Formulation of Disease Surveillance Policies in India

Disease surveillance in India progressed from the status of isolated pilot projects or being included with vertical disease control programmes towards a nation-wide integrated disease surveillance programme over the course of fifteen years from 2000-15. This studyexamines the process through which disease surveillance captured popular attention and attained the status of a national programme. I found that recent national surveillance programmes preceded by long list of overlapping state and national level experiments, conducted by a relatively small number of actors spread across the country. Most surveillance initiatives merged as a result of either a precipitating event and required the presence of one or more strong champions who could help develop a consensus about the need for such a programme and were able to maintain the political commitment required for sustaining such an initiative. The '‘evolution’ of disease surveillance policies not unidirectional; rather it is chaotic process influenced by multiple organizational interests’ at different levels and times. The advocates for differnt approches didn't necessarily have to be louder to be heard, but closer to the decision makers. A disempowered national technical leadership meant htat the other technial institutions such as international agencies were able to step in and influence the policy process. Interestingly, the pPower dynamics observed between international technical & donor agencies with national authorities were similar in many ways to those observed in the interaction between central/federal agencies with local state level authorities.