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Integrated Disease Surveillance Programme

Integrated Disease Surveillance Programme

Situational analysis

The integrated disease surveillance project was launched in Haryana State in the second phase in 2005 with the support of World Bank to establish decentralized State based system of surveillance. The aim was to detect early warning signals of impending outbreaks and help in initiating an effective response in a timely manner.

            The Haryana state has been able to achieve, improved surveillance and strengthening of data quality, analysis, improved laboratory Support and links to action. Trained stakeholders under IDSP have been able to increase disease surveillance, coordination and rapid action in cases of outbreak.

Following graphs demonstrate the surveillance activities and the disease trends in the State of Haryana:-

           The reporting had started in 2006 august with the reporting units being approx.300 which has increased up to >3000 from the year 2009 onward.

1. Comparative distribution of Cholera cases, 2006-10, Haryana

 

 

      Cholera outbreaks shows sporadic trend with multiple peaks

      There is decline in number of cholera cases over the years.

      In 2007, all cases were found in first half of year with maximum in 5th (20) and 11th week (22).

      In year 2008, five peaks were observed spreaded over whole year with maximum cases in 30th week (14)

      In year 2009, 5 cases were found in 13th week and 4 in 41st week

      In 2010 maximum cases (18) were found in 37th wk.

              

2. Week wise Comparison of Influenza A H1N1 cases, Haryana, 2009-2010

 

 

 

·         From 25th-35th week ( initial eleven weeks from 19th June to 31st August 2009), on an average 4-5 positive cases were reported

·         From 36th week onward there is surge in positive cases with peak in 38th week (15-21 Sept).

·         After a slanting decline in number of H1N1 cases from 39th week to 43rd week (n=5), the cases again peaked to 280 in 49th week, thereafter declining again since 50th week.

·         In 2010 maximum number of cases (n=30) was reported during 36th week.

·         There was no case reported during 8th wk of 2010 to 25th week of 2010.

·         In 2010 the H1N1 cases are very less (n=137 till 52nd wk) as compared to 2009 (n=1968).

 

 

3. Distribution of Influenza A H1N1 by their mode of treatment

 

 

·         Most of the patients are treated at home quarantine in both of the years.

 

 

4. Week wise distribution of cases of Enteric fever, Haryana, 2010

 

·         Maximum cases were seen in 39th week

5. Comparative distribution of Typhoid cases, 2006-10, Haryana

 

      Typhoid cases are present through year

      Each year it rises from 9th week onward till 45th week then it declines

      Maximum cases are seen in 45th week in 2006 (229), 29th week in 2007 (260), 31st week in 2008 (298), 11th week in 2009 (218) and 39th week (781).

      Overall typhoid cases were more this year as compared to previous years.

 

6. Comparative distribution of PV and PF Malaria. Haryana, 2010

 

  • Multiple peaks were seen in Malaria PV with maximum cases in week 37th (1432)
  • Malaria PF shows no peak in cases but maximum cases were seen in week 41st (82)

 

 

 

 

7. Comparative distribution of Malaria Vivax cases, 2006-10, Haryana

 

 

  • Cases of Malaria Vivax are distributed during week 16 to week 50 year with multiple peaks.
  • In year 2006, maximum cases were found  in 35th week (2107) while in 2007, peak number of cases (1310) were in 38th week
  • In year 2008 maximum cases were 2054 in 34th wk, and were 1039 in 35th week during year 2009.
  • In year 2010 the Malaria Vivax Cases were less as compared to previous years showing maximum cases in week 37 (n=1432).
  • It is clear that Vivax Malaria is more in weeks 35th to 38th.

 

8. Comparative distribution of Malaria Falciparum cases, 2006-10, Haryana

 

 

  • Cases of Falciparum Malaria are distributed sporadically through out year with multiple peaks
  • In year 2006, maximum cases were found  in 35th week (45) while in 2007, peak number of cases (156) were in 27th week
  • In 2007, multiple peaks were witnessed 33rd  week onward with maximum cases (106) in 33rd week
  • In year 2010 the malaria Falciparum Cases were less as compared to previous years showing maximum cases in 41st week (n=82).

 

 

 

 

9. Comparative distribution of Dengue cases, 2006-10, Haryana

  • There is decline in number of dengue cases from year 2006 to 2010.
  • Maximum cases were observed in 45th week in year 2006 (303).
  • In 2010 maximum cases were found in 40th week (155).

10. Comparative distribution of Hepatitis A & B, Haryana 2006-10

  • Hepatitis A & B cases are observed through out year with sporadic outbreaks
  • Hepatitis cases show decline over the years with maximum cases observed in year 2006, 77 cases in 27th week followed by 68 cases each in 25th week in 2007 and 27th week in 2008.
  • Hepatitis A & B cases were found maximum (n=51) in 21st week in 2010.

 

Target Diseases covered in IDSP

  1. Dengue/DHF/DSS
  2. Chikungunya
  3. JE
  4. meningococcal Meningitis
  5. Typhoid fever
  6. Diphtheria
  7. Cholera
  8. Shigella Dysentery
  9. Viral Hepatitis A/B
  10. Hepatitis E
  11. Leptospirosis
  12. Malaria
  13. HIV
  14. Tuberculosis
  15. Other (Specify) HbsAg

 

1.           Focus Areas:

·         Surveillance:-   Supporting a surveillance preparedness to enhance immediate reporting of outbreaks, regular surveillance and weekly reporting. Emphasis on provisional diagnosis by medically trained staff from public and private sectors, to generate early warning signals for appropriate and timely public health actions.

·         Reporting:       Districts with fully functional IT systems with on-line data entry and analysis, referral laboratories &     priority     laboratories undertaking routine laboratory surveillance. Outbreaks detected by system within one week of first case diagnosis   in  Outbreaks  /rumors   reported by other system/media Verified within 48 hours. District undertaking weekly surveillance analysis of data including graphs for trends over time and maps of incidence by area.   Further training for district epidemiologist and data manager on use of the portal. Demonstrating timeliness and improved quality of outbreak investigation and response in all state. The 1075 call center will be publicized to health professionals, and would particularly serve as an important supplement source of information and outbreaks in areas where surveillance infrastructure is yet to develop.

·         Community Participation: The community health workers such as ASHA, PRIs, Religious leaders to be encouraged for outbreak reporting to the surveillance team, so that timely action can be taken to control the epidemic. The DSO/Epidemiologist will have the regular meeting and the active community members can be provided with in the form cash/non cash encouragement. This meeting will be done at the time of regular monthly meetings of CHCs and PHCs

·         Infrastructure required in district Mewat and palwal: There is need of one separate IDSP unit at Palwal. Mewat IDSP unit also needs a  Data Manager and a Data Entry Operator as there is only an Epidemiologist at Mewat who is looking after the whole unit. This will lead to strengthening of surveillance activities in these areas. The separate IDSP unit should be provided at Palwal and the remaining post at the Mewat should be sanctioned/filled.

 

 

 

 

 

 

 

1.            Achievements

Physical Achievements: Upto  year 2010-2011

Human resources:-

S. No

Position

No. Sanctioned

No. Working

Training Status

No. Trained

1.

State Surveillance Officer

1

1

1

2

State Nodal Officer

1

1

1

3.

Consultant Training

1

1

1

4.

Consultant Finance

1

-vacant

-

5.

DSOs

20

20

20

6.

Data Managers

21

19

1(rest to be trained)

7.

DEOs

22

19

To be trained

8.

Epidemiologists

22

17

11

9.

Microbiologists

3

2

1

10.

Entomologists

1

1

To be trained

 

Training Activities

Category

Target

Achievement

Master Trainers

83

88

State level training

Medical Officers

465

696

Multi Purpose Health Workers including Pharmacists

2700

4660

District Lab Technicians

100

160

Peripheral Lab Technicians

Other categories of staff

21 district RRT and 1 State RRT has been trained

 


 

IT Network

EDUSAT is installed at five sites at District headquarters (Gurgaon, Hisar, Rohtak, Sonepat & Yamunanagar) and at State Headquarter. It is fully functional at State and District HeadQuarters.

All the districts are connected to the SSU through internet .Communication to the districts is done through e-Mail.

            All districts are also connected through Broad Band. In the Year 2010-2011software has also been installed and subsequently all the districts will be connected through the portal.

 

Laborotary Upgradation

 

L3 Labs

L2 Labs

L1 Labs

2006-07

1

20

64

2007-08

-

-

-

2008-09

-

-

-

2009-2010

1

1

-

 

Note: In the year 2010-2011two priority labs i.e. Hisar and Karnal have been upgraded and equipments i.e. Elisa reader, washer has been purchased.

  Reporting Units:

Year

Public Units

Private Units

Total Reporting units

2006

218

30

248

2007

2689

117

2806

2008

2689

117

2806

2009

3108

123

3231

2010

3473

124

3597

 

Surveillance Activities

·         All the districts of Haryana send us the weekly Reports regularly and timely.

·         Reports are being analyzed at State HQ as well as Districts HQ and the compiled reports are sent to CSU and feedback is done both through CSU and SSU as well as at DSUs also.

Financial Achievements

 Funds Utilization: From 1.04.2010-30.09.2010

Year

Opening balance

Fund Rec.

Interest

TOTAL FUND

Expenditure

Closing balance

2010-2011

48.13

24.61

.66

73.40

48.24

25.16

 

Activities to be completed under different components

1.  Surveillance preparedness-

·         Training of epidemiologist, microbiologists and entomologist would be conducted through NHSRC. The entomologist and microbiologist’s group training will be facilitated by respective units of NCDC.

·         Ensuring fully functional IT system including software with the help of NIC.

·         A mechanism will be developed to enhance data integration and flow from telephone, Email and Fax and portal system.

·         Infrastructure would be provided to district Mewat and Palwal for fully functional IT system.

·         To promote the use of toll free services, the number will be publicized among health professionals, private hospitals and general public .


 

The major activities proposed to be implemented during the year 2011-12 under IDSP

A. Surveillance Preparedness

  1. Training:-

Following trainings to be conducted in the year 2011-12:

·         One day training of Hospital Doctors (Target 210 to be trained in 2011-12 in 21 batches at district level) @ Rs 8000 per batch =1,68,000/- 

·         One day training of Hospital Pharmacist / Nurses (Target 675 to be trained in 2011-12 in 45 batches at district (2 per district) level) @ Rs 11000 per batch =4,95,000/- 

·         One day training of Medical College Doctors (Target 10 to be trained in 2011-12 in 1 batches at Medical college Rohtak) @ Rs 8000 per batch =8,000/- 

·         One day training Data entry and analysis training for Block Health Team (Target 150 to be trained in 2011-12 in 10 batches at district level) @ Rs 11000 per batch =1,10,000/-

·         One day training of DM  & DEO (Target 42 to be trained in 2011-12 in 4 batches at SSU Panchkula) @ Rs 9000 per batch =36,000/-

Sub Total = 8,17,000/-

  1. Human Resources:-

Following remuneration under HR component is required for the year 2011-12:

·         State / district Epidemiologists (1 at state HQ- SSU and 1 each at District HQ- DSU) @ 30,000/month*12 months*22 units =79,20,000/-

·         State/district Microbiologist (1 at State HQ and 1 each at District priority lab) @ 20,000/month*12 months*3 Units =7,20,000/-

·         Entomologist (1 at State HQs - SSUs) @ 20,000/month*12 months =2,40,000/-

·         Consultant Finance (1 at State HQs - SSUs) @ 14,000/month*12 months =1,68,000/-

·         Consultant Training (1 at State HQs - SSUs) @ 28,000/month*12 months =3,36,000/-

·         Data Manager (1 at State HQs - SSU) @ 14,000/month*12 months =1,68,000/- and (1 each at district HQ - DSUs) @ 13,500/month*12 months*21 units =34,02,000/- hence total for Data mangers =35,70,000/-

·         Data Entry Operator (1 at State HQs - SSUs, 1 each at district HQ - DSUs and 1 identified Medical College/Other institutions) @ 8,500/month*12 months*23 units =23,46,000/-

Sub Total = 1,53,00,000/-

  1. Operational & Maintenance Cost:

The budgetary head of Operational & Maintenance Cost includes Transport expenses, Office Expenses (printing of reporting forms, maintenance and minor repairs of equipments, contingencies), Broadband Expenses, Expense for Collection and Transportation of samples during outbreaks and Other Misc. Expenses like incentives to ASHA for outbreak reporting etc. A total of 39,60,000/- (@ 15,000/month per Unit*12 months*22 units) is proposed under budgetary head of Operational & Maintenance Cost for the year 2011-12.

Sub Total = 36,60,000/-

 

B. Outbreak investigation and response

  1. Laboratory support:

Consumables and kits for identified priority district labs @ Rs 2,00,000/- per year per priority district lab (Identified priority labs in States are as follows Hisar and Karnal – 2,00,000/annum*2 units =4,00,000/-)

Sub Total = 4,00,000/-

Note: The total budget proposed for the year 2011-12 under IDSP is (1+2+3+4) =2,04,77,000/-


 

C. Strengthening of Labs

Situational Analysis: Many emerging communicable diseases have been identified in recent times. Laboratory plays an important role in establishing diagnosis of these and other endemic communicable diseases. Also, reliable laboratory based surveillance data are essential for establishing health care priorities and planning health care programs.

Based on an initial survey of the identified labs against the standards for equipment and manpower. Budget for gaps in equipment and manpower may be prepared. Accordingly, the budget may be included under State PIP for 2011-12.

As per Instruction received from Government of India on 6.01.2011 5 Labs have to be upgraded and budget will be provided under IDSP as follows:-

Expenditure per Lab:

1.      Basic Equipments                                                       17.9 Lac

2.      Recurring Expenditure:

                                                                    I.            Staff salary (Normative only)                                11.88 Lac

                                                                 II.            Consumable and general lab ware(approx)            1 Lac per annum

                                                               III.            Cost of kits, media and reagents                            3.47 Lac

(Based on tests carried out)                                                                       

                                                              IV.            Contingency amount per annum                            45,000/-

Total Approx Budget for each district lab:

Item

Approx cost

Basic equipments (one time expenditure)

Rs. 17,90,000/-

Staff salary

Rs. 11,88,000/-

Other recurring expenditure (including consumable cost, cost of kits, media, reagents and contingency amount)

Rs. 4,92,500/-

Total

Rs. 34,70,500/-

 


 

One time expenditure at the beginning (approx):                                 Rs. 34,70,500/-

Annual expenditure per annum in future (approx):                 Rs. 16,80,500/-

Total Expenditure per Lab.                                                   Rs. 51,51,000/-

Total Expenditure for Five Labs =2,57,55,000/-

Note: The proposed budget for Strengthening of five district Labs (i.e. Rs 2,57,55,000/-) will be drawn from NRHM funds and will be included in Chapter 8 of State PIP.

 

D. Furniture and fixtures

The requirement of office furniture is essential as there has been new recruitment of the staff under IDSP at District as well State Level.

·         (Furniture for the V-SAT room, and the office of SSU) =2,75,000/-

·         (Furniture for the office of DSU) @ 1 Lac*21 units = 21,00.000/-

Total expenditure for procurement of Furniture and Fixtures =23,75,000/-

 

Note: The proposed budget for procurement of Furniture and Fixtures (i.e. Rs 23,75,000/-) will be drawn from NRHM Flexi-pool and will be included in Chapter 8 of State PIP.

 

E. Information, Education and Communication

During the year 2011-12, the following activities are proposed to be under taken under IDSP at various levels  on Information , Education & Communication, a sum of Rs.27.175 Lacs is required in the year 2011-12.

Peripheral & District Level:

·         Organization of sensitization workshops – Rs 40,000/ District i.e. Rs 8.40 lacs

·         Review meeting of District Committee – Rs 12,500/ District i.e. Rs 2.625 lacs

·         Press Advertisements – Rs 25,000/ District i.e. Rs 5.25 lacs

·         Print media- Rs 25,000/ District i.e. Rs 5.25 lacs

Sub total: 21.525 Lacs

State Level:

·         Organization of sensitization workshops – Rs 1.25 lacs (involvement of other departments)

·         Review meeting of State Committee/ DSUs –  Rs 0.70 lacs

·         Press Advertisements –Rs 1.85 lacs

·         Print media- Rs 1.85 lacs

Sub total: 5.65 Lacs

Grand Total =27,17,500/-

 

Note: The proposed budget for Information, Education and Communication (i.e. Rs 27,17,500/-) will be drawn from NRHM budget for BCC/IEC included in State PIP.

Component wise Project Costs

            Funds to be spend up to 31.03.2012:

  1. Surveillance Preparedness and Outbreak investigation and response                 2,04,77,000/-
  2. Strengthening of Labs                                                                                              2,57,55,000/-

(Will be drawn from NRHM funds under Chapter 8 of state PIP)                    

  1. Furniture and fixtures                                                                                                 23,75,000/-

(Will be drawn from NRHM Flexi-pool funds and under Chapter 8 of state PIP)                   

  1. Information, Education and Communication                                                           27,17,500/-

(Will be drawn from NRHM budget for BCC/IEC of state PIP)                                               

 

Total Grant in Aid required in the Year2011-12                                                               5,13,24,500/-  

 The proposed PIP of Rs 513.245 Lacs out of which Rs. 204.77 Lacs under the budgetary heads of Surveillance Preparedness and Outbreak investigation and response, Rs. 257.55 Lacs under budgetary head of Strengthening of Labs, 23.75 Lacs under the budgetary head of Furniture and fixtures and Rs 27.175 Lacs under the budgetary head of IEC/BCC for the year 2011-12 is submitted to the MD (NRHM).