©2011 Otto et al; licensee BioMed Central Ltd.
Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005)
1Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA
2Department of Environmental and Global Health, College of Public Health and Health Professions University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
3Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
4Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
5Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
6U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
7Makerere University Walter Reed Project, Influenza Research Programme, Post Office Box 7062, Kampala, Uganda
8University of Iowa Center for Emerging Infectious Diseases, 2501 Crosspark Road, MTF B145, Coralville, Iowa 52241, USA
9Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
10Medical Brigade/USAMEDDAC-Korea, Unit 15281, APO AP 96205-5281, USA
11Public Health Region-Europe, CMR 402, APO AE 09180, USA
12Navy Environmental Preventive Medicine Unit 2, 1887 Powhatan Street, Norfolk, VA 23511-3394, USA
13Pacific Air Forces, 990 Scott Circle, Hickam Air Force Base, HI 96853, USA
14U.S. Air Force School of Aerospace Medicine, Epidemiology Consult Service, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
15Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
16University of Buea, Department of Biochemistry and Microbiology, Faculty of Science, Post Office Box 63, Buea, South Western Province, Cameroon
17Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
18Public Health Region-South, Building 2472 Schofield Road, Fort Sam Houston, TX 78234, USA
19Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta, 10560, Indonesia
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Experts note a growing realization that to improve global public health substantially, a training agenda must be developed that will sustainably educate the public health work force. Numerous training efforts now exist, but more comprehensive and coordinated approaches are needed. Some of these current efforts are extremely robust, such as the Field Epidemiology and Laboratory Training Program (FELTP), long considered the gold standard in public health training. However, this program reaches limited numbers of public health officials due to its comprehensive nature [12
]. To fill this gap, shorter-term field, laboratory and academic training options are needed [13
]. These directed training opportunities allow for the rapid acquisition of specialized skills, especially in laboratory techniques, outbreak investigation, and response and control of emerging infectious disease. Importantly, they serve a key role in supporting the implementation of the IHR (2005) and in meeting the local and regional public health needs of developing countries.
Epidemiologic and laboratory training are key components of public health capacity building, and thus, represent an important strategic goal of the AFHSC-GEIS network. From September 2008 through October 2009, the AFHSC-GEIS network, through 18 partner organizations, conducted 123 training initiatives in 40 countries that reached 3,130 U.S. and host-country personnel. Expanded training activities in the areas of pandemic preparedness, outbreak investigation and response, EID surveillance, and pathogen diagnostic techniques have contributed to building robust capabilities at the local level, in direct support of the implementation of IHR (2005).
In addition to documenting the educational initiatives of AFHSC-GEIS partners, this review provides recommendations for improving training activities that merit attention. The first and second recommendations are “global” in nature, requiring action by entities outside AFHSC-GEIS. The third and fourth recommendations are internal to AFHSC-GEIS, relating to quality improvement. Finally, the fifth recommendation requires the action of other entities, as well as AFHSC-GEIS itself.
First, coordinate training initiatives among partners to avoid unnecessary duplication and maximize resources to address gaps. This should be done with other state and non-state entities (CDC and WHO), as well as nongovernmental organizations, academia and other groups involved in global public health education. Training is an essential but time-consuming activity. Training conducted by AFHSC-GEIS partners in fiscal 2009 appear to be largely project-specific and do not seem to be closely coordinated within regions or between partners. As shown in Figure , respiratory infections (namely influenza) represented the majority of training initiatives (68 percent) in fiscal 2009. Although these educational efforts targeting influenza were important, especially in light of the recent pandemic, increased coordination and communication among partners may have brought focus to gaps in training, such as in sexually transmitted infections, one of the AFHSC-GEIS pillars (Figure ).
Second, plan and develop training initiatives in a strategic, systems manner.
A strategic and systematic approach to identifying training needs and developing educational initiatives would enhance coordination of efforts, assist in identifying appropriate subject matter experts and lessen the burden on any single organization. Such an approach could allow for increased efficiency and reduce duplication of efforts. Several efforts are under way to catalog or map education efforts, with the intention of fostering collaboration. The efforts include the AfriHealth project and WHO’s Knowledge Management for Public Health [15
Third, enhance the involvement of central headquarters in coordinating and supporting training initiatives. Increased central coordination and scientific direction for AFHSC-GEIS projects can make existing training activities more efficient, productive and visible. Individual project progress may also benefit from more frequent scientific guidance. Given its ability to set policy and priorities for the global AFHSC-GEIS network and to interface with other interagency partners, AFHSC-GEIS is in a unique position to provide coordination and support of training initiatives.
Fourth, establish a central repository of training materials used in AFHSC-GEIS-funded training initiatives. A central repository of presentation slides, handouts, exercises and information on laboratory training kits would give partners a starting point from which to plan and coordinate their training activities.
Finally, implement evaluation metrics, including measurements of learning objectives and competencies (i.e., pre- and post-tests, self-assessments and learner satisfaction). Evaluation of the training initiatives is perhaps one of the most important steps. Simple pre- and post-tests could greatly enhance the efficiency and effectiveness of the training initiatives and identify the types of training that are the most successful and meaningful to the host country. Assessing the quality of training through a monitoring and evaluation framework across training programs, as well as assessing whether the level of sophistication is appropriate for the target audience, would be helpful.
The widespread realm of topics and geographic regions covered in the AFHSC-GEIS-funded training initiatives build on the center’s objective of worldwide emerging infectious disease surveillance and response. The training initiatives mentioned in this review all fall directly under the focus areas and targeted efforts of the IHR (2005) in developing the core competencies to identify, respond to and control public health threats and potential public health emergencies of international concern around the world. These AFHSC-GEIS-funded training initiatives serve as a conduit for member states and neighboring countries to communicate and collaborate on emerging infectious disease planning and development of their national strategies for addressing complex public health emergencies. Funding of training initiatives that enhance global emerging infectious disease planning and surveillance will greatly benefit the world’s population by preparing member states to address emerging infectious disease outbreaks in the future.