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

2. EPIDEMIC INTELLIGENCE SERVICE
PROGRAMME
Dr.Mahboob ali khan Phd

3. 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

4. Global Disease Detection Network
CDC-Funded Global Disease Detection Regional Centers

5. 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.

6. 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

7. 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

8. 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

9. 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

10. • Personally recognize it as one of the
best training programs in epidemiology

11. “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

12. 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

13. 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”

14. 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

15. India EIS First Cohort, 4th October 2012
(announcement for the 2
nd
batch soon)

16. 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

17. 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

18. 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)

19. 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

20. 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


21. 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

22. 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

23. 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

24. 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

25. 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!

26. For details, please see:
www.ncdc.nic.in
Thank you

27. 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

28. 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

29. 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

30. 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 1
st
cohort
* 2 slots available for non-sponsored candidates

31. 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


32. Q. Is EIS a training program or a
service program?

33. Q. Is EIS a training program or a
service program?
A. Yes
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013

34. 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

35. 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)

36. 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!