Vision 2035 - Public Health Surveillance in India

Surveillance is an important Public Health function. It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’.

‘Vision 2035: Public Health Surveillance in India’ is a continuation of the work on health systems strengthening. It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance. Public health surveillance (PHS) is an important function that cuts across primary, secondary, and tertiary levels of care. 

The vision document is a step in that direction, it articulates the vision and highlights the building blocks. It envisions a citizen-friendly public health system, which will involve stakeholders at all levels, be it individual, community, health care facilities or laboratories, all while protecting the individual’s privacy and confidentiality.

Vision

• To make India’s public health surveillance system more responsive and predictive to enhance preparedness for action at all levels.
• Citizen-friendly public health surveillance system will ensure individual privacy and confidentiality, enabled with a client feedback mechanism.
• Improved data-sharing mechanism between Centre and states for better disease detection, prevention, and control.
• India aims to provide regional and global leadership in managing events that constitute a public health emergency of international concern.

In 2035,

• India’s Public Health Surveillance will be a predictive, responsive, integrated, and tiered system of disease and health surveillance that is inclusive of prioritized, emerging, and re-emerging communicable and non-communicable diseases and conditions.
• Surveillance will be primarily based on de-identified (anonymised) individual-level patient information that emanates from health care facilities, laboratories, and other sources.
• Public Health Surveillance will be governed by an adequately resourced effective administrative and technical structure and will ensure that it serves the public good.
• India will provide regional and global leadership in managing events that constitute a Public Health Emergency of International Concern.

Gap areas identified in India’s Public Health Surveillance

The document identifies gap areas in India’s Public Health Surveillance that could be addressed.

• India can create a skilled and strong health workforce dedicated to surveillance activities.
• Non-communicable disease, reproductive and child health, occupational and environmental health and injury could be integrated into public health surveillance.
• Morbidity data from health information systems could be merged with mortality data from vital statistics registration.
• An amalgamation of plant, animal, and environmental surveillance in a One-Health approach that also includes surveillance for anti-microbial resistance and predictive capability for pandemics is an element suggested within this vision document.
• Public Health Surveillance could be integrated within India’s three-tiered health system.
• Citizen-centric and community-based surveillance, and use of point of care devices and self-care diagnostics could be enhanced.
• Laboratory capacity could be strengthened with new diagnostic technologies including molecular diagnostics, genotyping, and phenotyping. To establish linkages across the three-tiered health system, referral networks could be expanded for diagnoses and care.

Building blocks envisages for the vision

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’.

Four building blocks are envisaged for this vision:

• An interdependent federated system of Governance Architecture between the Centre and States,
• Enhanced use of new data collection and sharing mechanisms for surveillance based on unitized, citizen-centric comprehensive Electronic Health Records (EHR) with a unique health identifier (UHID). As well, existing disease surveillance data and information from periodic surveys will complement this information
• Enhanced use of new data analytics, data science, artificial intelligence, and machine learning, and
• Advanced health informatics.

Suggested Steps to move forward

• Establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.
• Identify broad disease categories that will be included under Public Health Surveillance.
• Enhance surveillance of non-communicable diseases and conditions in a step-wise manner.
• Prioritize diseases that can be targeted for elimination as a public health problem, regularly.
• Improve core support functions, core functions, and system attributes for surveillance at all levels; national, state, district, and block.
• Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action. These could include the use of situation-aware real-time signals from social media, mobile sensor networks, and participatory surveillance systems for eventbased epidemic intelligence.
•  Encourage innovations at every step-in surveillance activity.

The full document can be accessed at https://niti.gov.in/sites/default/files/2020-12/PHS_13_dec_web.pdf

Source : NITI Aayog