Kenya Field Epidemiology and Laboratory Training Program

For the last 13 years, K-FELTP has continued to contribute to the strengthening of health systems in the country in many ways, which include:

• Deployment of graduates of the advanced program, retention and leadership in MoH and MALF
  • As of December 2017, FELTP has trained 169 epidemiologists who now serve as highly skilled health workers and have significantly contributed to the strengthening of various components of public health in the country. 146 (86%) are Kenyans, out of which 119 (82%) are still working with either MoH (100) or MALF (19). Of the 119 epidemiologists working with the government, the majority work at the county level (70), and 49 work at the national level. In general, a total of 136 (93%) still work in the country either with MoH/MALF (national or county) or with in-country partners like CDC and WHO.
  • The graduates of the two-year master’s course currently serve in key leadership positions within the MoH and MALF in various programs at the national and county levels.

The program has trained more than 500 health workers through the basic epidemiology frontline course and 83 through the intermediate level training from over 47 counties.

Residents and staff support various units and programs in epidemiological skills as needed. The residents are trained through service provision, and they spend 70 percent of their training time in the field. The following are some of the ways the program staff and residents provide service:

• Outbreak investigations
  • The program takes the lead in outbreak investigations and jointly works with the Disease Surveillance and Response Unit during response to various outbreaks and in the process provides data for decision-making at various levels. Residents also support outbreaks outside Kenya, such as Ebola and Marburg.
• Operational research and surveillance support to various divisions, units, counties, and programs
  • FELTP residents are placed in various units and programs at the county and national level where they provide day-to-day support in surveillance evaluation, data analysis, operational research, and response to outbreaks depending on the placement site. The placement is for two years, and after graduation, some remain in these areas. The residents also undertake a planned protocol-based study which should answer an important question for the placement site.
  • Every year since 2015, the new class has participated in a class activity that consists of field work that supports a unit, division, or county in answering an important public health question. Over the last two years, the program has worked on the following:
    • Assessing knowledge attitudes and practices of health workers and the community on cholera
    • Evaluation of the cervical cancer screening program (in collaboration with the Alliance for Reproductive, Maternal and Newborn Health (RMNH), Division of Non-communicable Diseases (DNCD), the Kenya National Cancer Institute (NCI) and the United States NCI), the results for which were used to inform the cancer control strategy
    • Investigation of lead poisoning intoxication from a smelter factory in an informal settlement in Mombasa County
    • Water, Sanitation and Hygiene (WASH) activity in 12 counties, supplementing the cholera control efforts
• Two-week rotation at the Emergency Operation Centre (EOC)
  • In addition to supporting the processes that lead to establishment of EOC in Kenya, two to three residents are placed at EOC for two years. The program also developed a two-week rotation for all first-year residents. The objective is to provide additional persons to support operations at EOC and also make sure that all residents understand how EOC operates. The rotations have specific deliverables to make sure the residents learn while also providing service and become prepared to start a mini-EOC in their own counties once they graduate.
• Birth defects surveillance system (pilot)
  • Despite birth defects contributing substantially to neonatal mortality, there is no birth defects surveillance in the country, and there is limited research conducted in this area. In collaboration with the birth defects team in CDC Atlanta, K-FELTP started a pilot surveillance system in 2016 in four hospitals in the country.
  • In addition to this, the residents are undertaking various projects to understand the burden of neural tube defects and its risk factors, including folate levels among women of reproductive age.

The program staff also participate in various activities within the ministry.

• The program staff led two technical areas in the Joint External Evaluation process. WHO and other players developed tools where countries conduct self-assessment of the 19 technical areas of their IHR core capacities, which is verified via a peer-review process called Joint External Evaluations. During the Kenyan self-assessment of IHR core capacities and Joint External Evaluation, the FELTP staff led the assessment report development and presentations of two technical areas, namely workforce development and medical countermeasures.
• Kenya FELTP participated in the development of the initial concept for the National Public Health Institute (NPHI) and is a member of the NPHI national steering committee.
• KFELTP was accredited in 2017 by TEPHINET and is one of the only two programs accredited in Africa.
• The program moved from using paper questionnaires to using phones and tablets for data collection in 2016, which has significantly reduced the turnaround time of data analysis reports, especially in outbreak situations.

The program also houses and supports coordination of Improving Public Health Management for Action (IMPACT) program, an experiential training modeled on the Field Epidemiology and Laboratory Training Program (FELTP). IMPACT is comprised of two components which are the 2 years’ master’s program and the 6 month short course. It was designed in response to the need to strengthen the management skills of Kenyan public health professionals and to meet the challenges of the public health issues in Kenya. The IMPACT Program training places emphasis on service, providing real results to the health sector as the Fellows complete their field competencies. The IMPACT two-year training leads to an MSc in Public Health Systems Management and Application from Kenyatta University and is offered by the Kenya Ministry of Health in collaboration with Kenyatta University School of Public Health, and the U.S. Centers for Disease Control and Prevention (CDC). The IMPACT short course, referred to as the Distinguished Fellows Program (DFP) is a six month’s program is designed to provide intensive, advanced training to senior managers from across the Kenya Ministry of Health. Through a combination of classroom, field, and project work, IMPACT ‘Distinguished Fellows’ enhance skills and applied knowledge in key public health management competency areas.

 IMPACT DFP: We have successfully graduated 3 cohorts of the DFP course. The participants have been MoH senior level managers from both the national and county levels. The first cohort started class in June 2016 immediately after the program launch which was held at the Kenya School of Government. The class comprised fifteen (15) participants representing 6 counties and 9 participants from the national level. The second cohort started class in November 2017 with fifteen (15) participants representing 12 counties. This class graduated in April 2018. The third cohort also had 15 participants representing 11 counties and 1 participant was from the national level. This class graduated in January 2019 after being in class from August 2018.

IMPACT Master’s course:
The master’s course has also had three cohorts so far with one cohort having successfully graduated from IMPACT in January 2019. The course was launched in February 2017. The training is designed in a way that learning takes place through classroom-based lectures and case studies, as well as service-based training that occurs during periods of field placement. The students are placed at field sites that are different from their previous work sites. This is so as to enable them get new field experience as well as to ensure that they are able to complete the for IMPACT core activities for learning (CALs). At their field site, they each have a mentor and a supervisor who guides them to ensure that they complete all the expected assignments. All the mentors and supervisors are graduates from the IMPACT DFP and/or FELTP. Cohort 1 had eight (8) fellows who were previously stationed at the national and county level. The class had a mix of medical officers, clinical officers, and lab technicians. This cohort graduated from IMPACT in January 2019 and will graduate from Kenyatta University in July 2019. Cohort 2 fellows joined the program in February 2018. Cohort 3 fellows joined in November 2018. These eight fellows were also previously stationed at national and county levels. They also represent various professions from medical officers, pharmacists, nurses, clinical officers, public health officers, and nurses. They are expected to graduate from Kenyatta University in December 2020.