Effective communicable and non-communicable disease control relies on effective surveillance and response system. Information on priority communicable and non-communicable diseases is a key part of public health decision-making in the country. Disease surveillance is a critical component of health systems, providing essential information for optimal health care delivery, and cost effective strategies. In some cases large number of data on health events are collected, many of which do not constitute priorities for the country. Sometimes detection and reporting of cases and outbreaks are not carried out in time. Also analysis, interpretation and use of available data at all levels for decision-making and follow-up are not properly carried out.

The health services of the government of Bangladesh feel it necessary to have a comprehensive and quality reporting system of priority communicable and non-communicable diseases that are occurring nationwide. Timely reporting of cases and deaths helps the policy makers to formulate strategies for appropriate intervention, control and prevention of communicable and non-communicable diseases. Setting up of a nationwide surveillance for diseases could provide important findings in the pattern, trend analysis and proper management of cases and averting of deaths. This could also provide an early warning for any impending outbreaks and its containment in time.

At the Upazila (sub-district) and district level, weekly and monthly reporting system exists from filed to Upazila Health Complex (UZHC) which is supposed to be maintained in UZHC's monthly disease profile. These reports are sent to the district level at weekly and monthly intervals. However, these reports are not properly validated and intervened to find statistical significance of diseases and their course. The DGHS control room at the

DGHS office is responsible to collect report from the districts throughout the year, and so are the Civil Surgeons (C/S) control rooms in the district from the Upazila but they are only operational during disease outbreaks. It is thus apparent to improve the functioning of the control room to an acceptable level, so that, this can provide relevant information during important times.

Severe Acute Respiratory Syndrome (SARS) is the first readily transmissible new disease to emerge as a serious threat to international public health in the 21st Century. The disease has wide ranging social, economic, political and many other repercussions. It has proved to be an extremely demanding effective surveillance system to detect case rapidly and mount an adequate response with essential supplies and equipment into the country and ensure adequate monitoring and reporting. The current experience regarding the global pandemic of SARS has clearly highlighted the importance of preparedness in anticipating new emerging or reemerging infectious diseases by strengthening of surveillance for communicable diseases including HIV/AID/STI and Dengue fever for an effective intervention in the country.

A functional disease surveillance system is useful for priority setting, planning, resource mobilization and allocation, prediction and early detection of epidemics and monitoring and evaluation. There is now a keen intention to increase the capacity of IEDCR in carrying out Epidemiological surveillance's of communicable diseases with laboratory support integrated with non-communicable diseases for which specialized and related biomedical departments manned by enthusiastic qualified and experience scientists are available in the Institute to make IEDCR to be the apex Institute for epidemiological surveillance of the country.
The Directorate General Health Services (DGHS), through effective surveillance by the NDSP, is eager to improve and strengthen the existing government reporting system through establishing different sentinel surveillance post in the country, for priority communicable and non-communicable diseases, right from the grass route (ward, union and upazila) levels to the district and central level. These valuable data and its scientific interpretations at the DGHS will help the policy makers to identify and formulate developmental plans on public health importance.

The National Disease Surveillance Centre (NDSC) is a component of the National Disease Surveillance Program (NDSP) and the other components are the Sentinel Surveillance Post (SSP) at the Districts, Rapid Response Team (RRT) at National and District level, strengthening laboratory support for surveillance and etiological search out for causative organisms, organise training for different categories of health personnel, publication of quarterly health bulletins and to disseminate information on epidemiology and related health matter, which will improve the overall capacity of the institute.

The NDSC is an initiative of the DGHS, which is organized and run by the Director, IEDCR, who is provided the space, manpower and epidemiological support to make significant impact and enhance the potential of IEDCR to take the active role as part of the mandates of this institution, in communicable diseases surveillance integrated with non-communicable diseases, perform related research, forecast and respond to disease outbreaks in Bangladesh as a national institute. This will improve the technical and managerial capability of the institute and will ensure smooth functioning. The Director, Disease Control, DGHS will remain responsible for collection of reports timely from the whole country in order to support ideal functioning of NDSC. Confidentiality will be maintained regarding all information gathered from various sources and from the surveillance.
The NDSC is setup at the IEDCR, a room (room # 5, ground floor) with the technical and logistic support from WHO. The centre is equipped with computers, electronic mails, and telecommunications facilities, to receive and send reports and outbreak information to and from the sentinel posts, districts and central level, for collecting quick information and reports regarding morbidity and mortality of common and emerging and reemerging communicable and non-communicable diseases. All weekly information that is at present, being sent from the Upazila and district levels, will be at first physically checked for compatibility and consistency before entering into the computer. Using database package, frequency distribution and trend analysis of the reporting of morbidity and mortality will be carried out. This will strengthen the epidemiological surveillance system of MOHFW and DGHS in the country, as well as to forecast of impending outbreaks.

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Sentinel posts will be setup for improving existing reporting system. The establishment of post will be done in phases. During the first year, 20% of the districts (12) of the country will be taken up, followed by 20% of the district each year, which will strengthen Nation wide disease surveillance. The sentinel posts will be selected from the 2-3 districts of each division (in total 12-13 per year), and will include all the Upazilas of the selected district. Thus, in next 5 years time, all the districts will come under this network and surveillance data for both communicable and non-communicable will be available for the whole country.

The UH&FPO will head the surveillance with overall responsibility and will provide administrative support to the sentinel post in upazilla level. He will assign one of the Upazilla Health Complex (UZHC) Medical Officers (MO), preferably in charge of Disease Control to assist him for this purpose. The MO will maintain all records of morbidity and mortality report of Out Patient departments (OPD), In-patient department departments (IPD), and Emergency in the UZHC. He will collect, validate, compile and record all information regarding inpatient cases and deaths in a separate register. All the health complex's physicians will assist him in clinical as well as sample collection for laboratory diagnosis. He will also monitor and keep records of diseases occurring in the community by checking the field reports prepared by the UZ health statistical officer, Health Inspectors (HI), Assistant Health Inspectors(AHI), and health assistants (HA) for reporting of morbidity and mortality of cases. At the end of every week, all these reports from the sentinel posts will be sent to the district Civil Surgeon's (C/S) office.

The Civil Surgeon will head the surveillance at the district level and will designate a Medical Officer, who will be overall responsible for the reporting and recording of the cases and deaths received from the UZHC, and will send the reports to central level, at the DGHS "National Disease Surveillance Centre (NDSC)'', at weekly intervals. In case of any new disease occurrence or during the outbreak season, daily reporting from the field, upazilla and district level, to central level will be maintained.
In the C/S office, a Control room that already exists at the district level remains non-operational throughout the year except in the epidemic periods. Keeping it operational throughout the year will enhance the activities of the C/S control room in the district level, so that all these information that are being received from the upazilla level, are sent to the central level (NDSC) in due course of time.

Central level:
The NDSC is the central level and key centre for all kinds of disease surveillance. All the daily, weekly or monthly reports from all levels will be received, validated and will be entered into the computer for frequency distribution and trend analysis of the repotting of morbidity and mortality of cases. This will strengthen the epidemiological surveillance system of MOHFW and DGHS in the country, as well as to forecast of impending outbreaks.

Rapid Response Team (RRT)
The DGHS feels it necessary in establishing of Rapid Response Team (RRT) at the District and National level for strengthen the activities of the government medical teams to ensure timely interventions and investigation of disease outbreaks in the country. National level RRT is established at IEDCR and District level RRT is established in all the 64 districts in the country. Seasonal outbreaks of dengue fever, malaria, and watery diarrhea along with other communicable diseases need active intervention at the field level for quick management and prevention. The RRT members will be providing with intensive training on need assessment, epidemic investigation, intervention and etiological search during disease outbreaks.

The Director, IEDCR is organizing training for RRT members at the national level in IEDCR and for the District RRT members at 64 districts in the division regarding outbreak investigation and response. The Director will be also organized training for the different categories health personnels at the selected sentinel districts to develop proper reporting system and smooth functioning of the sentinel sites. The objectives of the training will be on importance of disease surveillance, epidemiology of diseases, analysis of reports and emergency response to disease outbreaks. During this training session, team members are expected to examine the data collection tools and get a clear and common understanding of the questions and what exactly to look for while collecting surveillance reports.

Diagnostic facilities are critical to support surveillance. Laboratories are essential to disease surveillance and most epidemiological surveillance systems require a laboratory component for confirmation. These serve both for the routine confirmation and for rapid confirmation of the causative agents, culture and antibiotic sensitivity pattern of diseases, during the outbreaks. Quick laboratory diagnosis will expedite the clinical diagnosis and treatment. It is proposed that at the surveillance districts, hospital laboratories will be provided with diagnostic supports. The quality of government medical laboratories in the district levels needs to be improved to support surveillance.

A quarterly health newsletter and an annual report will be published by the NDSC to provide important information regarding recent outbreaks and disease burden. This will enable the health professionals in understanding the disease epidemiology and formulating plans for investigation and intervention into outbreaks of diseases.

The WHO Bangladesh is extended all technical and logistic support to the initiatives of DGHS. Under the guidance of the WR, Bangladesh, all the 4 National Professional Officers (NPO) will be actively involved and collaborate to strengthen all these activities of the DGHS. They will train the government health personnel in different categories in proper reporting and analysis of data and in collaboration with Director Disease control, DGHS, will advice and monitor the reporting system, surveillance program activities at the district and upazilla levels and medical team's activities through field visits. The NPOs will assist the DGHS in preparing and conducting training program for the central, district and upazilla level health personnel and in publishing a quarterly health newsletter.

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