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Surveillance is particularly important for the early detection of outbreaks of diseases. In the absence of surveillance, disease may spread unrecognized by the responsible health care or public health agency, because sick people would be seen in small numbers by many individual health care workers. By the time the outbreak is recognized, the best opportunity to take intervention measures might have been over. Surveillance is essential for the early detection of emerging (new) or re-emerging (resurgent) infectious diseases. In the absence of surveillance, individual health care workers may not recognize the new disease. The continuous monitoring is essential for the 'early signals' of any outbreak of any epidemic, new or resurgent disease and the action loop to take effective public health action should be short and effective if disease surveillance were to prevent emerging epidemics.

Strategic Plan

Disease Surveillance is the backbone of an effective Public Health Administration. It is systematic collection of data on the incidence and prevalence of various priority disease conditions for the purpose of taking appropriate action for prevention and control. It is crucial for planning, management and evaluation of Disease Control Programmes. Govt. of Assam is planning an Integrated Disease Surveillance Project incorporating the following :-

  • Integrating existing vertical & horizontal Disease Surveillance Programme.
  • Surveillance of both Communicable and Non-Communicable Diseases.
  • Collaboration between Govt. & Non-Govt. Health Services i.e. Private Sector and community representatives
  • Action oriented and responsive to the needs of the State of Assam.


The overall objective of the IDSP in Assam is to improve the information available to the government service and private health care providers on certain diseases and to improve the response to such triggers. The components of the proposed project are

(a) Strengthen data quality, analysis and links to action: Activities will include:

  • real-time' on-line entry, management and analysis of surveillance data through use of computers and the Internet
  • Reporting surveillance data using standard software, including GIS, while allowing flexibility to add new systems as needed;
  • Email services between central sections and departments, within and between the states, laboratories;
  • And other persons and institutions involved in public health;
  • Rapid dissemination of 'health alerts' and other textual information; and electronic distribution of reports both to the public health staff and civil society;
  • Quality Assurance surveys of laboratory information.

The Information Technology aspects of the project will involve setting up a network to transfer data between various level of the system, provision of stand alone computers at the district level and links to districts, state and national units. Software for the system which will be developed by the IDSP CSU will be used to facilitate simplified data entry with multilingual formats, analysis and consolidation of data at each level, generation of alerts on the basis of disease-specific thresholds, documentation of the system and development of manuals, phased deployment of software, skills assessment of staff and provision of appropriate training.

The project will support incremental operating costs, purchase of services from NGOs, consultants, computers, developments and purchase of software, technical assistance, strengthening of electronic communication between the districts, states and center, IEC materials and media space.

(b)Improve Laboratory Support.

This component would consist of:

  • The upgrading of laboratories at the state level, in order to improve laboratory support for surveillance activities. Adequate laboratory support is essential for providing on-time and reliable confirmation of suspected cases; monitoring drug resistance; and monitoring changes in disease agents; and
  • The introduction of a quality assurance system for assessing and improving the quality of laboratory data.

The laboratory network for IDSP, Assam will have 4 levels; L1 - peripheral laboratories and microscopy centers; L2 - districts health laboratories; L3 - disease based state laboratories ; and L4 - reference laboratories and quality control laboratories.

L1 laboratories will provide information for the diagnosis of malaria, TB, typhoid, chlorination level in water and fecal contamination of water. Whilst these laboratories already handle examination of sputum and blood smears, some need minor internal modification as well as the provision of kits for typhoid diagnosis and assessment of fecal contamination of water.

L2 laboratories will need to carry out test for TB, malaria, typhoid, cholera and water quality, primarily to confirm results from the peripheral levels and for quality control. Some will require minor internal modification and additional equipment, reagents and kits
These laboratories will also be connected to the computer network. Staff will be as already assigned, reassigned from other laboratories or, in the case of microbiologists, hired on contract.

L3 laboratories will carry out tests, to confirm L1 and L2 results, as part of the internal quality control mechanism, and assays required for the non communicable disease surveys. The projects provides for some minor internal modification of laboratories, equipment required for additional tests, reagents and kits, and a computer, software and telephone connectivity.

External Quality Assurance surveys (EQAS) of laboratory data are an important tool in improving the quality of laboratory information. This will be carried out under contract to a third partner with external accreditation for medical laboratory quality assurance. Standard material will be supplied or the assay and assessment to a sample of IDSP laboratories in each state each year. These results will then form the basis for specific interventions in the IDSP system to improve laboratory quality.

The component would finance renovation of existing building, purchase of equipment, technical assistance, incremental operating costs and surveys.

(c)Training for Disease Surveillance and Action

The changes envisaged under the first three components will require a large and coordinated training effort to reorient health staff to an integrated surveillance system and provide the new skills needed. This component will support

  • General training for orientation of staff in both the public and private sectors to disease surveillance;
  • Specific training for disease control staff;
  • Specialized training in epidemiology;
  • Specialized training in data management and communication;

The issues to be covered for each group and the numbers to be trained are shown in the table below:

SL. NO. Trainees Content of training
I Training of district and state surveillance teams
  • Overview and introduction to surveillance with special reference to IDSP·
  • Basic epidemiology pertaining to surveillance including definitions like rates, ratios, Incidence Rate, Prevalence Rate, spot, maps, graphs, etc.
  • Details of case detection, including case definitions, reporting units and filling up forms, compilation and transmission of data
  • Collection and transmission of laboratory specimens and bio-safety issues·
  • Details of analysis and interpretation of data
  • Details on response to outbreaks·
  • Supervision Monitoring and Evolution·
  • Feedback ·
  • Training methodology·
  • Inter-sectoral coordination
  • Cluster survey sampling and analysis methods (state team only)
II Medical officers of PHCs, CHCs and Urban health sector. MOs of local medical colleges, MOs of NGOs/ Mission hospitals
  • Overview and introduction to surveillance with special reference to IDSP·
  • Details of case detection, including case definitions, reporting units and filling up forms, compilation and transmission of data ·
  • Collection and transmission of laboratory specimens and bio-safety issues·
  • Basics of analysis and interpretation of data·
  • Details on response to outbreaks·
  • Supervision Monitoring and Evolution
III Medical officers of the hospitals, Sub-districts hospitals, Medical College Hospitals
  • Overview and introduction to surveillance with special reference to IDSP·
  • Details of case detection, including case definitions, reporting units and filling up forms, compilation and transmission of data ·
  • Basics of lab confirmation - what specimens to be sent to which lab, and in what manner for confirmation.
IV MPWs (Male / Female), Health supervisors, NGO volunteers, unregistered Medical practitioners including ASHA.
  • Overview and introduction to surveillance ·
  • Syndrome description ·
  • Filling up forms·
  • Transmission of data·
  • Collection of specimens·
  • Bio-safety issues·
  • Basic response to outbreaks
V State and District level microbiologists / lab technicians. Also of the urban health sector. Also microbiologists from local Medical Colleges
  • Overview and introduction to surveillance with special reference to IDSP·
  • Hands on training on diagnosis of specific disease. Especially culture and sensitivity of stool and blood, serology etc.·
  • Quality assurance mechanisms·
  • Bio-safety issues
VI Training for lab assistants at CHC/PHC
  • Introduction to IDSP·
  • Testing for sputum AFB, Malaria smear, Typhoid test.
  • Collection, storage and transportation of specimens.
  • Bio-safety issues
VII Training for data management at district and state level
  • Introduction to IDSP.
  • Extracting of data from the computers and analysis.

Action Plan of IDSP for 2008-2009

1. Establishment of 150 PSU.
2. Renovating and functioning of 23 L2 labs at district head quarter.
3. Renovating and functioning of 150 L1 labs at BPHC.
4. Training of Medical officer, lab technician and MPHW.

  • DRRT & SRRT 5x20=100 members.
  • MO 4 batch in each district and each batch having 20 members.4x23=92 batch(1840 members)
  • Lab technician 7 Batch and each batch having 20members .20x7=140 members.
  • MPW 5 batch and each batch having 20 members.5x20=100 members in 12 district.

5. Appointment of Contractual staff.
6. State level sensitization meeting.
7. District level sensitization meeting.
8. Monitoring and quality assurance activities

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