This vision document on Public Health Surveillance in India by 2035 was published by NITI Aayog in its website as under which has been a result of extensive collaboration with the Institute of Global Public Health at the University of Manitoba and the national and global experts who have helped to compile this vision document titled “Vision 2035:  Public Health Surveillance in India – a White paper” With the arrival of COVID – 19, one does not need any justification for having public health surveillance in India. With the vision set for 2035, we are guarding ourselves for better protection against major diseases of our world. We shall face our economic tribulations, if any, much better with the visual projection of” Vision 2035.”

https://niti.gov.in/sites/default/files/2020-12/PHS_13_dec_web.pdf

Chapter wise names may lead to simple understanding of the subject.

1. Scope of the document

2. Vision 2035: Public Health Surveillance in India

3. Background and Introduction

4. Key Considerations in Creating Vision 2035

5.The Building Blocks for Vision 2035: Public Health Surveillance in India.

6. Steps towards achieving Vision 2035: Public Health Surveillance in India

7. Conclusion

Let me introduce the complex subject in the form of Question and Answers, to start with.

What is public health surveillance? Can it be explained for a lay-man?

 Enhancing Public Health Surveillance is an important public health function. This includes the detection of disease and early warning signs of impending outbreaks or epidemics, both those endemic to the country or those that constitute a public health emergency of international concern. Tracking acute and chronic disease trends and responding with timely and effective actions are critical functions of surveillance.

 It articulates the vision and describes building blocks. It envisions integration, enhanced citizen-centric and community-based surveillance, strengthened laboratory capacity, expanded referral networks, and a unified Surveillance Information Platform that will provide data for decision making and action.

How do I believe what the document says about surveillance?

9 top scientists from University of Manitoba, world leaders in epidemics, 4 top consultants from NITI Aayog, and 23 world level experts from WHO, various leading institutions like ICMR, institutions specializing on diseases in India collaborated and contributed towards the publication under discussion. It is intended to be a top reference manual for future.

Page 14 and para 5 extensively narrates our journey to be undertaken in 2035.

Why not the experts’ view on the same in 2035. (Obviously, I can’t dare to amend the scientifically explained paras)

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 (anonymized) 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.

In a simple one sentence, individual-level patient information that emanates from health care facilities, laboratories and other sources will form the foundation stone of my health care.

Let me explain it further. Presuming one as a diabetic with a start at the age of 50 or more which has been a recurring theme among our relatives in all walks of life and at all levels of income or living at all places like rural, urban or cosmopolitan areas. Sedentary living style with virtual no hard work for the body has resulted in this disease.

 Some people suffer for 3 or 4 decades with hardly any medical records. Exceptionally difficult to carry records that may involve thousands of pages of medical history, one may claim in exasperation. But in the West, with massive socialization of medicine for the society as a whole, this is a living example of reality. Yes, with a social security number (SSN) in U.S.A., the issue stands explained. With the hospitalization under government care in EU or UK, the situation is equally simple and easy to refer by doctors, hospitals or all stake holders.

Talking about 2035, does India with the most varied social structure have any checkered history of meeting the menace of epidemics in the past? Not many of the young Indians have known about any of them. Let me introduce you to the past which ranks among the best in human civilization.

Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures.

These actions are based on information from public health surveillance. India was able to achieve many successes in the past.

 Yes, one of the deadliest Smallpox was eradicated and polio was eliminated. India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts.

 Many outbreaks of vector-borne diseases, acute encephalitis syndromes, acute febrile illnesses, diarrhea and respiratory diseases have been promptly detected, identified, and managed.

I claim proudly that these successes emerged out of effective community-based, facility-based, and health system-based surveillance. The program response involved multiple sectors, including public and private health care systems and civil society. India is considered the capital of vaccine for the world over the past few decades.

Do we have the explosion of digital technologies in health?

Let me start with NITI Aayog and its past?

The NITI Aayog launched the National Digital Health Blueprint in July 2019. Two key recommendations from the National Digital Health Blueprint document were the use of a unique health identity number (UHID) and the strengthening of electronic health records in the public and private health care sectors.

I agree with you that these two recommendations will form central to the basis for the future of surveillance in India, as outlined in this vision document.

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

There has been an explosion of digital technologies in health.

There has been an explosion of digital technologies in health. The NITI Aayog launched the National Digital Health Blueprint in July 2019. Two key recommendations from the National Digital Health Blueprint document are the use of a unique health identity number (UHID) and the strengthening of electronic health records in the public and private health care sectors. These two recommendations are central to the basis for the future of surveillance in India, as outlined in this vision document.

Surveillance itself functions on a single Surveillance Information Platform that amalgamates all relevant information from multiple sources. Initially, this information can come from existing vertical and integrated disease surveillance programs.

But over a period of time, what will happen?

 However, over time, this would be driven from electronic health records (EHR) of populations and medical records of patients, that are individual centric and identified through the use of a unique health identifier (UHID).

 Information from vertical and integrated disease control programs, hospitals and health centers, laboratories and pharmacies, insurance related routine medical check-up, PMJAY and other insurance records, and occupational health surveillance will all be amalgamated into the EHR.

So, any Indian will carry at the most, an ID number which will be available even in the mobile for easy reference.

Can we visualize the picture from block level itself to the international levels of medical treatments?

Block/District level: Outbreak Investigation, Active and passive case-finding, contact tracing, Isolation of index, Quarantine of presumptive patients, Social/ physical distancing, limiting air, water, soil, food, blood and its products and vector borne transmission, Treatment of confirmed cases/contacts, Chemo for susceptible individuals, etc.,

 State/National Level: Legislation, Resource Allocation, monitoring trends, disseminate meaningful information to relevant stakeholders, monitor actions at different levels, etc.,

 International Level: Reporting under International Health Regulations and for public health emergencies of international concern.

What are the four blocs visualized for this vision?

1. An interdependent federated system of Governance Architecture between the Centre and States

2. Use of EHR with a unique health identifier (UHID). Data from periodic surveys on diseases will complement this information.

3. Enhanced use of new data analytics, data science, artificial intelligence, and machine learning, and

4. Advanced health informatics.

Drawing on best practices from India and other developing and developed country experiences, the document suggests next steps for India to move forward towards this vision.

 All these steps are in alignment with the principle to raise the profile of surveillance as a tool for the public good. The steps are suggested as a continuous cycle rather than a sequential process.

Let me make it simple for you to understand.

1. We shall establish a governance framework that is inclusive of political, policy, technical, and managerial leadership at the national and state level.

2. Identify broad disease categories that will be included under Public Health Surveillance.

3. Enhance surveillance of non-communicable diseases prioritize diseases that can be targeted for elimination as a public health problem, on a regular basis.

4. Improve core support functions and surveillance at all levels – national, state, district, and block.

5. Establish mechanisms to streamline data sharing, capture, analysis, and dissemination for action. Innovation will get automatically encouraged as a matter of priority for survival itself.

Having ventured to learn a lot about the above document for 2035, let us learn the names of a few diseases under Integrated Disease Surveillance Program as given as under:

  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 10. Viral Hepatitis E 11. Leptospirosis 12. Malaria: PV, PF.
  2. Let us recollect Diseases under Presumptive (P form) Surveillance also: 1. Acute Diarrhea Disease (Cholera) 2. Bacillary Dysentery 3. Viral Hepatitis (A/E) 4. Enteric Fever 5. Malaria (PV, PF) 6. Dengue / DHF / DSS 7. Chikungunya 8. Acute Encephalitis Syndrome (JE) 9. Meningitis 10. Measles 11. Diphtheria 12. Pertussis 13. Chicken Pox 14. Fever of Unknown Origin (PUO) 15. Acute Respiratory Infection (ARI) / Influenza Like Illness (ILI) 16. Pneumonia 17. Leptospirosis 18. Acute Flaccid Paralysis < 15 Years of Age 19. Dog bite 20. Snake bite 21. Any other State Specific Disease (Specify) 22. Unusual Syndromes NOT Captured above (Specify clinical diagnosis); e.g., scrub typhus.

One often hears Indian Council of Medical Research which also plays a major role in vaccine for COVID-19. What is its role? Can we summarize some of them?

Page 69 leads us to full information.

Though I have tried to give below some of its noble functions, one who is serious can easily refer to the original list on page 69. (My list is a reproduction from the said page only)

The ICMR’s contribution in understanding various diseases of national importance such as malaria, Japanese Encephalitis, tuberculosis, AIDS, Kala-azar, Filariasis, Leprosy and Poliomyelitis is remarkable.

Additionally, ICMR has made extensive contributions in the areas of nutrition, reproduction and maternal and child health, occupational and environmental health with research complementing health systems. The ICMR has a regional network of 26 institutes.

 They are involved in the evaluation of new drugs, insecticides, vaccines, devices, diagnostic kits. Additionally, they play a key role in interventions for all diseases of national health priority along with neglected and regional diseases.

 ICMR has linked 106 viral research laboratories, which are used for lab testing in epidemic outbreaks and is involved in mathematical modelling for Malaria and Dengue in North East. Point-of-Care devices are being piloted for Leptospirosis.

Conclusion

You have been given a bird’s view of the vast document of 76 pages with 4 list of tables and 14 list of figures. Any economic student, analyst of Indian future in medical field from any angle, or vast medical establishments who want to establish its foot hold in India, and the most promising economic giant in the world would find the document prepared by NITI Aayog the most authentic guide for planning, establishing or flourishing of business in medical field. With a curious list of vast number of its citizen in both the younger as well as senior categories of population, India offers a very long of its coming years as a golden period for development in modern medicine. The huge investments in medicine will also help India to grow economically as well as socially as a modern nation with its best medical care for its citizen, not to forget the millions from poorer countries who visit India for medicinal nirvana. Even yesterday, one traveler from Afghanistan reminded me this fact.

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