Training the Future Public Health Workforce in Malawi: the Field Epidemiology Training Program (FETP)
Malawi FETP-Frontline Cohort 2 trainees with mentors and guests during graduation ceremony: Photo courtesy: Kiran Bhurtyal, CDC
At 4:00 PM on July 12, 2016, I received an urgent email from the CDC Malawi office asking if I had any information on a typhoid outbreak in Malosa in southern Malawi. The U.S. Embassy in Malawi was planning a visit to Malosa by the Second Lady of the United States, and they had received reports of an unusually high number of typhoid cases there. Fortunately for me, one of our trainees from the Field Epidemiology Training Program (FETP) had presented on the same outbreak earlier that day during the FETP graduation ceremony. My colleagues from CDC and USAID and I used data from this presentation to map the outbreak areas and compare them with the proposed sites for the Second Lady’s visit. We were able to determine that although the Second Lady’s motorcade would pass through some typhoid-affected areas, the risk of contracting typhoid was minimal. Our CDC Malawi Deputy Director communicated this to the U.S. Embassy and the Second Lady’s visit went according to plan.
Malawi’s first ever FETP-Frontline training program was launched on April 16, 2016 with ten trainees. Since then, the Malawi FETP program has successfully graduated 30 trainees from three cohorts, including epidemiologists, environmental health officers, nurses, laboratory officers, and veterinary officers from Malawi’s Ministry of Health (MoH) and Ministry of Agriculture (MoA).
Each cohort undertook ten days of intensive training conducted in two blocks of five days each. The in-class training covered topics such as outbreak investigation and response; surveillance data collection, analysis, and interpretation; monitoring and evaluation of surveillance systems; and data quality assessments. In addition, the training included specimen collection and transport, surveillance problem analysis, report writing, and scientific presentation skills. The ten-day training was followed by five weeks of fieldwork, during which trainees conducted projects to practice and implement the skills they had learned.
Trainees’ projects have included conducting data quality audits, producing surveillance summary reports, performing surveillance problem analyses, and participating in case and outbreak investigations. The typhoid outbreak investigation was a successful field project of one of our FETP-Frontline trainees. The data from this outbreak informed decision-making not only for diplomatic visits, but also for disease surveillance and outbreak preparedness for Malawi in general.
Post-training test scores from the three cohorts showed improvement compared with the pre-training test scores, suggesting comprehension and retention of concepts taught during the classroom training and reinforced by the field work. Trainees’ evaluations of the course showed that they were satisfied with the course content overall and expressed more confidence in playing an active role in their district’s surveillance data, resulting in an 86% graduation rate across the three cohorts. Moreover, abstracts by two of the FETP field work graduates have been accepted for presentation at the 9th Global TEPHINET Conference in Thailand in August 2017. The Malawi FETP program has taken important steps to ensure sustainability and continued quality assurance:
- Six graduates have been selected to be local mentors for future cohorts. These mentors will provide local capacity for long-term sustainability of the program.
- The second and third cohorts were composed mostly of officers working at the district level, where most surveillance activities take place. This is especially important because they will be able to use their skills in day-to-day surveillance activities in the field.
- Since the cohort recruitment and program roll-out occurred in three separate regions (with the fourth cohort starting in the northern district), the graduates are spread across Malawi, meaning that the knowledge and expertise gained will serve more people.
- Malawi’s FETP-Frontline program has developed trainee performance standards to ensure quality of the training and is in the process of implementing this for subsequent cohorts. Malawi’s is the first FETP-Frontline program with performance standards integrated into the program structure.
Malawi has made much progress in public health in the past decade, but it has a long way to go to meet the goal of having at least one qualified field epidemiologist per 200,000 individuals. FETP-Frontline graduates fill this gap by strengthening Malawi’s public health workforce and surveillance capacity. Continuing the FETP program in Malawi will help ensure that surveillance officers in Malawi are trained on field epidemiology.
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