SYLLABUS: GS MAINS PAPER 2- HEALTH AND GOVERNANCE
To detect and respond to outbreaks in the early rising phase India urgently needs a strong Disease Surveillance System. Information from surveillance system can be used to monitor the burden of a disease, Overtime, determine risk factors, detect changes in disease occurrence etc.
● A defining moment in the history of epidemiology was the removal of the handle of the water pump.
●In 1854, a deadly outbreak of cholera affected soho area of London.
●A British doctor and epidemiologist John Snow (father of modern epidemiology) used the health statistics and death registration data from the General Registrar Office (GRO) in London to plot a map of the area, the distribution of cholera cases and deaths.
●Majority of cases and deaths were in the broad street area, which received supply from a common water pump, supporting his theory that cholera was a waterborne, contagious disease.
●The collection of health data and vital statistics by the GRO had improved over the previous decade-and-a half due to untiring efforts put in by medical doctor William Farr(founder of modern concept of disease surveillance system).
●The cholera outbreak was controlled in few weeks. It started the beginning of a new era in epidemiology.
● Epidemiology became a key discipline to prevent and control infectious diseases (and in present context for non-communicable disease as well).
●The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the disease.
●This is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
DISEASE SURVEILLANCE IN INDIA
● A major cholera outbreak in Delhi in 1998 and the Surat plague outbreak of 1994, prompt the Government of India to launch the National Surveillance Programme for communicable diseases in 1997.
●However, this initiative remained rudimentary, in wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).
●The focus under the IDSP was to increase the government funding for disease surveillance, train the health workforce, strengthen laboratory capacity and have at least one trained epidemiologist in every district of India.
●With that, between 2004 and 2019, every passing year, more outbreaks were detected and investigated than the previous year.
●It was on this foundation of IDSP (now a full- fledged programme) that when covid-19 pandemic struck, India could rapidly deploy the teams of epidemiologists and public health experts to respond to and guide the response, coordinate the contact tracing and rapidly scale up testing capacity.
●The disease surveillance system and health data recording and reporting systems are key tools in epidemiology.
NEED OF DISEASE SURVEILLANCE
●It contributes to better prevention and management of diseases.
●It provides and interpret data to facilitate the prevention and control of diseases.
For example, Kerala, one of the best performing disease surveillance states in India, as it is picking maximum covid-19 cases, it could pick the first case of the Nipah virus in early September 2021.
On the contrary, cases of dengue, malaria, leptospirosis, and scrub typhus received attention only when more than three dozen deaths were reported in several districts of Uttar Pradesh.
IDSP, by joint monitoring mission in 2015 conducted jointly by the Ministry of Health and Family Welfare, World Health Organisation and the Government of India. India had made a few concrete recommendations to strengthen disease surveillance system.
●The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the union and state governments.
●The laboratory capacity for covid-19, developed in last 18 months, needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
●The workforce in the primary health care system in both rural and urban areas needs to be retrained in disease surveillance and public health action.
●The ‘one health’ approach has to be promoted beyond policy discourses and made functional on the ground.
●There has to be dedicated focus on Registration and Vital Statistics (RVS) systems and Medical Certification of Cause of Death (MCCD).
●It is time to ensure coordinate actions between the state government and Municipal Corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
●The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.
The emergence and re-emergence of new and old diseases and an increase in cases of endemic diseases are partly unavoidable. We cannot prevent every single outbreak but with a well functioning disease surveillance system and with application of principles of epidemiology, we can reduce their impact.