Spotlight on the Cameroon Field Epidemiology Training Program

Editor's note: This story originally was published in the 2018 Annual Progress Report of the TEPHINET Secretariat.)

Nearly a Decade in Existence, CAFETP Continues to Fortify Public Health in Central Africa

In 2016, Cameroon weathered an avian flu outbreak. That same year, there was a catastrophic railway accident when a crowded passenger train overturned while in transit, killing 70 people and injuring nearly 600. In 2018, cholera re-emerged. Though each of these public health emergencies presented different challenges and required various needs, in each circumstance, graduates and residents of the Cameroon Field Epidemiology Training Program (CAFETP) were on site to provide leadership, support, and most importantly, expertise.

Launched in 2010, CAFETP is a joint effort of the Ministry of Public Health and the Ministry of Higher Education through University of Yaoundé I and Buea University in Cameroon. TEPHINET supports CAFETP by providing technical and programmatic support. CAFETP was established to increase the number of trained field epidemiologists and to strengthen Cameroon’s disease surveillance and emergency response systems.

“CAFETP was developed in Cameroon to strengthen health personnel capacity to respond to public health emergencies, monitor diseases, conduct research activities on priority public health issues, and, finally, to improve communication and networking in the country and throughout the region,” says Dr. Armel Evouna Mbarga, coordinator for the advanced training program of CAFETP.

The program’s main goal is to strengthen the public health workforce. Its strategy for doing so is to continue to provide advanced level training for medical and veterinary doctors as well as frontline training to regional and district level surveillance staff from the Ministry of Public Health, the Ministry of Livestock, Animal and Fisheries Industries, and the Ministry of Justice and Defense.

“CAFETP intends to be a platform for training health personnel to perform prevention, detection, management and response to public health events,” says Dr. Bohimbo M. Rose-Carole, Frontline FETP coordinator for CAFETP. “Through frontline and advanced trainings, we help develop practical skills in field epidemiology.”

Advanced FETP training is designed to give residents practical learning experiences. When residents are not in the classroom, they actively participate in different meetings and in the development of processes and tools to address surveillance or outbreak investigation during their internship in key surveillance departments or programs of the Ministry of Public Health. One of the deliverables of the advanced training is for residents to be actively involved in outbreak investigations. If there is a rise in, or risk of, a disease in the region, and the Emergency Operations Center (EOC) decides to plan for an outbreak investigation, a resident will always be part of the team and sometimes leads the activity. Since 2016 alone, more than 40 outbreak investigations have been conducted covering various kind of diseases including vaccine-preventable diseases, zoonoses, cholera and other water-related diseases.

Once residents finish the two-year advanced program, they are appointed to different positions within the Ministry of Public Health. They might continue the work they were doing as residents or bring their expertise to a new role. CAFETP has alumni occupying not only key surveillance positions in Ministry of Public Health departments and programs, but also alumni who are involved in international deployments. Alumni are supporting the Ebola outbreak response in the Democratic Republic of Congo (DRC), and some have applied to support the response to the cholera outbreak in Mozambique.

As a regional program that accepts residents from Central African Republic (CAR) and Chad as well as Cameroon, CAFETP has a broader reach. These residents graduate from the two-year advanced training program and take the knowledge they have gained back to their countries, where they address surveillance issues, investigate outbreaks and contribute to their ministries of health.

“We have so many success stories at CAFETP,” says Dr. Evouna. “In 2017, CAFETP received accreditation from TEPHINET, which means that CAFETP aligns with common standards that support quality training and is recognized for its value in supporting country public health priorities. In December 2018, four graduates from CAFETP cohorts two, three and four were assigned to new positions in the Ministry of Health in CAR. One was designated as the general director of epidemiology and disease control. The second one is now the director for family health and population. The third is the director of epidemiological surveillance and emergency management in public health, and the fourth is a department chief within the CAR Ministry of Health. In Chad, one graduate from cohort five moved from district medical officer to deputy director of occupational work, whose main task is to assess professional risk. CAFETP is honored when our graduates are nominated and assigned to higher posts with greater responsibility.”

Currently, CAFETP has graduated five cohorts and currently boasts 79 epidemiologists. Thirty-one residents in Cameroon, Chad and CAR are still in training. Since the implementation of Frontline FETP in 2016, approximately 600 key disease surveillance staff from the regional and district levels from the Ministry of Health and the Ministries of Livestock and Defense, as well as prison and police departments, have been certified in frontline field epidemiology in eight out of 10 regions in Cameroon. Graduates of the advanced program have been instrumental in leading this effort.

CAFETP, its residents and graduates have been recognized numerous times for their active contributions in the incident management system in response to many health events, including an avian flu outbreak in 2016 in three regions, a railway accident in the Center region in 2016, a cholera outbreak in North and Far North regions in 2018, and pediatric eruptive fever in 2017.

“Residents are involved in almost all outbreak investigations, and sometimes, they are the team leaders of the outbreak or public health interventions in the field,” Dr. Evouna says. “They are deeply involved in each incident management system once it’s activated.”

Through their training, CAFETP residents become more effective epidemiologists who have stronger research skills and share scientific information with their peers and professionals in their field. They have been recognized for their contributions to the research and scientific communities. For example, CAFETP residents have received scientific awards during international conferences, including first place in scientific innovation at the 6th AFENET Scientific Conference (2016), the first and second place prizes for best oral presentation at the 7th AFENET Scientific Conference (2018), and third place for best oral presentation at the 9th TEPHINET Global Scientific Conference (2017). A CAFETP graduate co-chaired a session at the American Society for Tropical Medicine and Hygiene conference in Atlanta, Georgia, USA in 2016.

Even as the program grows stronger, challenges remain.

“One of our main challenges is continuously researching funding sources to ensure our sustainability,” says Dr. Alain G. Etoundi Mballa, CAFETP program director, who is also director of the Department for the Control of Diseases, Epidemics and Pandemics. “We intend for the program to be a hub in field epidemiology training for activities related to surveillance in the Central Africa region.”

Additionally, gaps persist in surveillance and emergency response systems. Fortunately, CAFETP residents are challenging themselves to develop innovative approaches to address these gaps.

“CAFETP is a tool for change,” says Dr. Etoundi.

One of the program’s innovations is an outbreak investigation toolkit, a framework which includes documents and checklists that expedite the approval and funding processes for investigations and the process of assembling investigation teams. Once in place, teams consisting of residents and graduates can proceed to the field more quickly. The goal is to reduce technical and administrative delays and to be ready to intervene within 48 hours of notification to avoid the spread of disease due to late detection.

“To prepare an investigation takes some time,” Dr. Bohimbo explains. “We decided to set up an outbreak investigation toolkit that includes logistics, technical information, schedules, communication tools and necessary forms for different diseases in Cameroon and CAR. These drafted files can be adapted to the disease at hand, facilitating the preparation of all technical and administrative materials in relation to the field investigation. Having all of those things in one place allows us to get to the implementation phase much more quickly.”

As CAFETP residents continue to roll out the outbreak investigation toolkit and other strategic initiatives, it’s clear that there is pride among both residents of CAFETP and its leadership, especially for their persistence in the face of significant obstacles.

“Our residents are multitasking, they are willing to learn, and they accept challenges,” says Dr. Evouna.