Zambia FETP Strengthens Health Security by Empowering Field Epidemiologists

During a malaria data quality audit at one of the rural health centers within the Kaoma district, the team noticed an extremely ill child drifting in and out of consciousness on his mother’s lap, on a queue, waiting to be attended to. In the picture, Dr. Stephen Longa Chanda, a Zambia FETP resident, administers Artesunate to the child after quick history taking and investigation. The child had severe malaria. (Photo courtesy of Nyambe Sinyange)

The Zambia Field Epidemiology Training Program (FETP) was established in 2014 with a cohort of six advanced residents. With its guiding principle of learning by doing, the Zambia FETP endeavors to enhance the epidemiological capacity of the public health workforce and increase the use of science and data to appropriately respond to public health threats. Over the years, the program has seen an improvement in its different programmatic focus areas.

Beginning with the inaugural cohort in 2014, the program has seen an increase in the number of residents being enrolled in each new cohort, with eight being enrolled in cohort two, 10 in cohort three, and 11 in cohort four (who are currently in training). The three cohorts have so far graduated a total of 24 field epidemiologists. The program has not only seen an increase in the number of residents in each cohort, but the frequency of intakes has also increased from one every two years to one every year. Zambia FETP is leveraging a World Bank loan to begin recruiting an advanced cohort on the off-years to complement the existing cohorts, funded by the U.S. Centers for Disease Control and Prevention (CDC). This means that, beginning this year, the Advanced FETP will initiate a new cohort each year, doubling the output of the program. The advertisement for the Advanced FETP’s fifth cohort is currently running. Africa CDC will also sponsor three international residents to join cohort five.

With the increase in the number of intakes, there is a need for a corresponding increase in field placement sites. Three new sites have been included in the Advanced FETP field placements. These include the Luapula Provincial Health Office (PHO), which is malaria-focused; Western PHO, and Ministry of Health (MHO) Child Health Unit. Other existing placement sites include the Zambia National Public Health Institute (three positions), MOH-Public Health (tuberculosis), Eastern PHO, Southern PHO, Ndola Tropical Diseases Research Centre (TDRC), and National Malaria Elimination Centre (two positions).

Dr. Chilufya Mulenga, a veterinarian enrolled in cohort four of Zambia's advanced FETP, administers a rabies vaccine during a mass vaccination campaign in Itezhi-Tezhi district of Zambia. This is in an effort to promote and strengthen the One Health approach to the Zambia FETP. (Photo courtesy of Nyambe Sinyange)

To date, Zambia has graduated six cohorts of its Frontline FETP with a total of 106 health workers trained as field epidemiologists from different districts across the country. There is funding to increase the output of frontline field epidemiologists to six cohorts per year with the purpose of saturating the district health systems and hence improving epidemiological skills and data use at that level. With more trained workers at all levels, the epidemiologic capacity increases.

The program has worked with higher learning institutions, including the University of Zambia and Levy Mwanawasa Medical University (LMMU), to incorporate the Advanced FETP as one of the programs being offered wherein residents graduate with a Master of Science in Field Epidemiology. Previous cohorts have trained at the University of Zambia, while the current cohort is domiciled at LMMU. This is a cohort of medical doctors, environmental health officers, and surveillance officers. A veterinarian is among the doctors in cohort four; this is to strengthen the program's One Health approach.

Leveraging funding from the U.S. CDC, Zambia FETP has been able to expand its staffing this year after having a lean staff complement since 2014. The advanced and frontline programs now have dedicated coordinators. Additionally, four field mentors have been placed around the country to support FETP residents and help build capacity at the local level. The field mentors have been placed in four areas: the eastern (responsible for the Eastern and Muchinga provinces), southern (responsible for the Southern and Western provinces), Copperbelt (responsible for the Copperbelt, Northwestern, and Central provinces), and Luapula (responsible for the Luapula and Northern provinces). All positions have been recruited from among FETP alumni.

Zambia FETP has made a strategic decision to introduce training in the R programming language for the fourth cohort of the Advanced FETP. This is a transition from the legacy STATA program to one that trains residents in R. R is open source and free, and increasingly is becoming a global standard in field epidemiology. Residents will be able to avail themselves of the vibrant online R user community. So far, the U.S. CDC and the Centre for Statistical Analysis and Research (CESAR) from South Africa each hosted their respective training sessions with statisticians. With these, the Zambia FETP has been a success from its infancy to date and is seeking to apply for TEPHINET accreditation. Small grants from both the African Field Epidemiology Network (AFENET) and TEPHINET have been used to improve strategic areas of the program to help prepare it for accreditation.

The rising number of trained field epidemiologists in both the advanced and frontline programs throughout Zambia has been a part of their plan to strengthen health security in the country. Rayma Kumar and colleagues reported that "Within a relatively short time, the [Zambia] FETP has made clear contributions to national health security" (2020). The authors also highlight the importance of empowering residents by having the necessary mentorship, support, and opportunities; the success of the Zambia FETP is possible because of this. Therefore, as these programs continue to grow,  workforce empowerment is critical for the future sustainability and success of Zambia's efforts to strengthen health security.