Spotlight on the Bangladesh Field Epidemiology Training Program
(Editor's note: This story originally was published in the 2018 Annual Progress Report of the TEPHINET Secretariat.)
Established in 2013, the Field Epidemiology Training Program (FETP) of Bangladesh is still in its beginnings as an organization. However, it has been quick to make an impact on public health in the country.
“Although FETP is a young program in Bangladesh, the country is learning the importance of having field epidemiologists very quickly,” says Mallick Masum Billah, TEPHINET technical consultant, who was also the program’s first graduate. “Through the work of our graduates, the FETP is becoming well-known. We find that we are creating a demand.”
Started in an effort to strengthen public health through training field epidemiologists in Bangladesh, the FETP is a collaborative initiative between the Institute of Epidemiology, Disease Control and Research (IEDCR) in Dhaka and the US Centers for Disease Control and Prevention (CDC). The program, which spans two years, is supervised by a steering committee headed by the Secretary of Health of the Ministry of Health and Family Welfare.
“In Bangladesh, the public health professional sector is not enriched with enough human resources or other support for the prevention and control of diseases,” explains Salim Uzzaman, a public health scientist with IEDCR, coordinator with the Global Health Security Agenda program for Bangladesh and course coordinator for the FETP. “To develop a strong public health sector, we need public health fellows who have graduated from the FETP with leadership and managerial skills. Not only can we use these fellows for outbreak investigation and response and for surveillance activities, but we can also use their learned skills in improving public health system management.”
Uzzaman notes that there is much work to do to address the many public health concerns in Bangladesh. FETP fellows are useful in communicable and non-communicable disease control programs.
“We have achieved a lot in the control of infectious diseases, but in a country like Bangladesh, due to its high density population and incidence of natural calamities, we still have many infectious diseases,” says Uzzaman. “In 2017, around one million people, Forcibly Displaced Myanmar Nationals (FDMNs), were in Cox's Bazar, Bangladesh, and they brought with them some infectious diseases like diphtheria, cholera and measles because they were not properly vaccinated for immunization. FETP fellows also participate in health risk assessment of the FDMN population. In the non-FDMN population of Bangladesh, we have had a re-emergence of cholera; we are yet to contain Nipah virus infection, and we have also had a re-emergence of measles outbreaks in many pockets of the country. We also have a challenge with safe water supply and preventive health education with different types of populations.”
FETP fellows, who are government physicians and veterinarians, are selected objectively based on their performance. The program provides both basic-level frontline and two-year advanced field epidemiology training to the chosen fellows with the goal of training and sustaining a highly skilled public health workforce in Bangladesh.
With such a large job ahead of them, FETP fellows benefit from the leadership and guidance of advisers provided through TEPHINET. Priyakanta Nayak, a graduate of the CDC’s Epidemic Intelligence Service (EIS), is currently a senior advisor for the FETP through TEPHINET. His role in the FETP is extensive.
“As a senior advisor and acting resident advisor for FETP Bangladesh, I give mentorship to fellows, supporting them through their first and second years as trainees. I also give day-to-day technical support and provide program management to try and run the program in a holistic way.”
The emerging public health workforce, increasingly made up of FETP graduates, is tasked with leading outbreak investigations, strengthening surveillance systems, managing ongoing or new systems, providing evidence to make public health decisions based on solid data, consulting on epidemiologic methods, and training in surveillance and outbreak response for community health workers.
“FETP Bangladesh is the best public health program in country,” says Billah. “It is very different from the existing public health program, and the quality of the training is very high.”
With the understanding that field epidemiology training must be immersive to be truly effective, FETP Bangladesh fellows spend 20 percent of their time in a classroom and 80 percent in field placement. Fellows receive hands-on experience in various types of situations.
“FETP is a complete package of trainings that makes graduates capable of leading outbreak investigations, making rapid and feasible recommendations to control the outbreaks, communicating with different stakeholders, conducting surveillance to detect outbreaks and conducting research to prevent future outbreaks,” says Billah. “FETP trains us to be disease detectives.”
Through 2019, ten residents have graduated through the first two cohorts of the program’s advanced level training. One hundred and fifteen doctors and veterinary surgeons have completed its two-month FETP Frontline course, which was implemented in 2016. Following the completion of their training, approximately 80 percent of graduates from cohorts one and two have stayed in Bangladesh to work at the Ministry of Health and Family Welfare and to mentor fellows in cohorts three and four. As of 2018, FETP Bangladesh fellows have conducted 90 to 100 outbreak investigations.
Fellows have participated in various international conferences including TEPHINET global and regional conferences. In 2014, 2015 and 2016, consecutively, three fellows were awarded TEPHINET non-communicable disease mini-grants.
As the public health workforce in Bangladesh grows stronger, the ultimate goal is for Bangladesh’s government to assume control of the FETP.
“FETP Bangladesh is currently in a period of transition,” says Nayak. “Sustainability by the government is the goal, and we are working to ensure that the government is prepared to sustain the program on its own.”