INFORMATION & COMMUNICATION TECHNOLOGY NETWORK
Disease surveillance is recognized as an important tool for early detection of outbreaks for instituting effective control measures in timely manner. Though the health care infrastructure in India has grown immensely over the years, disease surveillance systems have not got the desired attention in the past, frequently resulting in late detection of disease outbreaks. One of the main reasons for limited success in disease surveillance in the country has been and still is to some extent, the time consuming and labour intensive manual methods of data collection, communication, analysis and feedback for taking action. A good surveillance system must be comprehensive and sensitive to achieve the laid down objectives, for which Information and Communication Technology (ICT) has proven to have played a definite role under IDSP.
The implementation under ICT consisted of the following three sub-components:
Supply, installation and maintenance of computer hardware and system / application software
Development, installation of specific software including training of human resources to use the software
Establishment of network between districts, states and central level (including handholding and support)
The ICT component of IDSP was initially envisaged to create a four-tiered network with Primary Health Centers and Community Health Centers connected using Interactive Voice Response System (IVRS); district health offices connected through computers and a low-end server; state health offices connected with computers and a mid-range server; and the Central Surveillance Unit connected through computers and larger number of mid-range servers. In Project Implementation Plan (PIP), it was conceived that five computers would be provided to each district to be installed at the District Health Office, District Public Health Laboratory, District Hospital, local Medical College and private sentinel surveillance unit. Significant hardware and software was proposed for procurement. The procurement process for the ICT items when under advanced stages of processing was forfeited in view of several other vertical health Programmes having supplied similar hardware and software to targeted health facilities. Different National Health Programmes including RCH, NVBDCP, RNTCP and NPSP have also provided computers to strengthen District Health Office. It was therefore agreed to that there is a need to reassess the hardware requirements at different levels taking into consideration the computers already supplied under these centrally sponsored programmes. Accordingly restructuring of the ICT component under IDSP was done in the year 2006. IDSP decided to establish an integrated health information centre supported by connectivity that allows distance training and video conferencing in addition to data transfer at the district level.
EDUSAT under ISRO
The feasibility of the EDUSAT (EDUcationSATellite) with the help of Indian Space Research Organization (ISRO) was explored. It was decided to set up a country-wide networking connecting all Districts, States, major Medical Colleges and Central Surveillance Unit at NCDC and NirmanBhawan.
The following major applications were planned for usage of this network:
Tele-education / Distance learning
Data entry, transfer and analysis from district unit to state/centre units
Video conferencing at State Surveillance Units and Central Surveillance Units.
In the initial stages of planning of ICT infrastructure of IDSP, the project had interacted with ISRO to explore the possibility of using the satellite network for this purpose. ISRO had, at that time, offered to do so under its EDUSAT programme by offering a total of 8 MHz bandwidth free of cost for all planned 800 locations. However the entire cost of infrastructure, such as Satellite Hub, VSATs, computers, training infrastructure etc., was to be borne by IDSP.
Accordingly, in September 2005, ISRO was entrusted with the task of providing a satellite based network initially at 100 locations along with creation of training infrastructure at these locations. To facilitate better coordination of establishment of infrastructure, 100 locations in the first phase were confined to a few selected State headquarters and Districts in States like Gujarat, Tamil Nadu, Maharashtra and few selected Medical Colleges. The Satellite Hub was installed in March 2006 at NCDC, Delhi. Subsequently funds were released to ISRO for extending this arrangement to cover an additional 300 locations, since the 8 MHz bandwidth as allotted by ISRO for 800 locations was not sufficient to meet the total scope of utilization of this infrastructure. ISRO conveyed that they would not be able to allocate additional bandwidth for IDSP network.
Considering ISRO’s inability to cover all 800 locations due to insufficient bandwidth, the National Informatics Centre (NIC) suggested that IDSP network could take advantage of both satellite and terrestrial technology to fully meet the requirements at an optimal cost. The next phase of 300 locations for which funds had been released to ISRO covered all State headquarters, Government Medical Colleges, Districts in North-East States, Jammu & Kashmir and Andaman & Nicobar Islands, where broadband connectivity from BSNL was not readily available or was likely to take some more time. All 800 sites covering District and State headquarters, Central Surveillance Unit and Government Medical Colleges were proposed to be set up using broadband connectivity from BSNL. In this network, all the 400 VSAT based sites were also augmented with broadband connectivity. Video conferencing facility was set up at District level, however, High-end Video Conferencing Equipment were set up only at State headquarter level covering around 40 locations across the country (35 States/UTs, NCDC, NIC and MOHFW).
MoU with NIC
Since NIC is a professional organization under the Government of India and supporting all the Ministries in ICT related activities, IDSP signed a Memorandum of Understanding with NIC in February 2007 for period of two years, which was further extended till 30th June 2010. The MoU was signed for the following IT support and facility management:
Creation of ICT infrastructure at DSUs, SSUs and CSU
Connectivity and Networking
IDSP Portal (Software development & online transmission of data)
Call Centre services
Manpower support (Data Managers and Data Entry Operators at all DSUs/SSUs; and DEOs at Medical College sites)
The list of equipment provided by ISRO and NIC is at Annexure 6.
IDSP has established linkages between Central Surveillance Unit, State Surveillance Units, District Surveillance Units, Government Medical Colleges and major Premier Institutions on a Satellite Broadband Hybrid Network. IDSP ICT project is a network of 800 interactive terminals.
Indian Space Research Organization (ISRO) has setup the satellite based interactive network covering entire Maharashtra, Gujarat and Tamil Nadu, North Eastern States, hilly States and Islands. The Network Operation Centre (NOC) or main teaching end of this network is located at the National Centre for Disease Control and the SITs are located at the SSU, DSU, Government Medical Colleges and Premier Institutions. 36 Sites (33 State/UT, NirmanBhawan-MOHFW, CSU-IDSP and NIC) are equipped with additional high-end VC equipment for better video-conference viewing. This network enables speedy data transfer, video conference and training. A total of 367 (out of 400) sites are already operational with EDUSAT connectivity by ISRO. Due to some unavoidable problem in EDUSAT (GSAT-3) from ISRO’s side, the EDUSAT network was down during September 2010 till February 2012. Then ISRO intimated about bandwidth allocation for IDSP (4.0 MHz) on the newly launched satellite (channel 8 on GSAT-12). To restore the IDSP network, existing installed hub and remote sites were migrated from GSAT-3 to GSAT-12.
National Informatics Centre being the technical IT support arm of MoHFW has been helping IDSP in establishing terrestrial connectivity at all 800 sites, and managing the entire network. For this, NIC has provided Data Centre equipment and Training Centre equipment for IDSP nodes at CSU, SSUs, DSUs.
Data Centre: The objective of data centre is speedy data transmission, weekly online entry of data (IDSP Portal www.idsp.nic.in), distance learning / training. Data Centre has been established at all SSUs, DSUs, Govt. Medical Colleges and Premier Institutions. A total of 776 (out of 800) sites have been installed.
Training Centre: Equipment at 400 Training Centres are provided by ISRO on SIT and 400 on a broadband based network provided by NIC.
Installation Status of Training Centres is as follow:
by ISRO on Satellite based connectivity - 367 / 400
by NIC on Broadband based connectivity - 378 / 400
State wise equipment installation status (as on October 2014) is as follow:
CSU is using video conferencing facilities to communicate with Districts/States for outbreak investigation, project review/monitoring for different aspects, training of data managers and data entry operators on data reporting and analysis, weekly reports and outbreak reports. A total of 1,539 video conferencing sessions has been conducted during the period October 2007 – December 2013. The standard VC is being used between the CSU and States HQs over VSAT and WebVC for all sites including VSAT.
Call Centre: A 24X7 call centre has been established to receive disease alerts from anywhere across the country on a toll free number 1075 (1800-11-4377) for verification of outbreak related rumors/alerts and initiating appropriate public health actions. The information related to the disease alert calls received at the Call centre is referred to the concerned DSU/SSU to investigate and respond to unusual health events. Since its inception in February, 2008, the Call Centre received more than 3.3 lakh calls till December 2013 of which 37,424 were related to H1N1 Influenza. From 1st April 2014 onwards, the Call Centre is non-functional.
IDSP Portal: The IDSP portal is a one stop portal (www.idsp.nic.in) which has facilities for data entry, view reports, outbreak reporting, data analysis, training modules and resources related to disease surveillance. About 90% of Districts are now reporting disease surveillance data in portal.
ICT component during 2010-2012 (restructuring & extension of IDSP)
The restructuring and extension of IDSP by two years (2010-2012) was agreed with the support of World Bank for CSU and nine States. However, the World Bank disagreed to reimburse the entire expenditure incurred by NIC and ISRO as a part of the restructuring exercise; and it only agreed to fund for the following ICT related activities, provided there was a direct contract between IDSP and the agency:
Call Centre Services (provided by private vendor M/s vCustomer)
Broadband Services (provided by MTNL through NIC)
Manpower - Data Managers and Data Entry Operators (provided by NIC)
Annual Maintenance Contract for the equipment provided by NIC and ISRO
Also, IDSP decentralized some components of the MoU to the States respectively:
BSNL broadband bill payment (which was earlier paid by NIC centrally) w.e.f 01.07.2010
Manpower - Data Managers and Data Entry Operators (which were earlier recruited and paid by NIC centrally) w.e.f 01.07.2010
IDSP signed a direct contract with vCustomer Services India Pvt. Ltd. (toll free call centre services) w.e.f 01.11.2010, which was earlier run and paid completely by NIC.
Annual Maintenance Contract of the equipment provided by NIC w.e.f 01.07.2011.
Issues and Challenges:
Indian Space Research Organization: ISRO’s EDUSAT network was down since September 2010, due to which VSAT based training Programmes and video conference sessions were not being held. The migration activity from GSAT-3 to GSAT-12 is under process and is likely to be completed soon. The remaining 33 VSAT sites could not be installed due to various reasons such as permission not granted to install the In-Door Unit equipment at few sites, space not allotted/are under construction/shifting needs to be done; equipment (like Sony Handy camera, amplifier, speakers) is either lost, damaged or missing after its delivery, etc.
Getting the Annual Maintenance Contract for all the VSAT sites itself is a challenge as the network is down since September 2010. There are various sites where many of the equipment may not be functional and before getting the AMC for all the sites IDSP has to get these equipment replaced. Since, VSAT equipment are costly and proprietary in nature and there are chances that this technology will be having compatibility issues now as Microsoft had already ended the support for Windows XP and changing the Desktop will create the compatibility issue with ISRO’s Teacher and Student Application. IDSP needs to explore the latest in technology to sustain the ICT activity specially for VC and distance learning purpose.
National Informatics Centre: 20 Data Centre sites in the states of Bihar (18), J&K (1) and West Bengal (1) and 13 Training Centre Sites in the states of Bihar (9) and Jharkhand (4) are yet to be installed.
Upgradation of ICT infrastructure for Data Centre is also important as Training Centre of ISRO
Pilot project on SMS-based Disease Surveillance System
In August 2008, Andhra Pradesh started the innovative SMS-based disease surveillance system as a pilot project in six of its 23 districts, with the objective to overcome administrative and operational challenges like lack of manpower, irregular supply of logistics, distant and remote reporting site locations, resource crunch, etc. The system was designed locally at the state level by the collaboration of State Directorate of Health Services and the National Informatics Center – State Cell at Hyderabad. The system used simple alpha-numeric codes to collect information of the prescribed IDSP formats from the reporting units across the state. SMS was sent to a central server at the state capital (NIC). Every reporting unit was identified with a unique identification number and SMS were accepted only from registered mobile numbers. The central server sent out automatic alerts to registered mobile numbers of concerned officials whenever the frequency of particular events crossed the pre-set threshold levels. Health workers in 3,832 health facilities across the six pilot districts used this system to send IDSP reports.
External evaluation of the system was done by IIPH-Hyderabad (PHFI) in five pilot districts in 2009-2010. The evaluation report concluded that “SMS based system can be used an enabler to enhance the overall efficiency and effectiveness of the IDSP but with clearly laid policy directives, system deployment guidelines, systematic training plans and adequate provisioning for resources required to run the SMS based system smoothly.” Many other operational and technical challenges were brought out including the logic of diverting resources from current IDSP implementation activities at a stage when IDSP itself is yet to stabilize. It was discovered that data from field was compiled at the PHC level and then sent through SMS. This defeated the purpose of capturing data from field through SMS. The State was accordingly advised to undertake the exercise in one block in such a way that data are sent by workers in the field itself and also to undertake a cost-benefit analysis of the entire exercise including listing all problems and their possible solutions
In the current era of ICT there are latest technologies which can be utilized for getting the reports instantly using the mobile technology. The option can be explored for L form initially and then may be followed with P Form using the Android/Windows/iOS applications.