CDC Launches New Noncommunicable Disease Training for Field EpidemiologistsPosted on by
Noncommunicable diseases (NCDs) are responsible for nearly 40 million deaths each year which represents almost three quarters of all deaths worldwide. These include deaths caused by injuries, such as motor vehicle injuries, and chronic diseases, such as cardiovascular disease, cancer, diabetes, and chronic respiratory diseases. Deaths due to NCDs are becoming more common in low- and middle-income countries, where the majority of NCD deaths occur and health systems are often not equipped to respond. The enormous social and economic toll of NCDs worldwide calls for an integrated strategic approach to reduce illnesses and deaths due to NCDs globally.
As an ORISE fellow with the Field Epidemiology Training Program (FETP) Branch in CDC’s Center of Global Health’s Division of Global Health Protection (proposed), for the last six months I have been coordinating the NCDs curriculum development process for the Field Epidemiology Training Program (FETP). This was the culmination of a two-year project undertaken by CDC, where subject matter experts from various centers provided technical expertise and capacity building support in piloting the NCDs curriculum and field activities, globally. Through the NCD curriculum coordination process, I have learned more about CDC’s global engagement. Working with teams that span across the various WHO regions, each decision is a practical exercise in adaptation and fidelity to the core. The nature of NCDs requires multisectorial partnerships, which are getting stronger and supporting the development of more evidence base by FETP residents and others. It’s very exciting to be working in an area that shows promise of reducing the global burden of disease and disability and to experience first-hand how CDC works with partners to support capacity building.
As part of its global strategy, CDC partnered with various ministries of health to support capacity building efforts to address the growing burden of NCDs. One aspect of these efforts was to support workforce development using the successful platform of the FETP program. FETPs include training and complementary field projects that provide opportunities for experiential learning not only for FETP residents, but also for the staff at the Ministry of Health (MOH). The aim of the capacity building activities is to develop competencies and leadership in surveillance, epidemiology, prevention and control of morbidity related to chronic diseases, maternal child health and injury.
Developing Noncommunicable Diseases Training Materials
The CDC developed a series of 24 NCD training modules. These training materials, along with complementary experiential field projects and active mentorship, are designed to increase competencies for NCDs epidemiology, and surveillance in areas such as analyzing and interpreting large datasets , prevention planning and program evaluation. The training modules are designed to be adaptable. The materials were developed with plain language principles and are available through the CDC website. There are three general categories: introductory, advanced and management. (See the training modules.)
In 2011, these modules were piloted in 5 countries across the WHO regions: China, Colombia, Jordan, Tanzania, and Thailand. Training also took place during workshops held at regional scientific conferences. Since tackling NCDs requires a multisectoral approach, the NCDs training was given in different settings to a variety of audiences. The modules were used to train public health workers, such as epidemiologists and staff at different levels of the MOH). The NCDs training modules were implemented as short courses with targeting managers in decision-making roles at the local and district level. Training of Trainer (TOT) courses were also held, to support the ability of MOH staff to promote NCDs activities and partnerships within their jurisdictions.
In Tanzania, one of the focus countries, training took place with district level health officers in a short course format. These officers were in a position to make management decisions based on data resulting from their field projects. In Latin America, the modules were translated to Spanish and disseminated through webinars to wider audiences. This will allow the modules to be used with Spanish language health workers, promentoras and other appropriate audiences in the US.
Adapting the Modules
There is an FETP presence in almost 70 countries. With burden of disease, and national approaches to NCDs ranging across the various MOHs, integration of NCDs activities to the standard FETP process will require flexibility and adaptability. The pilot process in the 5 countries has revealed implementation best practices, which can inform wider dissemination. The modules have been adapted to the local context through utilizing country-relevant case studies. Strong mentorship from experts with knowledge of local NCDs needs and institutions have resulted in field activities that are evidence based and relevant for decision-makers.
Also, similar materials have been developed for diverse audiences. For some topic areas, such as program planning, there is one version of the module which provides a short overview to audiences with limited knowledge of epidemiology and another for audiences with more advanced knowledge.
Training Multisectorial Audiences
At a UN High-level meeting on Prevention and Control of NCDs that took place in fall of 2011 the nature of the multisectorial factors affecting many noncommunicable diseases were discussed (UN Declaration). In the pilot countries, in addition to training individuals, there were also activities to strengthen infrastructure (for multisectorial collaboration) to increase the system’s ability to address NCDs.
One example of infrastructure strengthening was the development of a Chronic Disease Center in Pasto, Colombia. At this center, public health practitioners, researchers, and policy makers worked collaboratively to collect and analyze data for evidence based decision-making. One of initiatives that the Chronic Disease Center supported at the district level is increased enforcement of smoke-free policies. Partnerships in areas such as social services, police and traffic safety sectors are key to reducing NCDs burden of disease through illness, long-term disability and death.
Next steps will be to evaluate and better understand the impact of the field projects supported by the NCDs curriculum. Expansion of best practices through knowledge sharing, peer-learning, and development of communities of practice are under way. Careful evaluation will show how to better integrate the NCDs modules into the traditional FETP core curriculum and improve its flexibility to address country needs and priorities.