Developing Epidemiology

Workforce Through FELTP as

Critical Needs for Networks :

Lessons Learned and Next Steps

Dr Patrick M Nguku

1

Field Epidemiology & Laboratory

Training Program (FELTP)

• Closely supervised competency-based training

• US CDC Epidemic Intelligence Service (EIS)

• Pyramidal approach

– Two year full-time postgraduate training

– Intermediate and frontline

– Other modular /thematic approaches

• About 25% class work, 75% field placement

• May receive a certificate or a degree

• Aims at developing public health systems 2

Frontline Field Epidemiology

• Targets surveillance officers at district level

• Aims at improving surveillance, investigation, data

analysis and use

• Supports IDSR /IHR capacities

Workforce

Systems

Institutions

Culture FELTP

Public health system

Requirements of an Effective

Surveillance • Surveillance is the backbone of disease control

• Prerequisite for success of implementation:

• Well trained network of motivated staff

• Clear standardized guidelines and tools

• Networked and functional laboratory

• Communication means

• Rapid response and feedback

• Sustainable funding5

Competencies Required to Operate an Integrated Disease Surveillance and Response System

Source Perry et al, BMC Medicine, 2007

FELTP in Africa

• Over 1500 trained or in

training in 16 countries

•Support to IDSR /IHR

•Multi-disease

surveillance

•Response to

numerous outbreaks

•Research

•Networking

•AFENET

•One health

•Disease specific

•HIV

•Polio

• Ebola

•Noncommunicable

7

African Field Epidemiology Network (AFENET)

• A non-profit organization

and networking alliance dedicated to helping Ministries of Health in Africa build strong, effective and sustainable programs and capacity to improve public health systems

• Network of Field

Epidemiology and Laboratory Training Programs (FELTPs) in Africa

8

Vision

A healthier Africa

Mission

Committed to ensuring effective prevention and control of epidemics

and other priority public health problems in Africa

Objective

• To strengthen field epidemiology and public health laboratory capacity and, effectively contribute to addressing epidemics and other major public health problems in Africa

AFENET’s Footprint 2016• Operations in 30 African

countries including;

– Anglophone, Francophone and Lusophone countries

1. Advanced FELTPs: 16 Field Epidemiology

Programs– Angola, Central Africa,

DRC, Ethiopia, Ghana, Kenya, Mozambique, Nigeria, Namibia, Rwanda, South Africa, Tanzania, Uganda, West Africa, Zambia, Zimbabwe

9

FE(L)TPs in Africa

AFENET’s Footprint 2016

2. Frontline FETPs

• Benin, *Burkina Faso, *Cameroon, Cote d’Ivoire, *DRC, Gambia, Guinea, Guinea Bissau, *Kenya, Mali, Mauritania, *Nigeria, Senegal, Sierra Leone, *South Africa, *Tanzania, Togo, and *Uganda

*Countries with established FELTPs

10

Paradigm shift – Training

based service to service

based training

12

Enumeration outreach among underserved, Aug ‘12- April ‘15

No. LGAs visited

Totalsettlementsvisited

U5yrs children enumerated

U5yrs childrenmissed previous IPD (%)

Zero-dose U5yrs children (%)

375 67887 1,642,923 139,500 (8.5) 99623 (6.1)13

FELTP Support to HIV Service Delivery

• Data quality assessment & improvement– In-depth site level assessment for quality and

accuracy of data collection and reporting

– Facility level data validation

– Data quality improvement plan

• HIV Impact Assessment at sub-national – Describe the HIV epidemic; assess the access to,

use of and impact of ART, PMTCT, and HIV

– Measure HIV-related risk behaviors

• ART outcome evaluations

• PMTCT cascade evaluation 14

434

830

1532

234

6310

5521

55

222

Diethylene GlycolChlorine poisoning

Methanol poisoningLead Poisoning

MeaslesAcute Flaccid Paralysis

DiptheriaMumps

Meningococcal MeningitisHepatitis

CholeraRabies

Lassa FeverTrypanosomiasis

LeptospirosisDengue Fever

EbolaSchistosomiasis

LeishmaniasisBuruli ulcer

En

viro

me

nt

al

Va

ccin

eP

rev

en

tab

le

Wat

er/

Fo

od

Zo

on

ose

s/V

HF

Tro

pic

al

Dis

ea

ses

Outbreak investigation & response activities of the NFELTP:

2008 - 2016 (N=243)

Reduced response time

Containment

Less number of

cases/deaths

Noncommunicable diseases

and injuries • STEPwise approach to noncommunicable

disease risk factor surveillance (STEPS)

– Questionnaire

– Physical measurements

– Biochemical measurements

• Road traffic injuries

16

Jan

20

06

Formation of

National Influenza

Taskforce

(NIT) in response

to global H5N1

threat

De

c 2

00

6

Au

g 2

00

8

NIT Responded

to RVF outbreak

as RVF Task

Force – NIT

Renamed ZTWG

ZTWG starts

quarterly

meeting

Se

pt

201

0

Multi-sectoral

workshop to

discuss

formation of OH

Office

MOU signed to

form ZDU

Au

g 2

01

1

Epidemiologists

from MoH & MALF

deployed to ZDU

Mar

201

2

Oc

t 2

01

2

Official opening of

ZDU and

launch of OH

Strategic Plan

17

Environmental Health Disasters

Key Lessons Learned

• Epidemiology workforce development has to be

integrated within the existing public health

system

– Relevant to existing public health challenges

– Within existing national HRH plans

• Service/needs driven

• Multi-disciplinary / multi-sectoral approach

• Deliberate efforts to cover all sub-national

levels

– number per population or administrative unit

– Database , networking , quality / accreditation

• Supportive public health structure – retention,

deployment , tools for working, technology

Use of data to guide interventions that benefit populations more efficiently is

precision public health.

1. Register births and deaths- civil registration, vital statistics,

mortality surveillance

2. Track diseases – IHR framework

3. Incorporate laboratory analysis

4. Competent skilled workforce