Private sector participation in disease surveillance IDSP training module for state and district surveillance officers Module 4

Learning objectives List the reporting units involved in surveillance in the Integrated Disease Surveillance Project in your district  In public and private sectors  In rural and urban area List the key functionaries in reporting units responsible for surveillance related activities and describe their roles Fill the specific reporting formats without error from various reporting units Draw a flow diagram of the process and dynamics of timely flow of information

Involvement of the private sector in the Integrated Disease Surveillance Project Challenges Managerial Leadership Patience Perseverance Outcome Better surveillance Early outbreak detection Better control over health problems

Topics discussed Need for private sector participation How to initiate partnership Criteria for selection Data collection Surveillance sensitivity Integrating private sector Sustaining partnership

Need for private sector participation in disease surveillance Most patients (>70%) go to private sector Private physicians are the preferred first contact Private sector is more likely to detect early warning signs of outbreak Lack of public sector service provider especially in urban areas

Initiating partnership MOU (memorandum of understanding) with IMA/IAP/other professional bodies National/State/District level Training

Criteria for inclusion Reporting units  Hospitals  Nursing homes  Clinics Various systems of medicine Geographical distribution Involve professional associations  Indian Medical Association  Indian Academy of Pediatrics

Expected numbers of practitioners to include Rural areas  15-45/100,000 population Urban areas  15-30/100,000 population Increase the number in phases More private practitioners in rural areas

Increasing sensitivity Involving more private practitioners through rumour registry Give paid post cards to report any unusual trends/disease  No need for zero reporting

Integrating private sector: Role of the health inspector Supervision of every reporting site by a health inspector Regular visits  Once a week/fortnight Assistance to collate information from sentinel sites Provision of assistance to reporting sites

Data collection Only ‘probable’ cases  No laboratory confirmation More flexibility possible  Number of diseases  Mode of reporting Weekly reporting necessary Zero reporting mandatory

Sustainability Reimburse actual costs Provide support time Include name in network directory Ensure representation in the district surveillance committee Give feedback Provide Continuing Medical Education credits

Sustainability: The personal touch of the district surveillance officer Motivate Sensitize Educate Train Make them feel important

Summary Involvement of the private sector is crucial for effective surveillance The district surveillance officer has an important role in involving the private sector The human touch will make all the difference!

Leader “A leader is a person who has the ability to get other people to do what they don’t want to do, and like it.” Harry S Truman

Points to remember (1/3) State surveillance officer should specify the number and criteria for selection of sentinel private providers required in each state The district and state surveillance units will develop a master list of private health providers in each district using existing databases The district surveillance officer will finalize the list of sentinel private providers based on criteria through consultation initiated IMA and IAP Written understanding with each sentinel private providers must be ensured

Points to remember (2/3) The district surveillance officer will train all partners to ensure quality of reporting in the private sector State surveillance office will specify the role of Health inspectors / Leprosy inspectors in integration of sentinel private providers The district surveillance officer should distribute pre-paid post cards through sensitization meetings to wider groups of health providers in formal and informal sector to report unusual health events and changing trends of disease

Points to remember (3/3) The district and state surveillance units should ensure that partnership is sustainable and mutually beneficial by regular feedback, privacy, respect of partners and timely re- imbursements of costs and incentives The district and state surveillance units should ensure that internal and external evaluations of private sector is carried out in time and feed back provided to all stakeholders