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Setting up the Integrated Disease Surveillance Programme (IDSP) at district level

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?

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Setting up the Integrated Disease Surveillance Programme (IDSP) at district level

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  1. 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? 2

  3. Outline of the session • Warm up session • Initiating surveillance • The district surveillance unit • Initiating passive surveillance 3

  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 4 Warm up

  5. Number of blood slides tested for malaria in Phuentsholing, Bhutan, 2001-2004 600 500 400 2004 Number of slides tested for malaria 300 2003 200 2002 100 2001 0 5 Warm up 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

  6. What happened in 2004? • Observe the data • What do you see? • Interpret the information • What action will you take? 6 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 7 Warm up

  8. What happened in 2003? • Observe the data • What do you see? • Interpret the information • What action will you take? 8 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 9 Warm up

  10. The 2004 Dengue outbreak was detected A 2003 falciparum outbreak was missed Number of slides tested for malaria in Phuentsholing, Bhutan, 2001-2004 600 500 400 2004 Number of slides tested for malaria 300 2003 200 2002 100 2001 0 10 Warm up 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

  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! 11 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? 12 Info for action

  13. 1. Collect and transmit data 4. Make decisions 2. Analyzedata 3. Feedbackinformation A functional vision of surveillance All levels use information to make decisions 13 Info for action

  14. Questions to address to set up a surveillance system • What is the objective of the programme served by the surveillance system? • What kind of decisions need to be made? • What information will be needed? • What indicators will be needed? • What data will be needed? 14 Info for action

  15. Questions to address to set up a surveillance system: Cholera example • What is the objective of the programme served by the surveillance system? • Detect cholera outbreak early • What kind of decisions need to be made? • Investigations and control • What information will be needed? • Sudden rise in incidence • What indicators will be needed? • Baseline incidence rates to detect unusual rates • What data will be needed? • Number of new cases per week 15 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 16 Info for action

  17. District surveillance committee Representative Water Board CMO (Co. Chair) 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 Medical College Representative if any * District collector or district magistrate District Surveillance Officer (Member Secretary) 17 DSU

  18. District surveillance unit Chief medical and health officer • Response team • Epidemiologist • Microbiologist • Clinicians 18 DSU

  19. District epidemic investigating team (DEIT) Microbiologist Clinician (Pediatrician/ Physician) * Selected from programme officers other than district surveillance officer, based on disease 19 DSU ** Only when vector borne disease is suspected

  20. Information flow of the weekly surveillance system Sub-centres Programme officers C.S.U. S.S.U. P.H.C.s 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 20 DSU

  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 21 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 22 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? 23 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 24 Starting up!

  25. The role of the district within the surveillance system Reporting units Feedback Action District Compilation Analysis State Data are compiled before they are passed on 25 Starting up!

  26. Interactive session:How would you address obstacles to passive reporting in a district • What are the obstacles to data collection? • What are the obstacles to data compilation? • What are the obstacles to data transmission? • What are the obstacles to data analysis? • What are the obstacles to review by committee • What are the obstacles to using surveillance information to make decisions? 26 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 27 Starting up!

  28. Example: Data collection • Obstacles • Medical officers do not write the diagnosis in the registers • Solution • Phase in IDSP register with diagnoses 28 Starting up!

  29. Obstacles and possible solutions to initiate passive reporting (Fill with feedback from the groups) 29 Starting up!

  30. Take home message • Give life to your surveillance system • Design surveillance to make decisions • Implement the functions of the district surveillance unit • Identify and lift obstacles to initiation of passive surveillance 30

  31. Additional reading • Section 1 of IDSP operations manual • Module 2 and 4 of training manual • Annexure 4 and 5 IDSP guidelines 31

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