This article is written by Vivek Maurya from ICFAI Law University. The article deals with the Public health surveillance in India that is Vision 2035.

About vision 2035 white paper

This is a vision statement of the public health surveillance in India in 2035. This document outlines the concept, outlines architecture, describes the proposed flow of information, lists key questions and considerations needed to increase the scope of public health surveillance in India, outlines four building blocks, and outlines possible steps to achieve the vision.

The vision statement briefly describes India’s progress in public health disease surveillance and builds on the existing experience of public health monitoring programs by focusing on federal-based federalism management, promoting the involvement of national governments, and using the bottom-up approach. It is in line with inclusive growth and sustainability and the targets set out in the 2017 National Health Policy.

The focus is on universal health and health-focused care that is sensitive, effective, safe, convenient, and dignified as well as confidentiality and increased awareness to include non-communicable diseases, employment, injuries, and environmental conditions in a single public health care system.

This vision statement of India’s public health surveillance in 2035 builds on opportunities including the Ayushman Bharat program that establishes health and wellness facilities at the community level – strengthening disease prevention, detection, and non-compliance and ensuring that the government pays for medical expenses out of pocket money for individuals and families below the pyramid. Key features of the vision 2035 are:

1. Build on efforts like the IHIP Integrated Disease Control Program.
2. It is in line with the citizenry values ​​highlighted in the 2017 National Health Policy and the National Digital Health Blueprint. It promotes the use of mobile and digital platforms and point-of-care devices as well as integrated diagnostics and data analysis.
3. It highlights the importance of spending money on programs such as The Clinical Establishments (Registration and Regulation) Act, 2010 to increase private sector involvement in monitoring.
4. It highlights the importance of a concerted effort by higher institutions including the National Centre for Disease Control, the Indian Council of Medical Research, and others. Also, there may be a need to establish an independent Institute of Health Informatics.

NITI Aayog

NITI Aayog was established in 2015 by the Government of India as a policy think tank. Its purpose is to achieve the sustainable development goals through co-operatives, to promote the involvement of the State Government, and to implement a complementary approach. Recently, the Government of India launched a program to review Public Health Surveillance.

NITI Aayog has released a white paper, “Vision 2035: Public Health Surveillance in India” which is expected to serve as a vision statement for promoting Public Health Surveillance (PHS) in India and establishing India as a global leader in the region. The white paper is a piece of information, usually issued by a non-profit company or organization, to promote or highlight features of a solution, product, or service.

This paper is a joint effort of Vertical Health, NITI Aayog, and the Institute for Global Public Health, University of Manitoba, Public Health Agency of Canada, with donations from technology experts from the Government of India, the United States, and international organizations.

Public health surveillance

Public health surveillance is a surveillance for monitoring of health related data so that a country can plan and implement policies against any diseases. It is very important for any country, so that they can minimise the effect of any disease and can eradicate it.

What is public health surveillance

Public health monitoring (also for diagnostic, clinical, or syndromic screening), according to the World Health Organization (WHO), is a continuous, systematic collection, analysis, and interpretation of health-related data needed for the planning, implementation, and evaluation of public health services. Emerging health-related issues are still young and practical solutions are available in a timely manner. Monitoring programs are often requested to provide information on when and where health problems occur and who is affected.

Public health monitoring systems can be implemented or operational. The idle monitoring system contains continuous reporting of diseases and conditions by all health facilities in a particular area. An effective monitoring system is where health facilities are visited and health care providers and medical records are updated to diagnose a specific disease or condition. Slow-duty monitoring systems are time-consuming and costly to operate but risk exposure to other diseases. Effective surveillance systems are best suited for epidemics or when the disease is intended to be eradicated.

Public health screening techniques have been used primarily to study infectious diseases. Many large institutions, such as the WHO and the Centers for Disease Control and Prevention (CDC), have developed state-of-the-art data and computer programs that can track and monitor outbreaks of diseases such as influenza, SARS, HIV, and bioterrorism.

Why is it important

Public health employment is an important public health profession that cuts across the entire three-tier public health system and the care provided. Monitoring is an ‘information for action’ and is an important means of diagnosing, preventing and many other activities such as:

Health screening

All data collected reflects people’s health. Public health employment keeps records of existing health problems and helps define death and illness.

Detecting changes in disease trends and health practices

Ongoing recording of data informing disease status keeps track of disease. Monitoring also helps to determine the natural history of the disease.

Data collection, monitoring and evaluation

The required data for planning, monitoring and evaluation is provided for consideration, is the basis for evidence-based policy development and assists the program builder in prioritization. It is also helpful in evaluating the effectiveness of an intervention.

Early warning and outbreak detection

Public health monitoring informs you about the disease and all the details also help in diagnosing the disease, which helps prepare for the epidemic.

Simplifying emergency planning

Public health monitoring helps provide a measure of the health problem and assists in emergency planning.

India’s current public health surveillance system

The World Bank funded the Government of India in 2004 with its ten-year ‘Integrated Disease Monitoring Program – IDSP’. This was later converted into a program and funded under program 12 (2012-17) within the National Health Mission. The IDSP Central Surveillance Unit was held at the National Centre for Disease Control (NCDC), New Delhi.

The Indian Council of Medical Research (ICMR) has played an important role in strengthening observational and research-related research. The ICMR network continues to expand and currently has 106 Virus Research and Diagnostic Laboratories (VRDL), 35 diagnostic centers and many tertiary institutions. Together, these institutions play a key role in identifying new and varied viruses, controlling emerging diseases (SARS, Nipah virus) and measuring the burden of disease through the modeling of statistics for diseases such as malaria and dengue fever.

In 2019, the World Health Organization (WHO) in partnership with the Government of India launched the Integrated Health Information Platform (IHIP) within the IDSP program. IHIP is an open digital platform that captures individual data in real time, generates weekly and monthly outbreak reports and early warning signs and takes feedback with ‘rapid response’ groups on 33+ disease cases.

Some sources capture information on some of the most important national diseases such as TB. TB became a popular disease in 2012 and the Nikshay platform serves as a source of information for measuring load and tracking styles and outcomes of diseases. Towards the end of 2019, the COVID-19 epidemic provided additional impetus to strengthen Public Health Service in India.

Over the years, these various organizations, networks and programs have worked well. Smallpox was eliminated in India in 1979, a year before the global epidemic broke out. India was declared ‘Polio free’ in 2014, three years after the last convictions in India in 2011. The SARS, Nipah and rotavirus epidemics were quickly detected by effective viral testing and the ICMR network of diagnostics was successfully managed.

The ICMR network plays a key role in preventing the COVID-19 epidemic. The epidemic has expanded government of India information infrastructure and health information data for consideration, which is reflected in ‘performance information’.

Key aspects of the vision 2035 white paper

Monitoring is defined as the primary public health function that ensures that relevant information is available at the right time and place to inform public health decisions and actions. In short, the observation should be “information for action”.

The key elements of the 2035 white paper vision are:

1. Be a predictor of response, integration and testing of a disease and health monitoring system that includes the most important emerging and recurring infectious diseases. Readiness to take action in the community, institution and health as well as in governance systems are key elements of the response.
2. Be a program based largely on individual patient identification information that includes a health care facility and laboratory data as key sources, among others.
3. It is governed by an effective management and technology framework with adequate resources.
4. Assist the public with the provision of meaningful ‘details of performance’ to relevant stakeholders with proper privacy care and personal privacy, and empowering them through a client response process.
5. Provide regional/international leadership in accordance with international health regulations and events management that creates an international public health emergency.

Factors fuelling vision 2035

Apart from the great progress and strength of having an expanded and improved Public Health Surveillance Program in India, there are many challenges to the existing Public Health Surveillance that creates a 2035 vision:

Performance challenges – curved view, not complete

India needs to address these implementation challenges, be aware that relevant diagnostic and therapeutic information provided to citizens across the public and the private sector can be taken for granted. In addition, a way to modify, measure and maintain new driver/design models is urgently needed.

Monitoring activities on standing platform of programs and institutions

Vision 2035 anticipates that surveys will require the completion of traditional data entry systems based on the performance of a specific system, in obtaining real-time data from existing health records compiled using Unique Health Identification. Programs can be enabled to exchange transparent and secure data based on standard protocols, determined by integrated governance constructions.

Private sector involvement in monitoring is limited

Citizenship centrally Electronic Health Record (EHR) process in which a citizen receives the benefit of his or her health record from birth to death renewal in both the public and private sectors will facilitate real-time monitoring and quality and ensure full human inclusion. Provision of care becomes a major goal where surveillance can work.

Insufficient communication of illness and death details

The Reproductive and child Health (RCH) program has recently begun to focus on improving maternal and maternal mortality reviews so as to identify potential impacts and potential solutions to inform health service delivery and prevent future deaths. However, monitoring of maternal mortality, childbirth mortality, infant mortality, linking mortality and morbidity reports have not yet been fully integrated. The information contained in this important registration process has not been shared / linked to IHIP.

Staff challenges:

The recruitment of state and regional monitoring staff has been transferred to countries, however, the response of countries to address these vacancies is different. Health is a topic from the government, and health surveillance is a national right. Staff vacancies and staff capacity continue to plague the program.

Public health capacity training

There are many examples of training programs for community health professionals especially in the field of care. For example, the United States Epidemic Intelligence Service through the Center for Disease Control (CDC) is conducting a two-year Masters in Public Health on Epidemic Intelligence Service to develop a highly trained and skilled pathology field. India does not have enough public health professionals with this technology.

Limited use of digital, social and print media in viewing

Communication and printing resources are increasingly being tested for use. A few states in the country have media scanning cells or media promotion methods that help highlight disease outbreaks, or help identify a sudden increase in hospitalization or death due to a rare event.

Limited focus on the management of non-communicable diseases

Non-communicable disease (NCD) screening was introduced in most developed countries about 35-40 years ago. India suffers from both the burden of non-communicable and infectious diseases. ICMR has played a key role in improving the diagnosis of diabetes, heart disease and cancer rates. However, comprehensive integration of NCD risk assessments, morbidity and mortality statistics, as well as injury and accident monitoring, air pollution and its implications remain to be considered.

Separate and minor approaches to occupational health surveillance

Many employees in the legal profession have health insurance that covers the cost of hospitalization. However, apart from these advances and the availability of occupational health data from these sources, Occupational health surveillance is not an integral part of India’s Public Health Survey. Silicosis is a common disease under The Factories Act, 1948 but it has not yet been included under the Public Health Act. Many doctors have little training for health and disease at work.

Challenges to creation and implementation of vision 2035

Some of the key ideas in implementing Vision 2035 Public Health Employment in India are outlined below. Concerned stakeholders including policy makers and the government will need to address these questions in order to formulate and implement the vision of public health employment by 2035.

What could be the principles of public health monitoring

• Predicting and preparing for an outbreak of infectious and outbreaks of non-communicable diseases, both diseases re-emerge in various forms (influenza, MDR-TB), or new outbreaks (NIPAH virus, Coronavirus, etc.,) or a new focus on NCD.
• Health promotion and prevention tips: Identify new/hidden dams and sources of infection, prevent rapid transmission chains and reduce illness, disability or death.
• Responding to outbreaks and future guidance systems for disease control: Include general procedures for a) showing results beginning with molecular testing, b) digital results and final action in real-time, c) generating genetic mapping to identify pathogen variability or potential manager.

What are the next steps to follow

• Priorities: Can this include chronic and difficult conditions, especially in the context of health, the environment and health? Is it possible that sections of the community, institutions and system-level including seeking health care and social health structures can be included within Surveillance?
• Staff identification and capacity building: How do we ensure that we have a community health cadre dedicated to local, regional, government and national levels, with adequate numbers and integrated renewable skills?
• Landscaping and strengthening laboratory capacity: How can we increase laboratory capacity in the public and private sectors? How do we strengthen point-of-care diagnostics, self-assessment agreements and referral networks to reduce the time taken to produce reliable, valid and useful diagnostic or diagnostic results for the patient and provider? How do we ensure that laboratory results are well integrated with relevant clinical and social knowledge that contribute not only to better patient care but also to community health services?
• Developing and promoting technologies and methods: Is it possible to have advanced scanning early warning signs using platforms such as WHO, PROMED and others? What is the role of communication? How do countries quickly learn how to prevent, respond to and act according to the experience of new outbreaks in a different part of the world? How do we ensure that ‘big data management integrates Artificial Intelligence and machine learning into surveillance platforms’?
• Integration and management: Policy, technology, administration and digital?

How can Public health surveillance utilize existing talent and platforms

• Digital health intervention;
• Integrated Communication Technology; and
• Scientific, technical, social and business platforms.

How can we regularly collect individual patient data to create human-based data sets

• Unique health indicator;
• Integrated health / Medical record;
• General data sharing agreements;
• Interaction between programs and systems.

Can public health monitoring integrate different sources of analytical data, and how do we ensure that feedback takes place between sectors

• Statistics of plants, animals and human diseases;
• Natural indicators;
• Economic details.

What is the Federal National Implementation Architecture

• Governance and cooperative federalism.
• Data capture: Metadata, data levels, case descriptions, data protection, etc.
• Methods of patient care and continuing care: Individual, Family, Disease, etc.
• Open input/output methods: Call center, India’s health portal, health programs, insurance.

How does Public health surveillance increase access to data for relevant stakeholders to include all stakeholders while ensuring the required patient confidentiality

• Public / public access;
• Acquisition of intellectual property;
• Apex Centers for the promotion of research on diagnosis and vaccination;
• Large data publishing and data analysis;
• Business development of multiple electronic manufacturers.

What diseases can India look for in ending by 2030 and what could be the path to removal

• The WHO has provided a list of diseases that are intended to be eradicated by the WHO. How can India use this list to define their list of diseases and timelines for disease eradication?
• The eradication of disease seems to be the most difficult goal and so far only achieved smallpox. However, with so many diseases set to be eradicated by 2030, can the disease eradication agenda also be defined? For example, many developed countries today are confronted with an epidemic of syphilis and other sexually transmitted diseases, which were previously eliminated.

Conclusion

In conclusion, India’s Vision 2035 for Public Health Surveillance enoses the integration in the three-tiered health system, which strengthens public scrutiny, expansion of transmission networks, and improved laboratory capacity. Electronic Health Record (EHR) becomes the primary basis for observation and is subject to periodic national/provincial/regional screening, specialized studies and research in order to limit and redefine general definitions of cases, as disease patterns change. Monitoring does not depend solely on diagnostic or operational monitoring programs, although this may not always be an important aid to intelligence. The building blocks of this idea are an integrated Governance-based intergovernmental system, a new data allocation that is not based on traditional data entry systems but is based on existing diagnostic systems. Monitoring uses new analytics, health informatics and data science as well as new ways to disseminate ‘information for action’. This will also strengthen India to become a global/regional leader in Public Health Surveillance.

References

• https://niti.gov.in/sites/default/files/2020-12/PHS_13_dec_web.pdf
• https://www.drishtiias.com/daily-updates/daily-news-analysis/vision-2035-public-health-surveillance-in-india

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