Evaluation of Ethiopia’s field epidemiology training program – frontline: perspectives of implementing partners

Abstract

Background Field Epidemiology Training Program (FETP) has been adopted as an epidemiology and response capacity building strategy worldwide. FETP-Frontline was introduced in Ethiopia in 2017 as a three-month in-service training. In this study, we evaluated implementing partners’ perspectives with the aim of understanding program effectiveness and identifying challenges and recommendations for improvement. Methods A qualitative cross-sectional design was utilized to evaluate Ethiopia’s FETP-Frontline. Using a descriptive phenomenological approach, qualitative data were collected from FETP-Frontline implementing partners, including regional, zonal, and district health offices across Ethiopia. We collected data through in-person key informant interviews, using semi-structured questionnaires. Thematic analysis was conducted, assisted with MAXQDA, while ensuring interrater reliability by using the consistent application of theme categorization. The major themes that emerged were program effectiveness, knowledge and skills differences between trained and untrained officers, program challenges, and recommended actions for improvement. Ethical approval was obtained from the Ethiopian Public Health Institute. Informed written consent was obtained from all participants, and confidentiality of the data was maintained throughout. Results A total of 41 interviews were conducted with key informants from FETP-Frontline implementing partners. The regional and zonal level experts and mentors had a Master of Public Health (MPH), whereas district health managers were Bachelor of Science (BSc) holders. Majority of the respondents reflected a positive perception towards FETP-Frontline. Regional and zonal officers as well as mentors mentioned that there were observable performance differences between trained and untrained district surveillance officers. They also identified various challenges including lack of resources for transportation, budget constraints for field projects, inadequate mentorship, high staff turnover, limited number of staff at the district level, lack of continued support from stakeholders, and the need for refresher training for FETP-Frontline graduates. Conclusions Implementing partners reflected a positive perception towards FETP-Frontline in Ethiopia. In addition to scaling-up the program to reach all districts to achieve the International Health Regulation 2005 goals, the program also needs to consider addressing immediate challenges, primarily lack of resources and poor mentorship. Continued monitoring of the program, refresher training, and career path development could improve retention of the trained workforce.

Evaluation of field epidemiology training programs: a scoping review

“…Table 1 presents the characteristics of the studies along with a summary of their findings. The evaluations covered the three different program modalities in various countries or regions, including Yemen ( 12 ), Ethiopia ( 13 , 14 ), Guinea ( 15 ), Tanzania ( 16 ), United Kingdom ( 17 ), South Africa ( 18 ), Kenya ( 19 ), Ghana ( 20 ), India ( 9 ). Two studies evaluated the FETPs in selected countries in the EMR ( 7 , 8 ).…”

“…Two studies evaluated the FETPs in selected countries in the EMR ( 7 , 8 ). Five studies evaluated the frontline FETP ( 7 , 13 – 15 , 19 ), one study evaluated the intermediate FETP ( 16 ), and six studies evaluated the advanced FETP ( 8 , 9 , 12 , 17 , 18 , 20 ). Ten studies were published between 2019 and 2023 ( 7 , 8 , 12 – 19 ), and two studies were published between 2011 and 2012 ( 9 , 20 ).…”

“…One study included the technical staff ( 12 ). In addition, some studies included the policymakers ( 12 ), key informants from FETP implementing partners ( 13 ), heads of district health offices ( 13 ), a director of a health facility ( 15 ), epidemiologists, consultants in health protection, information scientists, and administrative staff ( 17 ).…”

The Field Epidemiology Training Program’s Contribution to Essential Public Health Functions in Seven National Public Health Institutes

“…There are noted challenges in how FETP are linked with universities, ministries, and international agencies, and in the process of how FETP becomes institutionalized [ 19 , 20 ]. FETP graduates in Ethiopia and Tanzania also suggested to provide refresher courses and additional training, as well as to improve mentorship [ 21 , 22 ].…”

Attack Rate, Case Fatality Rate and Predictors of Pertussis Outbreak During Pertussis Outbreak Investigation in Ethiopia: Systematic Review and Meta-Analysis

“…In 2009 and 2017, Ethiopia introduced advanced field epidemiology and frontline programs, respectively to improve outbreak identification and investigation [ 23 ]. Meta-analysis is a widely-used tool that integrates findings from various studies to inform decision-making in evidence-based medicine [ 24 ].…”