South Africa Field Epidemiology Training Program

Program overview

The South Africa Field Epidemiology Training Program (SAFETP) is a two-year, competency-based training program that was initiated in 2006 and developed as a collaboration between the South African National Department of Health (NDOH), the National Institute of Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), and the U.S. Centers for Disease Control and Prevention (CDC), to increase South Africa’s field epidemiological capacity. SAFETP uses an established applied epidemiology curriculum, providing an accredited Masters in Public Health (MPH) degree from the University of Pretoria (UP) and a Masters in Science (MSc) from the University of the Witwatersrand (Wits) with mentored practical field experience.

Following the establishment of democratic rule in South Africa in the early 1990s, the country was faced with growing expectations to provide basic health services for all, given the presence of substantial racial disparities in regard to health and socioeconomic status. At this time, South Africa reported one of the highest numbers in the world of people living with HIV, in addition to high rates of TB and other infectious diseases. South Africa also experienced growing chronic disease burden consistent with middle and high income countries that have undergone a demographic transition. In this context, the South African National Department of Health recognized the growing need to improve surveillance systems and build epidemiological capacity in the country.

South Africa was one of the fifteen focus countries at the launch of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2004 and was even allotted the largest PEPFAR budget. Therefore, epidemiologists were in great demand due to the need to understand and effectively respond to South Africa’s HIV/AIDS epidemic. Beginning in 2005, South African health officials, together with U.S. and locally based CDC officials, discussed and defined the development of a South Africa Field Epidemiology and Laboratory Training Program (SAFELTP), which was subsequently launched in 2006. SAFELTP began as an academic degree-granting program with a laboratory training component—similar to the Kenya and Tanzania FELTPs—and was supported as a collaboration between the NDOH, NICD, and UP School of Health Systems and Public Health, with technical and financial assistance from the U.S. CDC and PEPFAR. The program targeted physicians, nurses, laboratorians and other allied health professionals with a primary degree in the health sciences.

Achievements

A comprehensive impact evaluation of the SAFETP has never been conducted; however, evidence of the program’s impact can be gleaned from the work produced by the residents during their training, its impact on the health system as a whole, and the final placement of graduates in key positions.

Over 45 scientific manuscripts have been published in peer-reviewed scientific journals by SAFETP residents, based on their activities during the training program. SAFETP trainees have made significant contributions in investigating and responding to numerous disease outbreaks and priority health conditions. Additionally, graduates have engaged in various activities throughout the country that have provided key inputs for local, provincial, and national public health decision making. Selected examples include: outbreaks of Rift Valley fever from 2008 to 2011 that led to greater collaborations with the veterinary and animal health sector, an outbreak of multi-drug resistant Pseudomonas aeruginosa in a hospital in Cape Town in 2010, a diarrheal disease outbreak investigation in Free State that led to major improvements in the water treatment system, and the identification of the emergence of multi-drug resistant Candida auris fungal infections which led to the development of clinical and diagnostic guidelines for detection and investigation of future outbreaks.

In addition, SAFETP trainees have also assisted in responding to outbreaks in other African countries in the region. Selected examples of these include: an outbreak of typhoid in Zimbabwe from 2011 to 2012 which highlighted the role of contaminated boreholes in continued transmission, an outbreak of diarrheal illness in Swaziland in 2014, and an investigation of a cluster of hydrocephalus cases in Lesotho in 2017. Finally, residents have completed analytic research studies on the determinants of loss to follow-up among HIV patients in South Africa on anti-retroviral treatment enrolled in a pharmacovigilance cohort study from 2004 to 2012. The results helped bolster the strategy of community-based adherence support programs and integrated patient care that has been implemented by the South African HIV/AIDS treatment program. Residents also conducted analyses identifying risk factors for tuberculosis smear non-conversion in Western Cape Province from 2007 to 2013, helping health providers better target at-risk patients.

SAFETP trainees and graduates have also played a significant role in strengthening public health surveillance programs within the country. The trainees have contributed to the design, implementation, and evaluation of various surveillance systems at all levels of the health system within the country. In 2015, a team of six SAFETP residents and seven alumni conducted an evaluation of the National Notifiable Medical Conditions (NMC) surveillance system in the country. The findings from the evaluation have informed the re-engineering of the entire NMC surveillance system for South Africa.

Another significant impact of SAFETP is the employment of program graduates to further strengthen the public health system in South Africa. The majority (n=19) of the epidemiologists employed by the NICD at central (n=12) and provincial (n=7) levels are SAFETP graduates. Research institutions and other health agencies within South Africa are increasingly recruiting SAFETP gradates, given their applied epidemiology training and experience. As SAFETP’s reputation grows for producing competent field epidemiologists, the positions for which graduates are being hired suggests an increasing influence in public health leadership capacity at program management levels. Furthermore, SAFETP graduates are increasingly involved in using applied epidemiology methods to address the key health burdens and initiatives in South Africa.