Vision & mission Vision Mission Countries throughout the world have effective and equitable public health systems to protect communities and enable people to live healthy and productive lives Mission Working with Ministries of Health and public health partners, we are committed to strengthening public health systems and developing the workforce using solid science, innovative programs. We are also committed to building sustainable capacity to meet our partners’ national priorities Sustainable Partnerships in Global Workforce Developent

New Field Epidemiologist Training Program Resident Advisor Orientation August 8, 2011

Basic Agenda for the Two Days Two days of orientation Focus on role of RA, address expectations and concerns, and coordinate support from colleagues in Atlanta and the field Meet teams and partners Social Dinner Regional and country specific side meetings MENA team will be meeting on August 10th Egypt, Morocco and Iraq have set up side meetings with CDC partners Basic Logistics

Purpose of the Orientation Prepare and Empower Resident Advisors True Partnership in MOH-lead programs Clarity on the Role of Resident Advisors Quality and Impact

Overarching FETP Goals Increase the access and reach of FETP All low income countries should have access to a FETP Achieve 1 trained field epidemiologists per 200,000 people globally Continually strive to maintain/improve FETP quality Examine new areas for collaboration Utilize the added value of FELTP to address current and emerging global health concerns including NCDs, MCH, malaria and others Find sustainable regular funding for FELTP Examine new possibilities of funding mechanisms and sources Share lessons learned and best practices with global community Regularly publish and document results (min 25 peer-reviewed articles a year)

Pyramid of Public Health System Preparedness from Public Health’s Infrastructure: A Status Report, CDC 2001

FE(L)TP Overview Modeled after CDC’s Epidemic Intelligence Service Two-year, full-time postgraduate training program Supervised, on-the-job, competency-based training About 25% class work, 75% field placement Assigned to positions that provide epidemiologic service to MOH Graduates may receive a certificate or degree

Critical Outcomes A robust surveillance system is established and used effectively Public health events are detected, investigated, and responded to quickly and effectively Human capacity is developed in applied epidemiology and allied areas Public health decisions are driven by the scientific data

Current FELTP

FE(L)TP FETP that also trains laboratory scientists Fosters linkage between epidemiologists & laboratory scientists Enhance communication Lab-based Surveillance Build quality laboratory networks Examples: Kenya, Central Asia, Pakistan, South Africa A Field Epidemiology & Laboratory Training Program (FELTP) contains all the components of a traditional field epidemiology training program, plus trains select laboratory scientists using a competency-based curriculum that supports laboratory-based surveillance & outbreak response. This initiative is meant to foster collaboration & linkage between epidemiologists & laboratory scientists & the building of quality laboratory networks. Examples of FELTPs that DGPHCD supports are Central Asia, Kenya, South Africa & Pakistan. In Kenya, for example, both laboratory scientists & epidemiology trainees receive training in the basic concepts of biostatistics, epidemiology, field investigations, & management. The epidemiology residents are assigned to work in the Ministry of Health, in the collection & analysis of surveillance data, & in response to requests for epidemiologic assistance that come from provincial & local health authorities. The laboratory management residents are assigned to work in a laboratory such as the National PH Laboratory. During the two years the epidemiology & laboratory trainees share common courses & work side-by-side to respond to PH emergencies & build PH surveillance systems.

Evolution of an FETP In development (1 to 2 years) Bangladesh Botswana Active support (2 to 7 years) China Pakistan Independent Philippines Thailand Zambia Angola Central America Central Asia Some examples from each stage Brazil Zimbabwe

Country (MOH) Participation Provide access to surveillance systems & data Identify priority areas for planned investigations Provide support for investigations Clearly delineate trainee duties Provide administrative facilitation Provide counterpart with dedicated time Develop career structure for graduates

CDC Contribution Expertise in Applied epidemiology program development & implementation Curriculum development Training Evaluation Technical assistance from a multidisciplinary team Resident advisor placed in country for 4 to 6 years Linkages to other CDC experts in country’s disease priority areas Facilitate networking with other FETPs around the world CDC’s role in the development of an FETP is providing expertise in applied epidemiology program development and implementation, curriculum development, training, and evaluation.  CDC provides this expertise through a multidisciplinary team based in Atlanta and a resident advisor who is assigned to the Ministry of Health for 4-6 years.  The CDC team can provide linkages to other CDC experts in the countries disease priority areas and facilitate networking with other FETPs. 

FE(L)TP Services to MOH Detect & respond to PH emergencies (i.e., outbreaks, disasters, emerging infections) Enhance disease surveillance systems Analyze routinely collected data Conduct surveys, field studies, & evaluations Develop new or strengthen existing systems Communicate PH findings & recommendations Oral presentations & written publications Publish epidemiologic bulletin Conduct seminars & training for others Even though assigning trainees for 2 years to this program is a big commitment for ministries of health, the FETP & the trainees provide a number of services to the Ministry of Health throughout their training including outbreak & disaster response, enhancing disease surveillance systems, communication & recommendations of PH findings to guide interventions, & training for others.

FE(L)TP Key Features Country ownership of program Program tailored to country needs & priorities Resident advisor for first implementation phase Plan for sustainability Partnership enables additional collaborations with CDC & others In addition to the services that the trainees provide to the MOH, there are other key characteristics that distinguish FETPs from other training programs. FETPs are developed as ministry programs, not CDC programs. The program is located in the ministry of health & is tailored to the country needs & priorities. Because of the lack of expertise in the country in applied epidemiology at the beginning of the program, the CDC resident advisor plays a key role in the first phase of implementation. Tin the beginning, the resident advisor is responsible for most of the teaching & almost all of the mentorship & field supervision. This limits the number of trainees in the early cohorts. As the program progresses, FETP graduates can be identified to take on some of these roles & more trainees can be added. Because this is a ministry program, the goal is for CDC to provide enough technical assistance & support for the ministry to be able to conduct the program on their own within 4-6 years. Finally, the CDC team members working with the ministry can identify needs for additional expertise & facilitate collaborations with other experts at CDC or elsewhere.

Competencies & Curriculum FE(L)TP Training Competencies & Curriculum

Core Competencies 1 Epidemiologic Methods 2 Biostatistics 3 PH Surveillance 4 Laboratory & Biosafety 5 Communication 6 Computer Technology 7 Management & Leadership 8 Prevention Effectiveness 9 Teaching & Mentoring 10 Epidemiology of Priority Diseases & Injuries This table shows a list of the core competencies identified for applied epidemiology In some programs, a laboratory management component is included.

Competency Development Process Achieving competency in field epidemiology Blended learning & measurable results OUTPUTS Outbreak report Surveillance evaluation report Data analysis report Study protocol Thesis Abstract Conference presentation Seminar Bulletin article Scientific manuscript Dataset Teaching summary report Project statement & work plan - Epidemiologic methods - Biostatistics - Surveillance - Lab & biosafety - Communications - Computer technology - Management & leadership - Prevention effectiveness - Teaching mentoring - Epidemiology of disease & injury The trainees achieve competency in these areas (highlight competencies) through a combination of formal instruction, field activities, and mentorship (highlight corners of triangles). Through their coursework, the trainees produce a variety of outputs, such as outbreak reports, abstracts, presentations, epidemiologic bulletin articles, and scientific publications. Together these components develop the participants’ abilities in PH surveillance, outbreak detection, and disease control, as well as strengthen an evidence-based culture for management of PH programs. Field Activities Mentoring

Different Models FE(L)TPs Certificate or degree Multi-country or regional programs Laboratory Component Other components Short courses and/or DDM Priority diseases - Infectious diseases - Chronic diseases Emphasis on surveillance systems development Not all FETPs are alike. For example, most offer a certificate but others offer a graduate degree (e.g., Masters in PH). Many programs are single country programs but a few take trainees from several countries within the region. Other programs composed of several national programs, but with a strong regional identity. Some programs supplement classroom training with distance/internet based technologies for delivering content. Some programs offer a laboratory strengthening component to improve the linkages between laboratory and epidemiology in the country and improve laboratory-based surveillance. Programs also differ in what kinds of other activities are implemented in addition to the FETP. For example, in some programs, short courses in epidemiology and surveillance are offered for community level workers. In others, courses are offered for ministry staff in management and leadership positions, such as our Data for Decision making program. While many countries identify infectious diseases as their priorities, many are recognizing the impact of chronic diseases like hypertension, diabetes and obesity, on the health of their people. Our field staff and applied training programs can respond to these chronic disease priorities, for example, by assisting the MOH in conducting BRFS (Behavioral Risk factor Surveillance) or improving mortality surveillance, as in Jordan. Key Message: Our applied training programs build human capacity in PH using slightly different models but always within the context of MOH priorities and PH systems development.

Central America FETPs Multilevel workforce development

Intermediate Epi Program EEA Pyramid Model Selection and career path FETP Mentorship Cascade EPi Continue Education Intermediate Epi Program EEA I’d like to focus now on our curriculum and the award winning pyramidal FETP model. This model was first pioneered in Guatemala by Augusto. In essence, in addition to the 2-year FETP program, there is a nine-month or FETP-lite program geared towards the intermediate level of the MOH, and a 5-month program geared towards to local level health personnel. It is competency based, in-service training w/ participants acquiring mastery in competencies that are designed with increasing levels of complexity throughout the pyramid. The lower levels of the pyramid supply a pool of highly qualified, advanced FETP candidates and a cascade of mentorship is available from the higher levels. In this slide we see the multiplier effect and the surveillance network that has been created in Guatemala using this concept----their effectiveness was proven in the response to Hurricane Stan where clearly the districts w/ pyramid graduates clearly outperformed those without them in the collection of critical surveillance data. This slide is a depiction of a model used in the Central America regional FETP. Different types of training are offered for different needs within the pubic health system. Shorter courses are given to larger numbers of workers at the community level on basic epidemiology: These are generally 5 months in length. A longer courses in field epidemiology is conducted geared to epidemiologists in health department at the district or provincial level. This course is integrated into an in-service field component complete with required CALs (core activities of learning), but less intensive than the FETP level. Finally a small number of selected epidemiologists are chosen to participate in the full, 2-year FETP. In Central America academic portion of the FETP has been accredited as a Masters Degree. Slide 53: Pyramid Model: Central America Example This pyramid model has several advantages. Reach larger numbers of public health workers that are on the front line Each level of the pyramid can serve to identify workers who may be ready for the next level of training―so there is a higher quality of trained personnel entering each level. Trainees at the higher levels can provide mentorship for the workers at the other levels―this is referred to as a mentorship cascade. The pyramid model gives countries options, particular for poorer countries that may not have resources or qualified health personnel to start right away at the most advanced level. In addition, as is being implemented in Central America; the competencies are developed vertically in an integrated manner, i.e. building block approach. Health personnel at EEA and CEAL are generally likely to stay within the MOH for a long time. They go back and form the human infrastructure for the national surveillance system. Basic Epi Program CEAL 80% Field, 20% Classroom (modules) FETP: Field Epidemiology Training Program EEA: Specialization in Applied Epidemiology CEAL: Applied Epidemiology at Community Level

China FETP Growing influence The china FETP, C-FETP, in 2001 by China CDC. Since then , C-FETP officers and staff have played major roles in China’s surveillance, epidemiological investigation, and response activities. Over the past six years the C-FETP has conducted about 50 investigations a year on a wide range of public health problems. The China FETP is growing and we have a second CDC epidemiologist assigned to the FETP.

CFETP Graduates Currently Hold Key Positions Throughout the China CDC System 1 Deputy Director of Emergency Response Division 1 Section Chief of Respiratory Diseases 1 Section Chief of Zoonosis Diseases 8 China CDC 1 Section Chief of Disease of Unknown Causes 2 Health Education, HIV/AIDS Dept. 2 CFETP instructors 6 Division Director 11 Emergency Division 5 Vice Director 34 Provincial CDC 6 Director 17 Disease Control and Prevention 4 Vice Director 5th cohort graduates not included 6 EPI or other areas 7 Technical Lead

Branch Overview Branch supports 28 FETP/FELTPs in 47 countries 7 regional programs, 11 FELTPs 55 Staff members 29 Resident Advisors 26 HQ Staff 8 Epidemiologists/1EIS Officer 9 PHAs 4 Instructional Designers 2 Program Analysts 2 Heath Scientists

Regional Teams