Policy Update
Nandini Arya
Background
India has made some pivotal decisions in the prevention, control, and elimination of major communicable diseases. The eradication of smallpox worldwide and the elimination of polio in India are notable achievements. Additionally, the incidence of HIV infections has been halved over the last two decades. Pandemic outbreaks such as COVID-19 and the Nipah virus have been effectively contained. These successes underscore the importance of strong public health surveillance systems.
NITI Aayog has recognized the need to enhance surveillance for non-communicable diseases and to transition from traditional data-entry systems to modern digital health technologies. This aligns with the National Digital Health Mission and the 2017 National Health Policy, which emphasizes the integration of citizen-centric and community-based surveillance. The Health and Wellness Centres established under Ayushman Bharat provide a platform for enhancing community-based surveillance for both infectious and non-communicable diseases.
The COVID-19 pandemic has highlighted the necessity of revisiting emerging diseases due to increased human-animal-environment interactions. Early identification at this interface is crucial for breaking the transmission chain and building a resilient surveillance system. The Vision 2035 document articulates this strategy and outlines the building blocks necessary for a unified and integrated public health surveillance system in India.
Functioning
Vision 2035 aims to establish a public health surveillance system that is both comprehensive and integrated, bringing together multiple elements to create a robust framework for monitoring and managing public health.
- Data Integration: The system will focus on creating a unified platform that gathers health data from a wide range of sources, including hospitals, clinics, laboratories, and national health programs. This platform will ensure that data flows smoothly and is easily accessible to all relevant stakeholders. By integrating data from different sectors, the system will provide a holistic view of public health, allowing for better decision-making and quicker responses to health issues.
- Technology Utilization: To enhance the accuracy and predictive capabilities of health data, the system will leverage advanced technologies such as artificial intelligence (AI), machine learning, and big data analytics. These technologies will help in identifying patterns, predicting outbreaks, and managing public health more effectively. By using these cutting-edge tools, the surveillance system will be able to process large volumes of data with greater precision, leading to more informed and timely interventions.
- Capacity Building: An important component of Vision 2035 is the establishment of training programs aimed at healthcare professionals. These programs will focus on equipping them with the skills needed for effective surveillance, including the use of new technologies and data management techniques. By building the capacity of the healthcare workforce, the system ensures that there are skilled professionals available to manage and analyze the health data, making the surveillance system more effective and responsive.
- Community Engagement: The success of the surveillance system also depends on active participation from communities. Vision 2035 emphasizes engaging local communities in the data collection and reporting process. By involving communities at the grassroots level, the system can gather more accurate and timely data, which is essential for tracking and responding to health issues. This bottom-up approach also fosters a sense of ownership and responsibility among community members, making them active participants in public health efforts.
- Policy Support: To ensure the smooth functioning of the surveillance system, supportive policies and regulations will be developed. These policies will facilitate data sharing across different health sectors and ensure that all stakeholders, including government agencies, healthcare providers, and communities, are aligned in their efforts. By creating a conducive policy environment, Vision 2035 aims to remove barriers to data sharing and cooperation, making the surveillance system more effective and sustainable in the long run.
Performance
The initial implementation of Vision 2035 has shown promising results. Improved mechanisms for data collection have been established in several states, leading to more detailed and accurate health data. Pilot projects that utilize AI and machine learning for disease prediction and outbreak management have demonstrated notable success. Numerous workshops and training sessions have significantly increased the capacity of healthcare workers in surveillance practices. Additionally, public awareness campaigns have effectively educated people about the importance of health surveillance, especially in regions where awareness was previously low.
Impact
The Vision 2035 initiative is expected to have a profound impact on public health in India:
1. Early Disease Detection: Enhanced surveillance systems are pivotal for the prompt identification of potential disease outbreaks. By continuously monitoring health data, these systems can detect anomalies and patterns that signal the emergence of a new disease or the resurgence of an existing one. This early detection is crucial as it allows health authorities to respond swiftly, implementing interventions that can contain the outbreak before it spreads more widely. Such timely action not only minimizes the impact on affected populations but also reduces the overall burden on the healthcare system.
2. Efficient Resource Allocation: Accurate and comprehensive health data gathered through improved surveillance systems are essential for the strategic distribution of healthcare resources. When health authorities have access to precise data, they can identify which regions or populations are most in need of medical attention and resources. This ensures that resources such as vaccines, medical personnel, and supplies are directed to areas with the highest demand, optimizing the use of available resources and improving health outcomes in the most vulnerable communities.
3. Informed Policymaking: Reliable data plays a critical role in shaping effective public health policies. With a robust surveillance system in place, policymakers can base their decisions on concrete evidence rather than assumptions or incomplete information. This evidence-based approach enables the creation of public health strategies and programs that are more likely to succeed, as they are grounded in a clear understanding of the health challenges facing the population. Consequently, informed policymaking leads to more targeted and effective interventions, ultimately improving public health outcomes.
4. Global Health Security: India’s role in global health security is strengthened by the development of a robust public health surveillance system. Such a system not only protects the health of the nation’s citizens but also contributes to the broader effort to prevent the international spread of diseases. By detecting and controlling outbreaks early, India can help to prevent diseases from crossing borders, thereby supporting global initiatives to maintain health security. This collaboration is vital in an interconnected world where the spread of infectious diseases can have far-reaching consequences.
Even with the progress made, there are several key challenges that need to be addressed to ensure the effectiveness of public health surveillance systems.
Emerging Issues
- Data Privacy: One of the primary concerns is ensuring the privacy and security of health data. With the increasing digitization of health records, the risk of data breaches or misuse is ever-present. Protecting sensitive health information from unauthorized access is critical, not only to maintain trust between the public and health authorities but also to comply with legal and ethical standards. Strong encryption methods, secure data storage, and clear policies on data access and usage are essential to safeguarding this information.
- Interoperability: Another significant challenge lies in integrating data from various sources, such as hospitals, clinics, laboratories, and national health programs. Different systems often use different formats and standards, making it difficult to ensure seamless interoperability. This lack of integration can lead to gaps in data collection, delays in information sharing, and inefficiencies in tracking health trends. To overcome this, there is a need for standardized protocols and systems that can communicate effectively with one another, ensuring that all relevant data is captured and utilized in real-time.
- Sustainability: Maintaining the momentum of surveillance initiatives is crucial for their long-term success. This includes ensuring continuous funding and resources to support ongoing data collection, analysis, and reporting efforts. Without sustained investment, there is a risk that surveillance systems may become outdated or underfunded, leading to a decline in their effectiveness. This could result in slower responses to emerging health threats and less reliable data for decision-making. Ensuring that these initiatives remain a priority in public health agendas is key to their sustainability.
- Community Resistance: Engaging communities in surveillance efforts can be challenging, particularly in rural and remote areas where there may be skepticism or resistance to such initiatives. This resistance can stem from a lack of understanding of the purpose and benefits of surveillance or concerns about privacy and data usage. Building trust within these communities is essential, which can be achieved through transparent communication, education, and involving community leaders in the planning and implementation of surveillance activities. Overcoming these barriers is critical to ensuring widespread participation and the success of surveillance efforts.
Way Forward
To achieve the goals set out in Vision 2035, several actions need to be taken. Strengthening policies to support data sharing, privacy, and interoperability is crucial, ensuring that data flows smoothly while protecting individual privacy. Increasing investment in public health surveillance infrastructure and technologies is essential, as sustained financial support will enable the development of more advanced systems. Enhancing collaboration between government agencies, the private sector, and international organizations will improve the overall effectiveness of the initiative, as combined efforts can lead to more comprehensive solutions.
Additionally, continuous training programs must be regularly updated to keep healthcare workers informed of the latest techniques and technologies, ensuring they have the skills needed to effectively utilize new tools and methodologies. Public engagement is vital to building trust and encouraging participation in health surveillance activities, fostering a sense of collective responsibility and ensuring that surveillance efforts are well-supported by the community. This multifaceted approach will help create a robust and resilient public health surveillance system, aligning with the vision for 2035.
Integrating Key Initiatives
The NITI Aayog was established in 2015 by the Government of India as a policy think tank to achieve Sustainable Development Goals through cooperative federalism. The recent initiatives of the Government of India provide an opportunity to reevaluate public health surveillance. The Ayushman Bharat program, which focuses on comprehensive primary healthcare through Health and Wellness Centers and reducing out-of-pocket expenditure through the PMJAY insurance scheme, offers a platform for enhancing public health surveillance.
Additionally, the Prime Minister’s Atma Nirbhar Swasthya Bharat Yojana (PMASBY) aims to make India self-reliant by enhancing laboratory infrastructure and health systems at the block level to prepare for future pandemics. Surveillance is crucial for timely and effective public health responses, cutting across primary, secondary, and tertiary levels of healthcare.
Unified Surveillance Information Platform
The vision document emphasizes a unified and integrated surveillance system that encompasses a ‘One-Health’ approach, amalgamating health information from human, plant, and animal surveillance. This system will utilize real-time data from various sources, including social media, mobile networks, and citizen participatory surveillance systems, alongside traditional systems and electronic health records. The goal is to create a unified Surveillance Information Platform that provides data for decision-making and action.
Similar Approach in Different Countries
The “Vision 2035” document suggests a significant shift towards a more digitized and interoperable health surveillance framework. This approach reflects the global trend, as seen in countries like the United States and the United Kingdom, where digital health records and advanced analytics are increasingly utilized for disease prediction and outbreak management. However, India’s emphasis on a federated system of governance, involving both central and state governments, is a distinctive feature that aligns with the country’s unique federal structure.
India’s Vision 2035 for Public Health Surveillance aims to create a unified e-health record system by integrating diverse data sources, such as electronic health records (EHRs) and electronic medical records (EMRs), with a unique health identifier (UHID). Drawing lessons from global practices, India’s approach can benefit from the U.S.’s Electronic Case Reporting (eCR) system, which allows real-time data exchange between EHRs and public health agencies, enhancing disease tracking and management.
Similarly, Taiwan’s Laboratory Automated Reporting System (LARS) standardizes laboratory reporting for efficient community-based surveillance, integrating data from clinical laboratories and hospital systems into a national platform. Canada’s federated approach to public health surveillance emphasizes collaboration across various government levels, ensuring comprehensive and coordinated efforts. By adopting these best practices, India can strengthen its surveillance infrastructure, making it more effective, responsive, and capable of addressing both communicable and non-communicable diseases. This integration of global insights will help India achieve a resilient and comprehensive public health surveillance system by 2035.
Self-Analysis
Reflecting on the Vision 2035 initiative, it is evident that the ambition to transform India’s public health surveillance system is both timely and essential. The COVID-19 pandemic has starkly demonstrated the importance of robust health surveillance systems that can quickly identify and respond to emerging threats. However, the success of this vision hinges on overcoming significant challenges such as ensuring data privacy, achieving interoperability among diverse data systems, and securing continuous funding. The integration of advanced technologies and community engagement are critical to the initiative’s success. As we move forward, it will be crucial to maintain momentum and adapt strategies to address emerging issues and opportunities in public health.
Conclusion
The Vision 2035 document lays the foundation for integrated surveillance of both communicable and non-communicable diseases in India. It identifies four building blocks: an interdependent federated governance system between the Centre and States, new data collection and sharing mechanisms based on citizen-centric Electronic Health Records, enhanced use of data analytics and AI, and advanced health informatics.
This vision aims to propel India to be a regional and global leader in public health surveillance, ensuring timely and effective responses to health challenges. By addressing the identified challenges and taking proactive steps, India can build a resilient public health surveillance system that protects the health and well-being of its population, now and in the future.
The insights and ideas provided in this document, developed in collaboration with the University of Manitoba and various national and global experts, pave the way for India to achieve this vision. It is a crucial step towards integrating public health surveillance into the broader socio-economic development of the country.
References
- NIHB Public Health Projects. (n.d.). National Indian Health Board. Retrieved August 9, 2024, from https://www.nihb.org/public_health/eCR.php
- PIB Delhi. (2020, Dec 14). NITI Aayog releases ‘Vision 2035: Public Health Surveillance in India’. PIB. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=1680519
- VISION 2035 PUBLIC HEALTH SURVEILLANCE IN INDIA A WHITE PAPER. (n.d.). NITI Aayog. Retrieved August 9, 2024, from https://www.niti.gov.in/sites/default/files/2023-03/Vision-2035-Public-Health-Surveillance-in-India.pdf
About the Contributor- Nandini Arya is a research intern at IMPRI with a background in Government Administration, having graduated with a BA (Hons) from MIT-WPU, Pune. She is set to begin her Master’s in Public Policy at Queen Mary University of London.
Acknowledgement– The author would like to thank Ms Aasthaba Jadeja and Ms Ishani Mitra for reviewing their article.
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