Integrated Disease Surveillance Program implemented in 36 States/UTs, Responsible for surveillance of 33 plus epidemic prone diseases

New Delhi: The Government of India has taken many initiatives to combat Antimicrobial Resistance (AMR). The initiatives include constitution of a National Task Force on AMR Containment in 2010 leading to development of the National Policy on AMR containment in 2011. 

The Government launched the National Programme on AMR Containment in 2013. Union Health Ministry has taken the following steps to combat Antimicrobial Resistance (AMR):

National surveillance networks including laboratories from across the country have been established and are generating National AMR Surveillance reports annually and also submitting data to the Global AMR Surveillance System (GLASS).

National Guideline on Infection prevention has been launched and translated to training material. Training of trainers held for all States and UTs. Trainings are being further cascaded in States.

To promote judicious use of Antimicrobials, surveillance of Antimicrobial use has been initiated at tertiary care hospitals.

Ministry of Health & Family Welfare launched the National Action Plan on AMR (NAP-AMR) in 2017 which was developed in alignment with the Global Action Plan on AMR. The Action Plan is being implemented by various stakeholder Ministries. The duration of NAP AMR was for 5 years.

Following National expert consultations were held towards development of NAP-AMR 2.0 in 2022:

The consultations were held for the human health sector, research sector, professional associations and civil society organizations, environment and animal husbandry sectors.

Each consultation was attended by experts who represented with the private sector, technical institutions, professional groups, industry, cooperatives, NGOs, International partners and other relevant organisations.

Objectives of these consultations included undertaking SWOT (Strength, Weaknesses, Opportunities and Threats) analyses across various sectors in context of the existing NAP-AMR and beyond as well as proposing the structure and contents of the proposed NAP 2.0. and to recommend essential elements of AMR research policy and research agenda of the country under NAP 2.0.

Integrated Disease Surveillance Program (IDSP) is an important program under National Health Mission for disease surveillance in the country. IDSP is implemented in all 36 States/UTs. The program is responsible for the surveillance of 33 plus epidemic prone diseases. The surveillance tool consists of S (Syndromic) form filled by Auxiliary Nurse and Midwife (ANMs) at the Sub-centre level, P (Presumptive) form filled by medical officers at health facility level and L (Laboratory confirmed) form filled by laboratories as per standard case definitions. Every State has designated laboratories like District Public Health Laboratories (DPHLs), State Referral Laboratories (SRLs) under IDSP for investigation and surveillance of these diseases.

In the year 2021, to strengthen the disease surveillance in the country the programme has shifted from a paper-based, aggregate, weekly reporting to a paperless, case-based, near real-time reporting through Integrated Health Information Platform (IHIP) where all the 36 States/UTs are reporting. IHIP is an information platform that integrates data from various “registries” to provide near real-time information on health surveillance from all across India for decision-makers to take appropriate public health action. IHIP provides Geotagging of the individual cases reported in outbreaks for visual geospatial analysis, along with heat map.

IDSP performs media scanning & verification of print and electronic media to strengthen the event-based surveillance. Artificial Intelligence is also used in Media Scanning and Verification to detect early warning signals and generate alerts for the timely management of potential outbreaks.

The Government through the National Centre for Disease Control (NCDC) has collaborated with various International Organizations/Countries to address AMR and enhance disease surveillance. The details of collaboration with International Organizations/Countries are attached at Annexure.

NCDC is coordinating the National AMR surveillance network under which State Government medical college hospitals/laboratories are being strengthened for AMR surveillance and containment. Trainings are held round the year for AMR data management using the offline software WHONET. Capacity building is also done on specialized lab testing procedures. Trainings have been imparted to healthcare workers on Infection prevention and control.

The India-US Centre for Disease (CDC) collaboration has focused on AMR surveillance activities, development of Standard operating procedures (SOPs) for AMR surveillance and data management, use of WHONET software, digital trainings using ECHO platform for standardization of bacteriology testing procedures across the network. CDC has also supported the ICMR-AIIMS project for HAI surveillance. Collaboration with United States Agency for International Development (USAID) is focused on strengthening AMR containment in 6 States.

Under Indo-Netherlands collaboration, pilot project was conducted on integrated AMR surveillance with one health approach in Krishna district of Andhra Pradesh.

UK's Fleming Fund phase 1 grant for which WHO India was the implementing partner has supported National Training of trainers on IPC and strengthening 3 State AMR surveillance networks in the country and Point prevalence survey on antibiotic use in tertiary care hospitals.

Under India-Denmark collaboration, India has recently developed plan of action plan for technical collaboration on AMR.