Why a structure approach to tracking and monitoring diseases is now essential
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Indian disease surveillance system - towards smart control
- The story: "Surveillance" refers to a systematic collection, analysis, and interpretation of outcome specific data for use in planning, implementing and evaluating public health policies and practices. The term became common during the pandemic time.
- Disease surveillance: A disease surveillance system serves two key functions; early warning of potential threats to public health and programme monitoring functions which may be disease specific or multi-disease in nature.
- History: In the second half of Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the disease surveillance system. These efforts received further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.
- The Indian situation: A huge cholera outbreak in Delhi in 1988 and the Surat plague outbreak of 1994, nudged the Government of India to launch the National Surveillance Programme for Communicable Diseases in 1997. But this initiative remained rudimentary till, in wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP). The focus under the IDSP was to increase government funding for disease surveillance, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India. With that, between 2004 and 2019, nearly every passing year, more outbreaks were detected and investigated than the previous year.
- Epidemiology: It is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined populations. It is a cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for pre It is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
- Why needed: A well-designed surveillance system will help in better management because when diseases are predictable, theoretically, health systems can be designed to manage them. If hospitals know the seasonality of influenza, pneumonia or diarrhoea, they can plan for the surge in admissions, ensuring that beds and staff are available when needed.
- In a country with 1.4 billion people, with a marked inequity in health care, dense urban populations, multiple contact with domestic and wild animals, frequent internal migration, a large diaspora, international air links and a warm climate, we are uniquely positioned to be most at threat from indigenous and imported infectious diseases.
- In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly. An example is Kerala, one of the best performing disease surveillance states in India, as it is picking the maximum Covid-19 cases; it could pick the first case of the Nipah virus in early September 2021.
- On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported in multiple districts of Uttar Pradesh.
- Summary: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments. The workforce in the primary health-care system in both rural and urban areas needs to be retrained in disease surveillance and public health actions. The vacancies of surveillance staff at all levels need to be urgently filled in. The laboratory capacity for Covid-19, developed in the last 18 months, needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections. The emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health. Thus, the ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground.
- EXAM QUESTIONS: (1) Explain the resources needed to build a strong disease surveillance system in India. (2) What will be the three key elements of a well-functioning disease surveillance system? Explain. (3) Can a disease surveillance system help contain the next pandemic, whenever it strikes? Explain.
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