Pakistan Field Epidemiology and Laboratory Training Program
In 2003, the Pakistan Federal Ministry of Health formally requested the U.S. Centers for Disease Control and Prevention (CDC) to start a Field Epidemiology and Laboratory Training Program (FELTP) in Pakistan. In 2006, the program was launched; the first cohort was inducted in 2007 and comprised eight fellows. A National Steering Committee (NSC) was established in the same year to oversee the work and progress of P-FELTP. The NSC is composed of the Secretary (chair), Ministry of National Health Services, Regulations and Coordination (MoNHSR&C), provincial secretaries of health, provincial and federal DGs and other stakeholders. FELTP fellows fulfill the eligibility criterion nominated by their respective province/region and department.
FELTP Pakistan is a joint initiative of the National Institute of Health (NIH), MoNHSR&C, and CDC aiming to strengthen national capacity in disease surveillance and outbreak response. The objective of FELTP Pakistan is to strengthen the workforce capacity to meet core capacities of International Health Regulations (IHR) and Global Health Security Agenda (GHSA).
FELTP Pakistan has trained more than 2,000 health workers, including doctors, veterinarians, nurses, laboratorians, paramedics and allied staff. FELTP Pakistan mainly offers two types of training courses; FELTP (2-year advanced and Frontline) in addition to multiple short-term trainings conducted on disease surveillance, outbreak investigation, response, risk communication, incident management system, contact tracing and case management, etc. As of now, 12 cohorts have successfully completed the FELTP 2-year advanced training. All 246 advanced graduates are serving in their respective departments. Currently, the 13th cohort (comprising 34 fellows) is under training.
FELTP Pakistan has conducted 13 Frontline trainings in all provinces and regions. A total of 296 health care workers from public sector and parastatal organizations have trained through the Frontline program. 80 officers (Frontline and advanced) are working in the National Stop Transmission of Polio (N-STOP) program and are deployed in high-risk districts and areas. Since the emergence of the COVID-19 pandemic, FELTP fellows/alumni are engaged in contact tracing, case investigation, setting up surveillance at point of entries, COVID-19 vaccine role out, establishing surveillance systems for adverse events following immunization (AEFI), and conducting operational research for evidence-based decision making.
To strengthen zoonotic disease surveillance systems and enhance collaboration among the human and animal health sectors, a cooperative agreement was executed with the National Agriculture Research Center (NARC) and provincial veterinary departments. In the light of the One Health approach, veterinarians are now part and parcel of this training program and have enrolled for the last six cohorts.
Upon the emergence of COVID-19 in China in 2019, Pakistan was considered a high-risk country for disease transmission as it shares a border with China. Consequently, the government of Pakistan initiated COVID-19 screening of incoming travelers at all airports and ground crossings. FELTP graduates and fellows were deputed to formulate and implement standard operating procedures at all points of entry. This trained workforce are playing a pivotal role in COVID-19 surveillance, investigation, response and capacity building. The relentless efforts and contribution of FELTP graduates and fellows made it possible to halt transmission through active case finding and identifying hotspots, implementing interventions, and ultimately enhancing immunization uptake. Moreover, as FELTP alumni are appointed to key high-level positions in federal, provincial, and regional health departments, they are involved in policy making.
In 2009, FELTP Pakistan initiated a sentinel site surveillance system for acute viral hepatitis. In 2011, the National Stop Transmission of Polio (N-STOP) program was launched to support the Global Polio Eradication Initiative. An event-based surveillance (EBS) system was launched by establishing six Disease Surveillance and Response Units (DSRUs) in provinces/regions in 2015 and expended to 19 units in 2020.
FELTP Pakistan received the CDC Directors Award for Excellence in Epidemiology and Public Health Response twice (in 2016 and 2020). The Independent Oversight and Advisory Committee for the World Health Organization (WHO) Health Emergencies Programme stated in its Pakistan mission report (2017) that FELTP Pakistan demonstrated sustainable impact on capacity building, not only for polio, but also for management of other outbreaks and it is a model that might be of benefit to other countries. In 2019, FELTP Pakistan attained accreditation from TEPHINET. In 2019, the FELTP was recognized as a degree-granting program (MSc in Field Epidemiology) in collaboration with the University of Health Sciences, Lahore.
FELTP fellows have done substantial work in scientific research and communication. More than 260 abstracts have been accepted in various international conferences. FELTP Pakistan received third place for presentation among 70 countries participating in the 9th TEPHINET global scientific conference in 2017. The program had nine consecutive years of abstract acceptance for FETP International Nights during the annual CDC EIS Conference, the highest number of abstracts at the 6th EMPHNET conference in 2018, the award for best presentation at the 6th and 7th EMPHNET conferences, the award for best poster presentation at FETP International Nights during the 68th annual EIS Conference, as well as multiple awards in national conferences. The program has also produced more than 150 publications in international journals.
A total of 28 fellows were selected for emerging infectious disease and One Health fellowships at the University of Iowa, University of Florida and Duke University. Graduates and fellows have investigated more than 650 outbreaks involving the FELTP Disease Surveillance and Response Units, which resulted in the vaccination of more than 100,000 children and the organization of 900 public health education sessions. Ninety-five percent of these investigations were paid for by the government. The Government of Pakistan has allocated sufficient funds to run the program with indigenous resources.