AFPA

Vision 2035: Public Health Surveillance in India

The NITI Aayog has released a white paper, “Vision 2035: Public Health Surveillance in India” which aims to serve as a vision document to establish India as a global leader in the health system and give a boost to the Public Health Surveillance (PHS) in India.

A white paper is an informational document, to highlight or promote the features of a solution, product, or service, which is usually issued by a company or not-for-profit organization,

The mandate of NITI Aayog is to give strategic directions to the various sectors of the Indian economy. In accordance with this mandate, compiled in a volume entitled ‘Health Systems for New India: Building Blocks-Potential Pathways to Reforms’ during November 2019 a set of four working-papers was released by the Health Vertical.

This white paper is a continuation of the work on strengthening the health systems.

About the White Paper:

This white paper is a collaborative effort of Health Vertical, NITI Aayog, and Institute for Global Public Health, University of Manitoba, Canada with contributions from technical experts from the Government of India, States, and International agencies.

Through the integration of the three-tiered (primary, secondary and tertiary) public health system into Ayushman Bharat, India’s vision 2035 for PHS is laid down.

By suggesting mainstreaming of surveillance by making individual electronic health records it contributes the basis for surveillance.


Main Features:

It reduces out of pocket expenses of individuals and families and strengthens non-communicable disease prevention, detection, control.

Initiatives such as the Integrated Health Information Platform of the Integrated Disease Surveillance Program are drawn through it.

It also lines up with the citizen-centricity emphasized in the National Digital Health Blueprint and the National Health Policy 2017.

The use of mobile and digital platforms and point of care devices and diagnostics for combination of data capture and analyses are also encouraged.

To enhance private sector involvement in surveillance, it highlights the significance of capitalizing on initiatives such as the Clinical Establishments (Registration and Regulation) Act 2010.

The significance of a cohesive and coordinated effort of apex institutions including the National Centre for Disease Control, the Indian Council of Medical Research (ICMR), and others are pointed out by it.

Vision:

To make India’s PHS system more responsive and predictive to enhance preparedness for action at all levels.

It is enabled with a client feedback mechanism, to make it more citizen-friendly to ensure individual privacy and confidentiality.

It’s vision to refine the data-sharing mechanisms between Centre and states for effective disease detection, prevention, and control.

By providing regional and global leadership it is intended to manage events that constitute a public health emergency of international concern.

Public Health Surveillance:

  • PHS is an important public health function thatcuts across the three-tiered public health system and care provided. Surveillance can be termed as ‘Information for Action’ and is a vital action for disease detection, prevention, and control.

Challenges:

  • Data Collection and Sharing: Various verticals to collect data work differently and in separation with no mechanism for data sharing.
  • Surveillance data generated by target specific populations like the National AIDS Control ProgrammeNational TB Elimination Programme, etc. could be understood in its entirety as there is no single system available to do so.
  • Poor Quality Data:The data generated is of low quality and the research or use of data to answer critical health policy questions of the country has been very limited.
  • Limited Synchronisation: There is the limited ability of programme implementation structures to work in synchrony with research organisations and vice versa.
  • Missing Linkages: India invests significant resources in the registration of deaths. However, various reviews also could not link the causes of mortality with morbidities. Still no proper link was there to find common ground between the causes of diseases and deaths.
  • Lack of Human Resources: Human resources also form a formidable challenge. As many as 42% vacancies existed at state and district level surveillance systems.
  • The positions of the Central Surveillance Unit at the Centre are mostly filled either by deputation or on contract and the individuals are loaded with multiple other responsibilities.
  • Lack of Epidemic Intelligence: India does not have an adequate number of public health professionals having expertise in the field.
  • All the activities related to early identification of potential health threats can be termed as ‘Epidemic intelligence’, their verification, assessment and investigation in order to recommend public health measures to control them also accounts as ‘Epidemic intelligence’.
  • Under-developed Systems: A surveillance system of non-communicable diseases (NCDs) hardly exists in India and other factors like integration of surveillance for NCD risk factors, air pollution and its effects, surveillance of injury and accidents, etc. are yet to be incorporated in surveillance.
  • Lack of Occupational Health Surveillance: This type of surveillance addresses issues like lead toxicity, silicosis, etc. Whatever data has been generated hardly became part of India’s PHS system.
  • Emerging Challenges: Growing antimicrobial resistance (AMR), new infectious diseases or new strains of existing diseases and increased rate of NCDs.

 

  • Suggestions:
    • Creation of a skilled and strong health workforce dedicated to surveillance activities.
    • Integration of NCDs, reproductive and child health, occupational and environmental health and injury into PHS.
    • Merger of morbidity data from health information systems.
    • Amalgamation of plant, animal, and environmental surveillance in a One-Health approach that also includes surveillance for antimicrobial resistance and predictive capability for pandemics.
    • Strengthening of laboratory capacity with new diagnostic technologies including molecular diagnostics, genotyping, and phenotyping.
    • Establishment of a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
    • Enhancement of surveillance of NCDs, citizen-centric and community-based surveillance and use of point of care devices and self-care diagnostics.
    • Prioritization of diseases that can be targeted for elimination as a public health problem, regularly.
    • Improvement of core support functions and system attributes for surveillance at all levels.
    • Initiation of mechanisms to streamline, capture, analysis, data sharing and distribution for action.
    • The use of situation-aware real-time signals from social media, mobile sensor networks, and participatory surveillance systems for event-based epidemic intelligence could be included.
    • Encouragement of innovations at every step-in surveillance activity.

Way Forward

 

India has made good progress in improving the surveillance system despite of all the challenges, and implementation of this vision can drive India to be a global/regional leader in PHS.

The building blocks for this vision are an interdependent federated system of governance between the Centre and states, a new data-sharing mechanism that involves the use of new analytics, health informatics, and data science including innovative ways of disseminating ‘information for action’.