During a virtual TEPHINET global teleconference on April 7, 2022, Field Epidemiology Training Programs (FETPs) in Colombia, Ethiopia, and Pakistan shared their experiences and the impact of institutionalizing their FETPs. Institutionalization is a key component of FETP development and critical to strengthening health systems as it ensures the full integration of FETPs into the organizational structure of a country’s Ministry of Health (MOH) or National Public Health Institute (NPHI).
Dr. Alden Henderson from the Workforce and Institute Development Branch (WIDB) of the U.S. Centers for Disease Control and Prevention (CDC) began the teleconference by introducing the FETP Institutionalization Matrix. This tool helps guide and assess FETP institutionalization by providing recommended indicators and timelines for programs to transition from CDC support to in-country government support.
During the teleconference, participating FETPs shared the steps they took to achieve institutionalization, including utilization of the seven indicators included in the Institutionalization Matrix:
- Organizational integration within the Ministry of Health (MOH) or National Public Health Institute (NPHI)
- Program oversight (Advisory Board)
- Strategic and work planning
- Technical support and staffing
- Management/administrative support
- Financial support
- Utilization of FETP by MOH or NPHI
Institutionalization of the Colombia FETP
Since its formation in 1992, the Colombia FETP has worked to institutionalize within the National Institute of Health (Instituto Nacional de Salud, or INS) branch for human talent training for public health surveillance. While the Ministry of Health and Social Protection regulates and directs the public health surveillance and response system in Colombia, INS takes on surveillance operations and public health laboratory research in the country, approaching complex health threats with a branched, leveled system that links data from hospitals, municipalities, and departments to INS and international organizations.
Over the last three decades, the Colombia FETP has taken a number of critical steps to achieve institutionalization, including becoming compliant with accreditation standards defined by TEPHINET, establishing a public health emergency operations center, leading epidemic and emergency responses, and strengthening academic activities, including promoting virtual learning and opportunities for field work. Under Colombian law, the FETP has also structured its courses and training to award diplomas, certificates of specialization, and master’s degrees in field epidemiology to the frontline, intermediate, and advanced level candidates, respectively. As of April 2022, the program has provided its public health workforce with about 750 qualified field epidemiology professionals.
Institutionalization of the Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP)
Increasing Ethiopian public health capacity requires human, financial, technical, and training resources. With national finance, governance, oversight, and support, EFELTP has been able to become successfully integrated within Ethiopia’s health system. Its current administration ladder includes an Advisory Council (AC) and a Technical Working Group (TWG) with representatives from the Ministry of Health (MOH), Ethiopian Public Health Institute (EPHI), and partner institutions. Since 2015, EFELTP has been expanded to eight Ethiopian public universities, and over the years, EFELTP residents have trained 4,500 public health officials, producing many field epidemiologists with advanced skills in applied epidemiology and laboratory management. Successful institutionalization of the EFELTP has increased national and regional capacity and competency in responding to public health emergencies. EFELTP has directly strengthened national surveillance systems, performing more than 1,100 surveillance activities and responding to more than 800 outbreaks of emerging and re-emerging infectious diseases like COVID-19, dengue, cholera and Ebola virus disease (EVD). By hosting various scientific conferences and giving more than 70 scientific presentations, the EFELTP has also improved the network of public health practitioners in Ethiopia and Africa.
Institutionalization of the Pakistan FELTP
With an approved, progressive two-year strategic plan, Pakistan FELTP began receiving financial, technical, and administrative support from the national health system in 2021. The successful institutionalization of the program has included a number of steps, as outlined in the CDC FETP Institutionalization Matrix, including organizational integration with the National Institute of Health (NIH), program oversight, strategic planning, and more. Since the program’s establishment in 2006, it has been housed within Pakistan’s NIH. In 2007, the program established a National Steering Committee consisting of representatives from the Ministry of National Health Services and provincial health districts to oversee the work and progress of the FELTP. As mentioned, technical, administrative and financial support have also been implemented, and FELTP graduation is required for most jobs at the NIH and CDC Pakistan. As such, the outbreak investigations and findings of Pakistan FELTP are frequently utilized and deployed by NIH. Over the last fifteen years, Pakistan FELTP has strengthened and empowered Pakistan’s public health workforce in the face of public health threats, including the recent COVID-19 pandemic.
Every country needs to expand its public health capacities to safeguard its citizens against health threats. FETPs have been enormously successful in training field epidemiologists to join the public health workforce and providing more than 160 countries worldwide with critically-needed public health and global health surveillance and security services. The pandemic has created even more demand for effective global health facilities and capacities. Integration of FETPs into national public health systems is a critical step to strengthening health systems and building the capacity countries need to respond to public health threats; however, the slow pace at which this occurs has been an ongoing barrier to progress in global health workforce capacity building. The Strategic Leadership Group (SLG) of the FETP Enterprise is currently working to accelerate the rate at which institutionalization occurs, one of the recommendations of the Global Field Epidemiology Roadmap. In the meantime, FETPs can utilize CDC’s Institutionalization Matrix to take clear steps to accelerate institutionalization and should work on enhancing advocacy with partner governments.