Epidemic Intelligence Programme (EIP) Malaysia

Wednesday, 19 October 2005

Background

The Epidemic Intelligence Programme is skill training in public health that focus on ‘field epidemiology’. The program is based on public health experience in field investigation, disease surveillance, epidemiological methods, report writing and oral presentation. This ‘shoe-leather’ epidemiology involves case surveillance, interviewing, collection of specimens, application of statistical methods to assess factors responsible for illness and establishing control measures in coordination with other agencies.

In February 2002, the Ministry of Health, in collaboration with the IMR and IKU, endorsed for implementation, the paper titled: “A proposal for the development and implementation of the Epidemic Intelligence Program in Malaysia”.

This model of training had been adapted from the model of training offered in the Epidemic Intelligence Service of CDC, Atlanta, since 1951, and had also been applied in about 25 other countries around the world. Countries in Asia who use this model of training, referred to as ‘Field Epidemiology Training Programs’ (FETP) are: Thailand, Philippines, Indonesia, Taiwan, Japan, South Korea, India, China and Australia.

In May 2002, the Deputy Director General of Health (Public Health) directed that the EIP should be developed in two phases:

the long term plan was to initiate discussion with Malaysian Universities to incorporate critical elements of the EIP into the current 4-year MPH Programs, preferably starting by 2004;
the immediate plan was to initiate the EIP model by August 2002 for current MPH holders who are already in the public health workforce.

Rationale

Epidemiology is becoming increasingly complex, theoretical and specialized. The emphasis in all present models is on acquiring the theoretical research knowledge. Thus the graduates are equipped with knowledge and skill in research oriented epidemiology activities but not service focused.

The public health core service that is surveillance activity is not given sufficient training hours. The skills and competency which is very much needed by the public health professionals in carrying out their service activities such as outbreak investigation and surveillance evaluation is not emphasized.

At present the Ministry of Health typically sends medical officers (MO) and medical officer of health (MOH) abroad or to the local universities for post-graduate training for example PhD in Epidemiology or Masters in Epidemiology. This approach of training is costly, estimating as much as RM 100,000 per person per year. It is not only concern about the cost but the vacuum left once the officer is away. To get a replacement is a luxury and more often then not, the officer upon graduation; do not return to their original placing, to provide services. More importantly, it is disputed if the skills obtained in academic training especially those outside the country truly prepare the officers for working at home base.

Because of these concerns and because of the positive experience from the US CDC Epidemic Intelligence Services (EIS) program and other EIP programs, the Ministry of Health, has reaped this opportunity to start an in-service course in Epidemic Intelligence Course under the umbrella of the Disease Control Division/Infectious Disease Centre.

Goals and Objectives of the EIP

The goal is to strengthen human resources and organisational capacity to prevent and control communicable diseases in Malaysia.

The specific objectives are:

Human resources: To consolidate and extend the skills and competencies of public health practitioners to plan, implement and evaluate communicable disease programs, policies and services at the district, state and national levels.
Organisational capacity To develop and strengthen systems and procedures that will facilitate planning, implementation and evaluation of communicable disease programs. The systems and procedures include:
1. Systems to assess public health problems and needs, eg.
  - surveillance systems, defined as the systematic collection, collation, analysis and interpretation of data and the dissemination of the results to practitioners and decision makers for action;
  - other health information systems such as vital statistics (births and deaths) and hospital morbidity data for monitoring health status and trends;
  - situational assessments to identify health needs and problems in the community and the impact of potential threats to health.
2. Methods to apply an evidence-based approach to policy and planning, eg.
  - to formulate plans and policies to control communicable diseases;
  - to inform public health practice.
3. Methods to ensure appropriate implementation, monitoring and evaluation of control programs, eg.
  - vaccination programs, food and water hygiene, vector control;
  - responding efficiently and effectively to emergencies such as disease outbreaks.
4. Extending communications and collaborations to engage partners and networks across disciplines in initiatives to control communicable diseases.
5. Development of quality enhancement tools to facilitate ‘best practice’ in public health.

1. The EIP Model

The figure 1 below summarises the logical framework of the EIP model, with the inputs, outputs and expected effects of the program to strengthen the public health workforce and organisational capacity to plan, implement and evaluate communicable disease programs.

Strengthening capacity for disease control

The framework for strengthening capacity in public health is summarised in the figure below. The three fundamental functions of public health are assessment, policy development and assurance. Each of these functions is composed of defined systems, procedures and activities for which public health practitioners need relevant knowledge, skills and competencies to control communicable diseases.

The activities central to each of these functions include:

· Leadership;

inter-disciplinary and inter-sectoral partnerships and networks;

· effective written and oral communications with the community, decision makers, health bureaucrats, health care providers and peers;

Capacity strengthening is an approach to development and not a set of predetermined activities. There is no single way to build capacity. An early step is to identify and build on pre-existing skills, structures, partnerships and resources. The leadership must create an enabling environment within the organisation whereby senior managers will allocate resources for training and technical support to develop human resources and effective disease control systems and programs. The new capacity development initiative should be integrated into existing structures, and linked with existing positions and accountability processes.

The projects for strengthening capacity should be developed by addressing and solving current and priority public health problems in collaboration with local teams and partners. Participating teams should be supported to develop their skills in critical thinking, creative problem solving and self-directed learning on the path to life-long learning.

It therefore becomes essential to create a readiness among staff at all levels of the health system to take on the challenge of being agents of change, innovation and creativity.

1. The 18-month EIP Calendar of activities

The course will be for the duration of 18 months. During this period, EIP Fellows will continue working in their usual positions, and will be allocated study time (in-service training) by the work supervisor:

1. to participate in the 6 workshops, each for the duration of 2 weeks, as shown in the figure below;

2. to have the equivalent of 2 days per week allocated for working and completing projects considered to be of high priority at the district, state or national levels.

The 3 major projects to be completed over the 18 months will be identified by the Fellow in collaboration with the State Director/Deputy Director of Health or other appropriate senior official, and should be of high priority for the health unit.

The projects will include:

· a comprehensive review of the surveillance of a selected disease, including

o analysis, interpretation and a report to inform public health actions;

o evaluation of the surveillance system for that disease;

o and planning, implementing and evaluating actions to strengthen surveillance;

a detailed outbreak investigation, response and evaluation of the control measures, written up to a high scientific quality and effectively communicated to senior decision-makers in the Ministry of Health;
a study to inform public health policies and programs; this may include a cross-sectional study, a situational assessment of a health problem or evaluation of an intervention program.

Each project will require a written proposal and report in collaboration with the local supervisor and EIP Faculty member to ensure it meets specified scientific standards. Fellows will also involve other work colleagues into the local project team, and show evidence of other interdisciplinary and inter-sectoral collaborations. The report should be written to a standard that shows the Fellow has competencies listed under ‘Course Objectives’ below.

1. Organisation

1.1. The National Advisory Committe

Functions

The Advisory Committee will have the following functions:

· Advise on strategic decisions for shaping the program eg. identifying and involving stakeholders and training institutions, resolving the type of accreditation/certification to be offered to graduates.

· Act as a strong advocate and champion for promoting the EIP Course and career development structures for the graduates.

· Attract and maintain broad-based support for the EIP Course.

· Serve as a technical resource and assist in any inevitable hurdles in developing and implementing the course.

· Advise on recruiting a high level participation.

· Ensure the newly acquired competencies will be effectively engaged within the health system.

· Assure the program is continually addressing and meeting local and national needs.

· Ensure sustainability of the course.

Advisory Committee Membership

· Chairperson: Deputy Director General of Health (Public Health)

· Director of Disease Control

· Deputy Director Surveillance

· EIP/ Course Head

· Representatives of training partners; State rep, IMR rep, PHL rep, IPH (Institute of Public Health)

· University representatives

· External Consultant

1.2. The Faculty of EIP

Trainers will be selected from the Ministry of Health, NIH and Universities, and will include the following responsibilities:

· Central core trainer/Faculty: responsible for providing essential training support during workshops and throughout training course. Each EIP Fellow must have at least one consistent ‘Central Trainer/Supervisor’ to identify with, and from whom to get support as and when required. They will also participate in workshop activities.

· Workshop facilitators: selected on the basis of expertise to support workshop sessions.

· Workshop lecturers: invited to give lectures on selected topics.

· Field Supervisors: although their primary responsibility is to offer logistical support during fieldwork, and to ensure EIP Fellows are allocated time and opportunities to conduct projects, some may volunteer to support Fellows with their technical skills in the project.

· Content area experts: these experts will be invited to support Fellows and or the ‘Central Trainers’ according to the needs identified by or with an EIP Fellow in conducting the priority project. Ideally, they should be selected when the project is first selected so that they offer support in writing up the proposal and in the conduct of the study.

2. Standard of EIP Competency

To demonstrate that the trainees have acquired a competency in an area, they must actually implement the activity appropriately. For example, if they have understood how a cluster survey was done, then they have obtained the knowledge. If they are able to conduct a cluster survey, then they have obtained the skill. If they are able to do a cluster survey for the right reasons and interpret the results correctly then they have the competency.

The only way trainees can acquire competencies is by doing things appropriately in the field.

The competencies acquired during the study period will be developed by the trainees through the following key, practical, hands-on activities:

1. Conducting a rapid investigation and response to a potentially serious public health problem, for example, a disease outbreak, or natural disaster.

2. Analysing a surveillance database or other health information system, and using the results to advocate for public health actions at all levels of the health system, including senior decision-makers.

3. Evaluating an existing public health surveillance system, or designing and implementing a new surveillance system or other health information system.

4. Conducting and interpreting an epidemiological study eg, community survey, cohort study, case control study, and intervention study, randomised or quasi-randomised intervention trial.

These activities will usually incorporate development of written and oral communication skills by:

· Publishing a short report in a newsletter or journal for rapid communication of study results.

· Writing a scientific manuscript for publication in a national or international peer-reviewed journal.

· Presenting a paper at a national or international scientific conference.

· Writing a briefing or recommendations for action to senior decision and policy makers at the State and National levels.

· Preparing and conducting training sessions for first-year EIP Course trainees, and also for public health officers across all levels of the health system.

For a start the focus of the EIP Course will include a selected communicable disease from the MOH’s priority list, and subsequently may include non-communicable diseases. The early cohorts of trainees will also be taught how to provide training in field epidemiology to public health paramedics at peripheral levels (eg, health inspectors and public health nurses) to improve the efficiency and effectiveness of surveillance systems.

3. Budget

For 2002, RM 500 thousand was given under the One Off / Dasar Baru for this programme.

Budget will include:

· Incentives to attract external consultant.

· Workshop for curriculum development

· Allowance for field visits to trainees/trainers and for rapid response activities, eg, outbreak investigations and field surveys;

· Registration, travel and accommodation costs for staff development activities abroad and to present scientific papers at national/ international conferences.

4. The difference between Malaysian EIP and FETP from other countries.

Most FETP from other countries catered for non-Public Health doctors, i.e. those without the Master in Public Health. They will continue with a fulltime 2-year programme starting with basic epidemiology, statistic and public health lectures. However, in Malaysia, we will train medical doctors with MPH for a start. These fellows will be in the programme for 18 months as an in-service training. Both of the programmes have a similar model.

5. Benefits of the EIP to Ministry of Health and Public.

This is a cost-effective public health systems by strengthening and integrating health information systems, developing and strengthening individual, institutional and organisational capacity to provide core public health functions, and communicating public health messages and providing managers and decision-makers with timely information through national health bulletins.

The most visible aspect of the EIP comes from its support of field investigations for the control of diseases of local or national interest. The EIP will be part of an international network of training programmes in epidemiology and public health interventions (TEPHINET).

This programme will reduce the morbidity and mortality of infectious diseases in the country and will prevent the economic lost due to outbreak scare etc.

Last Updated ( Sunday, 20 January 2008 )

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