkantha are identified. Strengthening of these priority district reference laboratories have been completed; however microbiologists are still not appointed on contract basis for these two laboratories. Table 3.10 Referral lab network in 2012 Sr. Name of Institution Govt./Mun. District linked No. Corp./Private 1 B.J. Medical College, Ahmadabad Govt. Ahmadabad Rural, Mehsana, Sabarkanthha, Banaskanthha, Gandhinagar, Patan. 2 N.H.L Medical College Ahmadabad Muni.Corp. Ahmedabad Municipal Corporation area, Kheda, Anand 3 Govt. Medical College Vadodara Govt. Narmada, Vadodara Municipal Corporation, Panchmahal, Dahod, Bharuch. 4 Govt. Medical College Surat Govt. Surat Rural, Tapi, Navsari, Valsad, Dangs Table No Contd 158

35 Table No Contd Sr. Name of Institution Govt./Mun. District linked No. Corp./Private 5 Govt. Medical College Rajkot Govt. Rajkot Rural, Rajkot Corporation Kutch, Surendranagar 6 Govt. Medical College Bhavnagar Govt. Bhavnagar Rural, Bhavnagar Corporation, Amreli, Junagadh, Junagadh Corporation, 7 Govt. Medical College Jamnagar Govt. Jamnagar Rural, Jamnagar Corporation, Porbandar 8 Surat Municipal Corporation Medical Muni.Corp. Surat Municipal Corporation Area College(SMIMER) 9 Civil Hospital Govt. Mahesana District Mahesana 10 Civil Hospital Himmatnagar Govt. Sabarkanthha District Source :Annual report of IDSP ( Integrated Disease Surveillance Project ) To provide access to diagnostic facilities for epidemic prone diseases to the remaining districts and to provide referral diagnostic services to the state, functional laboratories at Govt. Medical colleges and private sector has to identify and to link them to adjoining districts. In this regard, following laboratories are identified as reference laboratories both from Govt. sector as well as from Municipal Corporation. Referral Lab 159

36 Network plan has been implemented in Gujarat whenever RRT required in concern district as per referral lab network plan attached medical college send their rapid response team to the affected area. Table 3.11 Test Performed under Referral lab network plan in Sr. Name of the Disease Name of the test No. 1 Enteric Fever Typhus Dot Test Blood Culture 2 Lepotspirosis Rapid Dot Test 3 Dengue IgM Elisa 4 Meningococcal Meningitis Rapid Latex Agglutination Test 5 Diphtheria Diphtheria Culture 6 Cholera Culture for Vibrio cholera 7 Viral Hepatitis A IgM Elisa 8 Viral Hepatitis E IgM Elisa 9 Measles IgM Elisa 10 Hepatitis B Anti HBc Source : Annual report of IDSP (Integrated Disease Surveillance Project)

37 Table 3.12 Year wise Cases of Malaria P.F.in Gujarat Year Sr No District Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Rajkot Table No Contd 161

38 Table No Contd Sr No District Sabarkanthha Surat Surendranagar Tapi Vadodara Valsad Ahmedabad MOH Bhavnagar MOH Gandhinagar MOH Jamnagar MOH Junagadh MOH Rajkot MOH Surat MOH Vadodara MOH Total Source :Annual report of IDSP ( Integrated Disease Surveillance Project ) Table 3.12 shows that 1. During 2008 to 2012 the highest number of cases of Malaria P.F was in Surat MOH. 2. The lowest number of cases of Malaria P.F in 2007, Dang, it was in Ahmedabad and in it were again in Dang. 162

39 Table 3.13 Year wise Cases of Malaria P.V. in Gujarat Year Sr No District Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Rajkot Sabarkanthha Surat Surendranagar Table No Contd 163

40 Table No Contd Sr No District Tapi Vadodara Valsad Ahmedabad MOH Bhavnagar MOH Gandhinagar MOH Jamnagar MOH Junagadh MOH Rajkot MOH Surat MOH Vadodara MOH Total Source :Annual report of IDSP ( Integrated Disease Surveillance Project ) Table 3.13 shows that 1. During 2008 the highest number of cases of Malaria P.V was in Jamanagar. 2. During the highest number of cases of Malaria P.V was in Surat MOH. 3. During 2008 the lowest number of cases of Malaria P.V was in Bhavnagar. 4. During the lowest number of cases of Malaria P.V was in Dang, and it was according to Tapi and Junagadh MOH. 164

41 Table 3.14 Year wise Cases of Cholera in Gujarat Year Sr District No 1 Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Rajkot Table No Contd 165

42 Table No Contd Sr No District Sabarkanthha Surat Surendranagar Tapi Vadodara Valsad Ahmedabad MOH Bhavnagar MOH Gandhinagar MOH Jamnagar MOH Junagadh MOH Rajkot MOH Surat MOH Vadodara MOH Total Source : Annual report of IDSP (Integrated Disease Surveillance Project ) Table 3.14 shows that 1. During the highest number of cases of Cholera was in Ahmadabad. 2. During the lowest number (ZERO) of cases of Cholera was in many District and MOH. 166

43 Table 3.15 Year wise Cases of Acute Diarrheal Disease in Gujarat Year SR District Name No 1 Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Table No Contd 167

44 Table No Contd SR District Name No 20 Rajkot Sabarkanthha Surat Surendranagar Tapi Vadodara Valsad Ahmedabad MOH Bhavnagar MOH Gandhinagar MOH Jamnagar MOH Junagadh MOH Rajkot MOH Surat MOH Vadodara MOH Total Source : Annual report of IDSP (Integrated Disease Surveillance Project ) Table 3.15 shows that 1. During 2008,2009 and 2010 the highest number of cases of Acute Diarrheal was in Rajkot. 2. During the highest number of cases of Acute Diarrheal was in Ahmedabad MOH. 3. During the lowest number (ZERO) of cases of Acute Diarrheal was in many District and in 2012 it was in Junagadh. 168

45 Table 3.16 Year wise Cases of Dengue in Gujarat Year Sr District Name No 1 Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Rajkot Sabarkanthha Surat Surendranagar Tapi Vadodara Valsad Table No Contd 169

46 Table No Contd Sr No District Name Ahmedabad MOH Bhavnagar MOH Gandhinagar MOH Jamnagar MOH Junagadh MOH Rajkot MOH Surat MOH Vadodara MOH Total Source : Annual report of IDSP (Integrated Disease Surveillance Project ) Table 3.16 shows that 1. During the highest number of cases of Dengue was in Ahmedabad. 2. In 2010 the highest number of cases of Dengue was in Junagadh. 3. During the highest number of cases of Dengue was in Ahmedabad. 4. During the lowest number (ZERO) of cases of Dengue was in many District and MOH. 170

47 Table 3.17 Year wise Cases of Enteric Fever in Gujarat Year Sr District No 1 Ahmadabad Amreli Anand Banaskanthha Bharuch Bhavnagar Dahod Dangs Gandhinagar Jamnagar Junagadh Kachchh Kheda Mehsana Narmada Navsari Panchmahal Patan Porbandar Table No Contd 171

48 Table No Contd Sr No District Rajkot Sabarkanthha Surat Surendranagar Tapi Vadodara Valsad Ahmedabad MOH Bhavnagar MOH Gandhinagar MOH Jamnagar MOH Junagadh MOH Rajkot MOH Surat MOH Vadodara MOH Total Source : Annual report of IDSP (Integrated Disease Surveillance Project ) Table 3.17 shows that 1. During the highest number of cases of Enteric Fever was in Ahmedabad. 2. During the lowest number (ZERO) of cases of Enteric Fever was in many cities of Gujarat and in 2012 it was in Junagadh MOH. 172