Академический Документы
Профессиональный Документы
Культура Документы
Dr Jai P Narain
Senior 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
Global Disease Detection Network
CDC-Funded Global Disease Detection Regional Centers
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
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.
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
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
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 programme
for 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
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
US Model Adapted for India
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 rapid
outbreak response throughout the country.
• To facilitate a more integrated approach to public
health practice through integration of field and
laboratory 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
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, communic
ation etc)
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
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
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
Two-Year Schedule
First Year Second Year
Inception course (4 wks) Month 13 – leadership
Placement workshop
Month 4 – surveillance Month 16 --
communication training
workshop
India EIS Conference
Month 7 – scientific writing
International Conference if
Month 10 – India EIS abstract accepted
Conference Visit to Atlanta for upto 4
Weekly Tuesday Afternoon weeks
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, presentatio
n)
• 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
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
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013
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
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