SRM University, Chennai (9-10)th January 2013
FIMDP 2013
DEPT OF COMMUNITY MEDICINE
SRM MEDICAL COLLEGE ,SRM UNIVERSITY
&
UNSW AUSTRALIA
9TH & 10TH JAN 2013
Health Workforce Training in India: Introducing the EIS Programme
Dr Jai P NarainSenior Adviser (Epidemiology and EIS)
National Centre for Disease Control, Delhi
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
The Changing Paradigm of Health
• A nation in transition; major improvements in last 50 years but progress uneven
• Old and new challenges (epidemiological transition); factors driving ill-health (poverty, inequities) persist; also new opportunities (partnerships, technology)
• National capacity building & international collaboration are critical for responding to these challenges
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
CDC-Funded Global Disease Detection Regional Centers
Global Disease Detection Network
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
GDD partnershipIndia – USA
President Barack Obama hosted IndianPrime Minister Manmohan Singh at theWhite House in November 2009. Letter of Intent to establish a GDD center in India signed.
Dr. L.S. Chauhan and Dr. T Frieden sign MOU during President Obama’s visit to India, November 2010.
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
GDD India Centre (GDDIC)
National Centre for Disease ControlDelhi, India
•NCDC•Centre Staffing
CDCNCDCGDDIC
• Priority areas:
- Epi training (EIS)- Foodborne diseases- Acute encephalitis syndrome - Research
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan
What is EIS?
EIS = Epidemic Intelligence Service
• In the US, it’s a competency-based training in epidemiology; an on-the-job service-based learning (shoe-leather)
• Mentors play a key role
• Trainees called “EIS Officers”
• Approved as Super Specialty programmefor Epidemiology Training
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
US Epidemic Intelligence Service (EIS)
• Vision of Alexander Langmuir to provide
“ adequate epidemiologic facilities to investigate outbreaks of disease in strategic areas.”
• Initiated in 1951
• More than 3000 trained already
• Apprentice program analogous to postgraduate residency
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
US model
• The EIS training, based at the U.S. Centers for Disease Control and Prevention (CDC), is a 2-year program
• EIS Officers engage in outbreak investigation, design and analyze epidemiological studies, evaluate surveillance data, and make scientific communications
• Personally recognize it as one of the best training programs in epidemiology
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
“Significant and Consequential” Epidemiology
• Significant: refers to the analytical rigor of the public health approach and the validity of the results
• Consequential: reflects the practical application of the results, trying to make a difference in health outcomes
Ref: Koplan and Thacker, Am J. Epid. 2001
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
US Model Adapted for India
• Only country outside of US to initiate an EIS Programme
• The India Programme modeled after the U.S. Programme, but adapted to the situation in India
• Will help further strengthen epidemiological capacity presently lacking in most states
• Run by NCDC, Delhi in close collaboration with US CDC
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Objectives
• “To create highly competent field epidemiologists within the public health sector.
• To produce a critical mass of graduates that meet national needs for public health officers.
• Strengthen public health system through rapidoutbreak response throughout the country.
• To facilitate a more integrated approach to publichealth practice through integration of field andlaboratory component”
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Key Milestones in Developing India EIS
• Steering committee headed by Secretary Health &Family Welfare approve the model in July 2011
• Series of consultation meetings spearheaded by NCDC
• Letter from Secretary Health to his counterparts in states
• Advocacy meetings held with State Health Secretaries/ Director Health Services
• Course announced in June 2012
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
India EIS First Cohort, 4th October 2012(announcement for the 2nd batch soon)
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Eligibility Criteria
• MBBS and MD (Public Health) or
MBBS and MD (Clinical or Para-Clinical) with 2 years experience in Public Health
AND
• Age 25–45 years at time of application
AND
• Presently working* for the Central or State Government, PSUs e.g ESI or Railways; Municipal Corporations, Local Bodies, etc (state sponsored)
* non-Government employees can also apply
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Desirable Characteristics of the Candidate
• Meets eligibility criteria
• Committed to career in public health in India
• Flexible re: assignments and work conditions
• Able to work independently (self-motivated)
• Can work in team, responsive to supervision
• Quantitative and problem-solving aptitude
• Has computer skills
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Training Methods
• Mostly experiential (on-the-job)
• Mentoring essential
• Classroom courses (≤10 weeks out of 104)
• Weekly seminar (attendance mandatory)
• Annual India EIS Conferences
• Other (i.e workshop on surveillance, scientific writing, leadership/management, communication etc)
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Core Activities of Learning (“CALs”)
1. Field investigation2. Epidemiological analysis 3. Surveillance analysis, evaluation4. Oral scientific presentation — long5. Oral scientific presentation — brief 6. Visual/graphic aids 7. Scientific manuscript for a peer-reviewed journal 8. Public health update — concise and timely 9. Scientific abstract(s)10. Presentation(s) to non-scientific audience, media. 11. Other services to agency
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Two-Year Schedule
First Year
Inception course (4 wks)
Placement
Month 4 – surveillance workshop
Month 7 – scientific writing
Month 10 – India EIS Conference
Second Year Month 13 – leadership
workshop
Month 16 --communication training
India EIS Conference
International Conference if abstract accepted
Visit to Atlanta for upto 4 weeksWeekly Tuesday Afternoon
Seminars
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Inception Course (4 weeks)
• Topics:– Descriptive epidemiology– Outbreak investigation– Surveillance– Analytic epidemiology (some)– Epi Info– Public health systems of India
• Methods– Lecture, exercises, case studies– Field exercise (data
collection, analysis, presentation)
• Approach– Hands-on, interactive
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Placement Sites
• Primarily in government sector
• Placement sites: national Programs or in the State Health Dept
• Officer will not be placed in sponsoring state or program (should go some where ‘new’!)
• Cluster of support: mentor for technical guidance 24/7, placement supervisor (for administrative support) and a NCDC co-mentor
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Evaluation
• Six monthly jointly by Mentors and Supervisors
• Candidates will be evaluated for knowledge, skills and services rendered during the training period
• Certificate at the end, after successful completion of training, given jointly by US CDC and NCDC
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Why Invest in the EIS Programme?
• An investment for public health in India; analytical approach & generating evidence that could drive policy and programme
• After 2 years, India EIS graduate will return:• As a highly skilled epidemiologist
• Potential mentor for future EIS Officers
• Networked to other practicing epidemiologists throughout India
• Someone who can raise visibility of the programmes
• A ‘brand’ name recognition
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
The Future
Vision and a road map
-- One EIS officer in each state in 3-4 yrs
-- One EIS officer in each district in 10 yrs
• Success will depend on:
-- Commitment from the governments
-- Collective effort (by all partners)
-- Communication
• For public health impact, quality and sustainability will be critical issues!
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
For details, please see:
www.ncdc.nic.in
Thank you
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Systems Approach to Capacity Building in Six Primary areas: Disease surveillance, detection
and outbreak response Training in field epidemiology
and laboratory methods Influenza and Pandemic
preparednessZoonoses: Human health-
Animal health interface Health Communication and
Information Technology Laboratory systems and
biosafety
Global Disease Detection Components
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Building a network through collaboration with ministries of health, multilaterals, U.S. agencies
Integrating activities
Surveillance
Training
Pathogen discovery
Outbreak response
Establishing and connecting Regional Centers
in all regions
Strengthening global systemsthrough the WHO Collaborating Center
Global Disease Detection Program Mission
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Timeline followed
• 13 June: Notice in newspapers• 4 July: Deadline for applications• 31 July: Screening of applicants completed• 10 Aug: Interviews completed• 15 Aug: Finalists chosen, notified• 20 Aug: Placements decided• 4 Oct: Inception course commenced• 30 Oct: Meeting of mentors, placement
supervisors, & co-mentors
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Application & Selection Process
• Following announcement, candidate submits
• Online application, including essay
• Screening process to eliminate applicants who do not meet eligibility criteria
• Final selection made by the India EIS Selection Committee, final decision by Director, NCDC
• 176 candidates applied, 12 selected, 8 enrolled for 1st cohort
* 2 slots available for non-sponsored candidates
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Criteria for Placement / Assignment
Assignments chosen on the basis of Access to surveillance and programme data to
analyze Each EIS officer will be supported by a
placement supervisor, mentor and a co-mentor Mentor who has time and can commit to
technically support the EIS programme Placement supervisor will provide an enabling
environment with adequate administrative support for EIS officer
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Q. Is EIS a training program or a service program?
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Q. Is EIS a training program or a service program?
A. Yes
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Service-based Learning
• Provides epidemiological service/support in his/her placement and addresses placement’s priorities in order to
• Develop applied epidemiology skills in:• Public health surveillance
• Epidemiologic field investigation, e.g., outbreak
• Study design
• Data analysis
• Epidemiologic judgment
• Communication, oral and written
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Conclusions• EIS programme: a India-US collaborative project
designed to augment epidemiological capacity
• Training to fulfill 11 core areas of learning or CALs
• Learning skills mostly by practicing on the job, under guidance
• Mentors and supervisors have key role; focus on quality & striving for excellence
• Will help creating a cadre of well-trained field-oriented epidemiologists serving in key central and state health departments (in 3-4 yrs) and at district level eventually (in 10 yrs)
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Context
• Health work force crisis:
Density: 0.6 doctor per 1000 popn
1.3 Nurse per 1000 popn
Mostly in urban areas, and in private sector
• Training and retaining
• Public health capacity especially epidemiological skills critical for generating evidence!
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013