Tanzania Field Epidemiology and Laboratory Training Program
The Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) is an accredited, two-year, competency-based training program that was established in 2008. The program is anchored within the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and collaborates with Muhimbili University of Health and Allied Sciences (MUHAS) and the National Institute for Medical Research (NIMR). In addition, TFELTP receives technical and financial support from various partners including the U.S. Centers for Disease Control and Prevention (CDC), the African Field Epidemiology Network (AFENET), the United States Agency for International Development (USAID), and the World Health Organization (WHO). Being a competency-based training program, trainees spend 25 percent of their time in class (didactic session) and the rest at their field placement (learning by providing services).
To build a critical mass of field epidemiologists, TFELTP adopted a three-tiered pyramid model in 2016 by introducing two new training levels of the program (i.e., frontline and intermediate training). The goal of this model is to address the need to improve the surveillance, epidemiology, response and scientific communication skills of health workers at each level of the health system (district, regional and national levels). Frontline training lasts for three months, while the intermediate course lasts for six. Both focus on detection of and response to disease or events of public health importance. The advanced TFELTP course originates from various regions of the country. After training, most of the trainees return to their regions, although a few have been relocated to other departments, units and organizations that either directly or indirect work on public health surveillance. The presence, coverage, and distribution of FELTP trainees has facilitated communication within the country and throughout the region, strengthened the capacity to respond to public health emergencies, improved early detection and notification of events, and enabled the surveillance and research of priority public health problems.
The goal of the TFELTP is to strengthen the capacity of MoHCDGEC to collect and utilize surveillance data and manage national programs by expanding surveillance programs and strengthening laboratory support for surveillance, diagnosis, treatment and disease-monitoring. The Government of Tanzania (GoT) is committed to strengthening its response to communicable and non-communicable disease epidemics through building the capacity of its health workers in areas of surveillance, epidemiology, and improving diagnosis through training in epidemiology and laboratory management.
The program has invested in building epidemiological capacity in the country. Over the years, the program has concentrated on hands-on training where residents have attained skills and competencies geared towards addressing public health challenges. Efficient communication of crucial information has improved, and the MoHCDGEC now utilizes evidence-based methods to establish health priority. Alumni and residents have been able to detect and respond to a number of outbreaks, emergencies, and threats in several parts of the country. They have also disseminated research findings in local and international conferences and meetings, as well as in peer-reviewed journals. This database of research has established a strong public health surveillance system in the country. The residents conduct studies that reflect the diversity of public health issues. In doing so, they identify research questions, design the studies, and gather critical data. Some of the work done through this program has resulted in policy changes. Currently, five senior positions in the MoHCDGEC are headed by graduates of the TFELTP. These include the Assistant Director of Epidemiology-Tanzania Mainland (who is also the Director of the Tanzania Field Epidemiology Training Program), Director of Preventive Services-Zanzibar, the Strategic Information Coordinator of Malaria, and the Director of Immunization Vaccine Development (IVD). Other graduates of the program are in national disease programs, hospitals, district and regional health management teams, and even non-governmental organizations. Graduates of the advanced level FELTP started an alumni association called the Tanzania Field and Laboratory Epidemiologists Association (TANFLEA). The association aims to ensure effective utilization of epidemiological and laboratory skills available within the country. Its vision and mission is to be a leading body in the field and laboratory epidemiology through provision of public health services to address public health threats in Tanzania and beyond. It is a non-profit, non-partisan and autonomous professional association. To date, 12 advanced level cohorts have graduated comprising 166 alumni.
In 2018, the program was accredited by TEPHINET. Thence, the program is trusted in its training quality to train even trainees of other nationalites. The program is successful in developing a sustainable network of highly skilled field epidemiologists and laboratory managers who are measurably improving public health. It managed to build a network from the district to the national levels to monitor disease and health events for early detection, response and prevention. Through residents' and graduates' research, the program was able to support the MoHCDGEC with evidence-based policies and plans such as: use of ≥ 3 doses of IPTp-SP in the second and third trimesters of pregnancy, viral load testing, HIV linkage to care, not all fevers are malaria, and HIV early infancy diagnosis. The program supported identification of cholera hotspots in the country following the 2015-2018 cholera outbreak. This was an important input in the development of the National Cholera Prevention and Control Plan. During the COVID-19 pandemic, the program facilitated the establishment of Alert Management Desks, mathematical modeling and prediction.
The program has been instrumental in supporting the MoHCDGEC in providing surveillance and data analysis skills to health care workers. This led to the improved ability of preparing daily situation analyses for various outbreaks, conducting periodic disease surveillance system evaluations, and conducting periodic data quality assessments (IDSR, HIV Data, HMIS). Outbreak detection capabilities have increased, where the program has been able to identify and control aflatoxin outbreaks. More than 100 outbreaks have been detected and controlled since the inception of the program. The program also supported the accreditation and accreditation sustainability of national, zonal and regional referral hospital laboratories and star ratings at district hospital laboratories. The program also supports national STOP teams for polio and cholera; supports program evaluation for the Pink Ribbon Red Ribbon-funded Tanzania Cervical Cancer Control Program (PRRR), and support mini-grants to address evidence-based policies on cancer, maternal and child health, injury and vaccination.