To safeguard and promote the health of its citizens, every country must have effective field epidemiology capacity. To that end, in 1980, the US Centers for Disease Control and Prevention (CDC) began supporting the development of Field Epidemiology Training Programs (FETPs) in countries throughout the world. This initiative has grown in importance since then, as many countries and regions with inadequate public health capacities face public health threats of increasing scope and complexity.
The FETP initiative has been enormously successful, such that after 38 years of steady investment by CDC, other US Government agencies, the World Health Organization, the European Union, individual countries, philanthropic foundations, and others, there are now 86 FETPs serving more than 160 countries throughout the world. While initially conceived simply as a training program producing field epidemiologists, over the years, it has become clear that the impact of the program is far greater, and more important, than the number of its graduates. The defining essence of the program today is the provision of critically-needed public health and global health security services, through a mentored, learn-by-doing approach that improves the effectiveness of the workforce and systems required to provide those services.
Participants at the FETP Roadmap Meeting in Bellagio, Italy.
However, as the number and variety of programs has grown, a variety of challenges to continued progress have emerged, including the slow pace of in-country institutionalization of the FETPs; program quality assurance; securing adequate, sustainable funding; assuring a career path for FETP graduates; specifying evidence-based targets for field epidemiology capacity; updating and enhancing the FETP curriculum and the larger FETP system; and mobilizing FETP graduates and fellows in support of international response to epidemics and other public health emergencies.
To provide an opportunity to address these challenges, the Task Force for Global Health convened a meeting of key leaders and partners (participant list) from across the globe working to develop effective global field epidemiology capacity. The meeting was held on June 11-15, 2018 at the Rockefeller Foundation Bellagio Center. The goals of the meeting were to craft a guiding, longterm vision of the global FETP initiative; clarify the roles and responsibilities of the various partners in this effort; harmonize the goals and expectations of funders and implementers; and assure effective in-country organizational integration and sustainable long-term funding for this global capacity-building effort.
The Vision of Our Global FETP Effort
After first reviewing the history of the FETP initiative and identifying current strengths and challenges, the group developed the following statement to serve as our guiding vision:
Every country in the world has the applied epidemiology capacities needed to protect and promote the health of its own population, and to collaborate with others to promote global health.
Defining the FETP Enterprise and Its Essential Functions
India EIS Officer conducting an immunization coverage survey in Alwar District, Rajasthan, India, October 2012.
The group also recognized that what had begun as a relatively small CDC grant program has now grown into a complex, multi-partner undertaking to improve public health and global health security by developing applied epidemiology capacity throughout the world. Consequently, the group developed a new, more comprehensive framing for this global partnership: the FETP Enterprise, defined as the totality of the leaders, funders, implementing partners, government agencies, and other stakeholders engaged in this global effort, along with associated workforce competency targets, standards, agreements, technologies, etc. that undergird this work. The group then specified a set of critical functions that the enterprise must perform to reach our vision.
These functions include (1) health system strengthening, through the learn-by-doing epidemiologic work undertaken for each country’s public health system; (2) education, training, and mentorship of FETP fellows, via provision of real -world experience in applied epidemiology; (3) mobilization for mutual assistance in response to international outbreaks and other public health emergencies; (4) management of specific epidemiologic and other projects that provide experience and deliver services; (5) quality assurance and improvement of FETPs; (6) institutionalization of FETPs into country public health systems; (7) program accountability; (8) monitoring and evaluation, including targeted operational research; and (9) strategic management of the overall FETP Enterprise, to sense and respond to needs and significant changes in the environment in which graduates work.
Recommendations for the Path Forward
In the Lukanga Swamps of Central Province, Zambia, the Zambia Field Epidemiology Training program responds to a cholera outbreak in the fishing camps located in the swamps. Community health worker, Mulenga, (in-back) administers an oral cholera vaccine to a fisherman along with Loveness Moonde (blue T shirt) and Patrick Kabwe (yellow shirt).
Keeping in mind the vision statement, the conceptual framing of the FETP enterprise, and the specification of critical enterprise functions, the group developed the following set of recommendations for action:
1. A broadly representative group of key partners and stakeholders should be explicitly tasked with the strategic management function of the FETP enterprise.
2. This Strategic Management group should identify needed changes in all aspects of the FETP enterprise, and adapt the system incrementally while preserving core principles.
3. The Strategic Management group should launch a process to develop applied epidemiology workforce targets at each level of a country’s need (basic [Frontline], intermediate and advanced), to assure the development of a workforce capable of achieving the public health and global health security capacities identified in the International Health Regulations of the World Health Organization (WHO). Finally, operational research should be initiated as soon as possible to evaluate and further refine these workforce targets.
4. The Strategic Management group should accelerate the institutionalization of FETPs in country ministries of health or other governmental public health authorities, through enhanced advocacy; explicit country planning for the transition from external support; technical support for transition planning (including securing of in-country funding); the development of clear workforce targets; integration of FETP into apex national public health institutes; and engagement of WHO to include and emphasize FETP in their normative policy guidance to countries with regard to their national health workforce.
5. The Strategic Management group should ensure there is a cadre of trained field epidemiologists who can contain an outbreak at the source and respond rapidly to an international public health emergency; and develop the framework needed to support cross-border mobilization of FETP alumni and fellows.
6. The Strategic Management group should continue and enhance efforts to assure and improve the quality of FETPs and the supporting FETP enterprise; and in particular, should continue and seek to expand the current FETP accreditation system.
7. The Strategic Management group should work to assure sustainable funding for the FETP enterprise. In particular, it should (a) sponsor an externally-commissioned, big-picture assessment of FETP effectiveness and impact, to develop a compelling, evidence-based narrative to support investment in applied epidemiology; (b) document the actual costs of the current FETP enterprise; (c) develop a mechanism for private sector contributions to support the FETP enterprise; and (d) improve efficiencies wherever possible.
Together with the vision statement, conceptual framing, and enterprise functional elements, we believe these seven recommendations comprise the roadmap to the future for the global FETP enterprise. This roadmap is intended to guide and coordinate the work of the many partners and stakeholders engaged in this effort. There is much work yet to do to build demonstrably effective applied epidemiology capacity throughout the world; but the goal is now clearly visible, and the path to success lies before us.
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