India has long experienced one of the highest burdens of infectious diseases in the world, fueled by factors including a large population, high poverty levels, poor sanitation, and problems with access to health care and preventive services. It has traditionally been difficult to monitor disease burden and trends in India, even more difficult to detect, diagnose, and control outbreaks until they had become quite large. In an effort to improve the surveillance and response infrastructure in the country, in November 2004 the Integrated Disease Surveillance Project (IDSP) was initiated with funding from the World Bank. Given the surveillance challenges in India, the project seeks to accomplish its goals through, having a small list of priority conditions, many of which are syndrome-based at community and sub center level and easily recognizable at the out patients and inpatients care of facilities at lowest levels of the health care system, a simplified battery of laboratory tests and rapid test kits, and reporting of largely aggregate data rather than individual case reporting. The project also includes activities that are relatively high technology, such as computerization, electronic data transmission, and video conferencing links for communication and training. The project is planned to be implemented all over the country in a phased manner with a stress on 14 focus states for intensive follow-up to demonstrate successful implementation of IDSP. The National Institute of Communicable Diseases chosen to provide national leadership may have to immediately address five issues. First, promote surveillance through major hospitals (both in public and private sector) and active surveillance through health system staff and community, second, build capacity for data collation, analysis, interpretation to recognize warning signal of outbreak, and institute public health action, third, develop a system which allows availability of quality test kits at district and state laboratories and/or culture facilities at identified laboratories and a national training program to build capacities for performing testing and obtaining high quality results, fourth, there must be a process established by which an appropriate quality assurance program can be implemented and fifth, encourage use of IT infrastructure for data transmission, analysis, routine communication (E-mail etc) and videoconferencing for troubleshooting, consultations and epidemiological investigations. These five activities must be addressed at the national level and cannot be left up to individual states/districts.