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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!
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!
