EPIDEMIC INTELLIGENCE SERVICE PROGRAMME by Dr.Mahboob ali khan Phd

EPIDEMIC INTELLIGENCE SERVICE PROGRAMME

Dr.Mahboob ali khan Phd

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

Global Disease Detection Network

CDC-Funded Global Disease Detection Regional Centers

GDD partnership

India – USA

President Barack Obama hosted Indian Prime Minister Manmohan Singh at the White 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.

GDD India Centre (GDDIC)

National Centre for Disease Control Delhi, India

•NCDC

•Centre Staffing CDC

NCDC

GDDIC

• Priority areas:

- Epi training (EIS) - Foodborne diseases - Acute encephalitis syndrome - Research

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 programme

for Epidemiology Training

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

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

“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

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

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 rapid

outbreak response throughout the country. • To facilitate a more integrated approach to public

health practice through integration of field and laboratory component”

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

India EIS First Cohort, 4th October 2012

(announcement for the 2nd

batch soon)

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

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

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, communic ation etc)

Core Activities of Learning (“CALs”)

1. Field investigation 2. Epidemiological analysis 3. Surveillance analysis, evaluation 4. Oral scientific presentation — long 5. 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

Two-Year Schedule

First Year

Inception course (4 wks)

Placement

Month 4 – surveillance workshop

Month 7 – scientific writing

Month 10 – India EIS Conference

Weekly Tuesday Afternoon

Seminars

Second Year

Month 13 – leadership workshop

Month 16 -- communication training

India EIS Conference

International Conference if abstract accepted

Visit to Atlanta for upto 4 weeks

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, presentatio n)

• Approach – Hands-on, interactive

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

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

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

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!

For details, please see:

www.ncdc.nic.in

Thank you

Global Disease Detection Components

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 preparedness

Zoonoses: Human health-Animal health interface

Health Communication and Information Technology

Laboratory systems and biosafety

Global Disease Detection

Program Mission

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 systems

through the WHO Collaborating Center

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

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

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

Q. Is EIS a training program or a service program?

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

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)

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!