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COMMENTARY
Year : 2018  |  Volume : 62  |  Issue : 2  |  Page : 143-145  

India epidemic intelligence service: Advocating for a unique mentor-based epidemiology training program


Senior Visiting Fellow, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

Date of Web Publication14-Jun-2018

Correspondence Address:
Jai Prakash Narain
University of New South Wales, Sydney
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_336_17

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   Abstract 


To strengthen epidemiological capacity in the country, the Government of India in 2012 initiated a unique, competency-based training in epidemiology. Modeled along the United States Epidemic Intelligence Service (EIS), this 2-year mentor-driven and practical-oriented program, based on “learning by doing,” is being implemented by the National Centre for Disease Control in Delhi, in close collaboration with the US Centers for Disease Control and Prevention, Atlanta. In its 4th year now, many lessons learned so far are being used to expand the program, without compromising on the technical quality. Many including the trainees who have completed the program speak highly of the epidemiological skills imparted in real time and feel that if the India EIS program is “regionalized” and expanded rapidly, it could in due course transform public health in the country.

Keywords: EIS, Epidemiology, India, Training


How to cite this article:
Narain JP. India epidemic intelligence service: Advocating for a unique mentor-based epidemiology training program. Indian J Public Health 2018;62:143-5

How to cite this URL:
Narain JP. India epidemic intelligence service: Advocating for a unique mentor-based epidemiology training program. Indian J Public Health [serial online] 2018 [cited 2019 Oct 21];62:143-5. Available from: http://www.ijph.in/text.asp?2018/62/2/143/234504




   Introduction Top


India is currently in a state of epidemiological transition. The country's dual burden of disease is being fueled by social and economic determinants of health, as well as demographic changes, and by factors such as globalization, urbanization, and changing lifestyles. As a result, the health infrastructure is already under severe strain.[1],[2]

Addressing these challenges requires decision-making based on evidence relating to disease burden, the distribution, and its determinants. In this context, epidemiology as the discipline focuses on collection and analysis of data so crucial for program planning and strategy development, as well as for advocacy.

There, however, is a huge current shortfall in the country of an adequately trained public health workforce, including epidemiologists. This was underscored in 2002[3] as well as in 2017 National Health Policy documents.[4]

To augment the availability of skilled epidemiologists at the national, state, and local levels, the government launched in 2012 the India Epidemic Intelligence Service (EIS) training program.[5] This program is being implemented by the National Centre for Disease Control (NCDC), Delhi, in close collaboration with the US Centers for Disease Control and Prevention (CDC), Atlanta.

The training has been modeled on the best practices of the United States EIS (US EIS) of “training through service.” Since 1951, the US EIS program has trained more than 3000 highly skilled epidemiologists who are at the forefront of public health in the USA, as well as internationally, including in the WHO and other international organizations, contributing to global health security both domestically and abroad.[6],[7],[8]


   An Analytical Approach to Problem-Solving Top


The EIS training program is a competency-based, specialized yet practical training in epidemiology, which emphasizes on significant and consequential epidemiology. Significant refers to a public health approach characterized by analytic rigor based on best available evidence, while consequential reflects the practical application of results for better health outcomes.[6]

Intended to complement the efforts for and assist in the strengthening of the existing disease control programs and outbreak surveillance and response initiatives, the trainees develop their analytical public health skills while being placed in a public health program or a state health department for 2 years, under the technical guidance of experienced mentors.

The recruitment of officers is done on the basis of a process agreed to and approved by the Government of India. Each year, applications are invited for enrollment of a minimum of 15 outstanding public health professionals (12 from state-sponsored candidates and 3 for self-sponsored candidates). In 2016, the number of seats were increased to 25 (20 sponsored and 5 self-sponsored). The eligibility criteria include MBBS degree with 5 years of public health experience or MBBS plus MD with 2–3 years of experience.[9]

Selection of both sponsored and self-sponsored candidates from among the applicants is made on the basis of a stringent, three-tier recruitment process including initial screening by a private agency, followed by written test and interviews by a panel composed of NCDC, CDC, and Ministry of Health and Family Welfare officials. Those completing the training obtain a certificate signed by the Director of NCDC and the US CDC.

The implementation of the India EIS program is spearheaded by Director, NCDC, with Head of the Epidemiology Department as the operational focal point. Technical and financial support is provided by the US CDC. A CDC Resident Adviser has been in place since the beginning of the course, along with a Senior Adviser from the Government of India side during the initial 3 years. Besides epidemiology, all NCDC departments contribute to the program in various program areas such as laboratory, together with national programs and state health departments and medical colleges as placement supervisors and/or mentors.

The officers are supervised by the head of the organization or program they are placed in, referred to as placement supervisors who are responsible for providing administrative and logistical support such as office space and other facilities and ensuring access by the officers to data collection and analysis in real time. As stated already, the mentors are the senior public health experts who are matched with an officer and have committed themselves to provide any technical support as required by the officer, 24/7.

On completion, the graduates are expected to be posted in positions where their skills can be fully utilized such as state surveillance officers and state epidemiologist and this is conveyed by the union health secretary to his/her counterparts at the state level.

Currently, in its 4th year, the India EIS officers have had the opportunity to engage or participate, as a part of training, in various epidemiological investigations such as evaluation of surveillance systems of different national programs; surveillance and investigation of infectious disease outbreaks; and conducting epidemiological analysis of various public health problems (both communicable and noncommunicable) in the country, as well as communication of these findings through preparation of scientific reports/papers and conference presentations.[10],[11],[12],[13],[14]

Since the inception of the course in 2012, 55 (40 sponsored and 15 self-sponsored) candidates have been enrolled for the 2-year program. Of these, 42 have completed the course, 8 dropped out, and 13 are currently undergoing training.


   Lessons Learned So Far Top


Many lessons have so far been learned that are helping to expand the program, without compromising on the technical quality of the training initiative. These include the following:

Being a new program, most health officials and public health professionals initially were not fully familiar with the EIS program and the value it can bring to public health. To brief the state health directorates which are the major providers of trainees, visits have been made to the states, and health officials and medical college faculty engaged through tele- and video-conferencing. As a result, there is now an increased level of awareness and interest, especially among the young public health professionals. In fact, the number of applications from the self-sponsored candidates far outnumbers those that were sponsored by the states. There is also a gradual increase in demand for the course. In the US too, like in India, a certificate is offered but the program there is highly regarded and very much in demand. The program is recognized by the National Board of Examinations, and EIS graduates are eligible to appear for DNB Part 2 examination.

Clearly, the strength of the program lies in its mentors, who play a critically important role in grooming the young professionals in their learning process. So far, the mentors who are subject matter experts in epidemiology have been committed and extremely helpful. Moreover, this has also been acknowledged by the EIS officers/trainees themselves. Furthermore, given the size of the country, there is a need for expanding the enrollment and to build capacity in as many states as possible. Greater enrollment and “regionalization” can help ensure that we in due course have enough epidemiological capacity for so large a country as India.

While at present, state-level officials are being trained, and thereafter, plan is to train the district epidemiologists. The vision of the program is to have a trained epidemiologist in each district within the next 10 years. WHO India too has begun to use this training for epidemiological capacity building of its staff, namely national consultants.

To ascertain feedback from trainees of the first two cohorts (13 in number) who had completed the 2-year program, a survey was conducted recently using questionnaires mailed to them. Of the 11 who returned the questionnaires, 10 (90%) considered the training program to be extremely-to-very useful for their work (one rated it useful). The training was considered as unique as it was mentor-based, provided hands-on training and skills of epidemiological analysis of health problems in real-time situation including outbreak investigations and response. While all but one (who was not sure) thought that the program had the potential to transform public health in India, they enlisted many teething problems in training. These included administrative delays such as in payments before field visits for outbreak investigations on an urgent basis, competing priorities within organizations, and the need for greater advocacy and visibility of the program both at the central and at the state levels.

These administrative issues, as important as they are and those that are likely to emerge as program expands, are being addressed. Indeed, achieving India EIS program expansion to meet the epidemiological capacity needs of the country remains a huge and critical challenge.


   The Future Top


Against the background of burgeoning health problems and looming global health threats, an investment on developing and sustaining skilled epidemiological workforce is clearly the need of the hour. Such an investment is likely to have transformational impact.

To achieve this vision, the India EIS training program must be expanded in terms of scale as well as speed. This also requires investment from the Government both at central and at state levels and partnership with the private sector willing to support such a skill building initiative.

Clearly, if the cadre of highly trained and skilled epidemiologists can be developed and sustained, this will indeed transform public health in the country – the way US EIS program has done to CDC in that country, recognized today as a global leader in technical excellence and competence in public health! Moreover, this training program is an excellent example of skill building in public health in line with the National Skill Development Mission launched by the Prime Minister in August 2014.[15]

At the same time, NCDC should plan to have a critical appraisal conducted as soon as possible and this is best done by an agency or experts outside the program. Such an exercise can help objectively evaluate not only the strengths but also the bottlenecks in effective management and expansion of the program. The review should also ascertain systematically how the skills of the EIS graduates are being utilized by the states and programs, after completion of the course.

With enhanced epidemiological capacity, India would be sufficiently and technically equipped to respond to any public health challenge, be it Ebola, Zika, or any other emerging infection that may threaten global health security, or to address the challenge of communicable or noncommunicable diseases causing unacceptably high child or adult mortality, or to ensure surge capacity for rapid deployment in case of a public health emergency such as natural disasters such as cyclone and floods in any part of the country.

Such a specialized workforce in epidemiology, with the capacity to generate evidence and apply the analysis of that evidence to immediately solve problems, would have a far-reaching and positive impact, not only locally and nationally but also within the region and at the global level.



 
   References Top

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Narain JP. Public health challenges in India: Seizing the opportunities. (editorial). Indian J Commun Med 2016;41:85-8.  Back to cited text no. 1
    
2.
Narain JP, Tanzin D, Kumar R. Noncommunicable diseases: Health burden, economic impact and strategic priorities. In: Narain JP, Kumar R, editors. Text Book of Chronic Noncommunicable Diseases: The Health Challenge of 21st Century. Delhi: Jaypee Brothers Medical Publishers; 2016. p. 1-18.  Back to cited text no. 2
    
3.
Ministry of Health and Family Welfare. National Health Policy. Government of India. New Delhi: Ministry of Health and Family Welfare; 2002. Available from: http://www.nhp.gov.in/national-health-policy-2002_pg. [Last accessed on 2017 Aug 26].  Back to cited text no. 3
    
4.
Ministry of Health and Family Welfare, Government of India. National Health Policy-2017. New Delhi: Ministry of Health and Family Welfare; 2017. p. 28.  Back to cited text no. 4
    
5.
Ministry of Health and Family Welfare. Compendium of Operational Guidelines for Epidemic Intelligence Service Like Training Programme in India. New Delhi: NCDC, DGHS, MoHFW; 2016. p. 1-16.  Back to cited text no. 5
    
6.
Koplan JP, Thacker SB. Fifty years of epidemiology at the centers for disease control and prevention: Significant and consequential. Am J Epidemiol 2001;154:982-4.  Back to cited text no. 6
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Robelotto D. History of Protecting America: The Epidemic Intelligence Service. Global Health; April, 2017. Available from: https://www.leadership.saportareport.com/globalhealth/2017/04/17/history-protecting-america-epidemic-intelligence-service/. [Last accessed on 2017 Dec 16].  Back to cited text no. 7
    
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Al-Shawaf M, Eaton D, Gronostaj M. CDC's zika response – Role of epidemic intelligence service officers in 2016–2017. Ann Epidemiol 2017;27:522.  Back to cited text no. 8
    
9.
NCDC. Inviting Applications for 2-Year India Epidemic Intelligence Service Programm. Available from: http://www.ncdc.gov.in/writereaddata/linkimages/EIS_Ad20162348994779.pdf 17. [Last accessed on 2017 Mar 10].  Back to cited text no. 9
    
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Yadav R, Garg R, Manoharan N, Swasticharan L, Julka P, Rath G, et al. Evaluation of Delhi population based cancer registry and trends of tobacco related cancers. Asian Pac J Cancer Prev 2016;17:2841-6.  Back to cited text no. 10
    
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Dhanaraj B, Papanna MK, Adinarayanan S, Vedachalam C, Sundaram V, Shanmugam S, et al. Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India. PLoS One 2015;10:e0124260.  Back to cited text no. 11
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Kumar T, Shrivastava A, Kumar A, Laserson KF, Narain JP, Venkatesh S, et al. Viral hepatitis surveillance – India, 2011-2013. MMWR Morb Mortal Wkly Rep 2015;64:758-62.  Back to cited text no. 12
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Shrivastava A, Srikantiah P, Kumar A, Bhushan G, Goel K, Kumar S, et al. Outbreaks of unexplained neurologic illness – Muzaffarpur, India, 2013-2014. MMWR Morb Mortal Wkly Rep 2015;64:49-53.  Back to cited text no. 13
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Yadav R, Swasticharan L, Garg R. Compliance of specific provisions of tobacco control law around educational institutions in Delhi, India. Int J Prev Med 2017;8:62.  Back to cited text no. 14
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Economic Times. Government is Committed to Skill Development. Available from: http://www.economictimes.indiatimes.com/industry/et-auto/news/industry/Govt-is-committed-to-skill-development/articleshow/41062740.cms. [Last accessed on 2017 Aug 26].  Back to cited text no. 15
    




 

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