In 2013, the Honduras Ministry of Health (MoH) began implementing a new healthcare model that enhanced early detection and response to vector-borne diseases and chronic diseases, strengthened workforce capacity and improved health equity.  With the support of the U.S. Centers for Disease Control and Prevention (CDC) to strengthen workforce capacity, the MoH established Frontline training within the Honduras Field Epidemiology Training Program (FETP). “FETP provides frontline public health professionals with basic training in surveillance, outbreak detection and response, and data management for decision-making. The training is primarily offered to public health professionals working at the local or district level where access to training in health surveillance and epidemiology may be challenging,” said Edith Rodriquez, former Chief of Surveillance and FETP graduate of the 1^st Cohort. Such is the case of the Honduran department (state) of Gracias a Dios. Although it is the second largest department in size, its population is sparse due to its complex geography.

Challenges to building Capacity in Gracias a Dios

Gracias a Dios has geographical, technical and language barriers that present multiple challenges to building workforce capacity and improving health equity. For example:

• The area has extensive pine savannahs, swamps, and tropical forests. Gracias a Dios is facing deforestation, rapid expansion of agricultural lands and unplanned urbanization that increases human and wildlife contact and is the perfect scenario for a spillover event. This makes increasing outbreak detection and response capacities a priority.
• Limited resources to transport public health workers by sea or land to receive training, severely impacts the number of public health officers trained in outbreak detection and response under a centralized, decentralized, and mixed management model, and poses a threat to human populations and global health security.
• The geographical complexity of the region makes internet connectivity nonexistent, and epidemiological training through electronic virtual platforms impossible.
• The population in Gracias a Dios is primarily composed of indigenous Miskitos, many of whom are poor, lack access to basic human needs such as education, food and health services and do not speak Spanish.

Collectively, these issues posed tremendous challenges to building workforce capacity and made it difficult for Spanish-speaking trainers from other parts of Central America who do not speak the indigenous language to effectively communicate with this population, build workforce capacity and improve health equity. The indigenous communities of Honduras include Mayans, Garifunas and Miskitos.

Impact of FETP Frontline in Gracias a Dios

Establishing FETPs contributes to building health equity, as well as building a country’s capacity to prevent, detect, and respond effectively to public health threats and advance global health security. In 2023, The Honduran MoH Department of Epidemiology, launched the fourth cohort of FETP Frontline in Gracias a Dios thereby increasing the number of field epidemiologists trained in FETP Frontline and Intermediate tiers from 0 to 18.  The fourth FETP Frontline cohort alone trained 18 health professionals from different municipalities and hospitals within Gracias a Dios and was able to: 1) describe the surveillance systems and outbreaks in the department, especially of Malaria, a vector-borne disease that is endemic in several municipalities, 2) present this work at the 11th TEPHINET Global Scientific Conference held in Panama City in September 2022, and 3) have four FETP residents successfully enroll and complete Intermediate-tier training. These FETP graduates are now part of the team of tutors that continue to train other FETP Frontline public health workers in Gracias a Dios. A new cohort of FETP Frontline workers in Gracias a Dios began training in July and will graduate in September 2023.

Moving Forward

Implementing FETP in challenging geographic areas like Gracias a Dios in Honduras allowed health personnel to access to FETP trainings that would otherwise have been impossible. “Through FETP Honduras, we can now serve the Miskitos, Maya and Garifuna indigenous communities, as well as the general population, regardless of their ethnicity, ensuring that the field epidemiology profession is inclusive and accessible to all,” said David Rodríguez-Araujo, medical epidemiologist, Executive Secretariat of COMISCA (Council of Health Ministers of Central America and Dominican Republic).