Infectious disease surveillance system at a CHC in Kerala
Even though widespread outbreaks of contagious diseases are significantly minimal in Kerala, consistent surveillance of them is very important to prevent any forthcoming outbreaks. Recently, I visited a CHC in Kasaragod district to learn how they are using the Integrated Disease Surveillance Project (IDSP)-Integrated Health Information Platform (IHIP) mobile app and a portal for reporting infectious disease cases.
IHIP was developed with the help of the World Health Organization (WHO) at the request of the Government of India to improve the real-time surveillance of infectious diseases in the country. It is a decentralised state-based surveillance system for early warnings of outbreaks or epidemics. Under the IDSP, the Central Surveillance Unit (CSU), a State Surveillance Unit (SSU) at all states and union territories and District Surveillance Units (DSU) at all districts were established. IHIP enables grass-roots reporting of suspected cases at the sub-centre level (which is now renamed the Health and Wellness Center) by the Junior Health Inspector (JHI) or the Junior Public Health Nurse (JPHN). Approximately 33 infectious diseases can be tracked using the IHIP portal.
The JHI or JPHN visits every house under their administration and will enter the suspected cases with the exact geographical location of the houses and house name or number through the mobile app. Entry to the IHIP portal is done through 3 forms: S-form, P-form and L-form. The S form is for ground-level workers like JHI/JHPN, whereas the P and L forms are for medical officers and laboratory technicians, respectively. The S-form is for suspected cases, the P-form is for presumptive cases and the L-form is for laboratory-confirmed cases. The key features of IHIP are real-time monitoring of data reporting, advanced data modelling and analytical tools, and a GIS-enabled reporting mechanism. There are chances of duplication of data and these are taken care of by the DSUs. The major challenges faced by the CHC in surveillance are people not revealing their symptoms to the healthcare workers during the house visits and patients going for treatment to other places; for example, in this context, from Kasaragod district, people may go to Mangalore for better treatment facilities. This will result in missing reporting of cases. Another major problem is the lack of internet connectivity in remote and hilly regions.