Kerala is a small state in India, having a population of only 34 million (2011 census) but with excellent health indices, human development index and a worthy model of decentralised governance. Integrated Disease Surveillance Program, a centrally supported surveillance program, in place since 2006 and have carved its own niche among the best performing states, in India.

Panchkroshi yatra is an annual ritual of circumambulation (yatra) of temples (Mahadevs) and 100,000 devotees walk for around 15 miles per day for six days and cover a total of 73 miles to worship important Mahadevs. The festival is held every year at the city of Ujjain, Madhya Pradesh, Central India. The yatra attracts large number of pilgrims especially from rural areas and usually women outnumber men. During the yatra, the pilgrims halt at several places and prepare their food in outdoors.

The IDSP is the key indicator based surveillance system in the country to fulfill the core surveillance and response functions requirement under the IHR–2005. Periodic reviews of the IDSP in the country have shown that it has been ineffective in meeting its main objective of disease control in the country. Efforts are required to systematically identify and adequately address the factors affecting the performance of IDSP for it to achieve its objectives and ensure compliance to the IHR-2005 requirements for national and global health security.

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