Field Epidemiology and Laboratory Training Program, Where Is the L-Track?

Abstract

Background: Modifications of the Field Epidemiology Training Program (FETP) curricula to include a laboratory track (L-Track), to become Field Epidemiology and Laboratory Training Program (FELTP), began in 2004 in Kenya. The L-Track offered candidates training on laboratory competencies in management, policy, quality systems, and diagnostic methods as well as epidemiology, disease surveillance and outbreak response. Since then several FELTPs have discontinued the L-Track and instead offer all candidates, epidemiologists and laboratorians, a single FETP curriculum. Reasons for these changes are reported here. Methods: A questionnaire was sent to directors of 13 FELTP programs collecting information on the status of the programs, reasons for any changes, basic entry qualifications, source institutions and where residents were post enrollment or after graduation. Data from previous CDC internal assessments on FELTP L-Track was also reviewed. Results: Out of the 13 FELTPs included, directors from 10 FELTPs sent back information on their specific programs. The FELTPs in Kenya, Mozambique, Cameroon and Kazakhstan and Mali have discontinued a separate L-Track while those in Ghana, Georgia, Nigeria, Rwanda, and Tanzania continue to offer the separate L-Track. Reasons for discontinuation included lack of standardized curriculum, unclear strategies of the separate L-Track, and funding constraints. Two countries Kenya and Tanzania reported on the career progression of their graduates. Results show 84% (Kenya) and 51% (Tanzania) of candidates in the FELTP, L-Track were recruited from national/regional medical health laboratories. However post-graduation, 56% (Kenya) and 43% (Tanzania) were working as epidemiologists, program managers, program coordinators, or regulatory/inspection boards. Professional upward mobility was high; 87% (Kenya) and 73% (Tanzania) residents, reported promotions either in the same or in new institutions. Conclusions: The FELTP L-Track residents continue to offer critical contributions to public health workforce development with high upward mobility. While this may be a reflection of professional versatility and demand of the FELTP graduates, the move from core laboratory services underscores the challenges in filling and retaining qualified staff within the laboratory systems. Results suggest different strategies are needed to strengthen laboratory management and leadership programs with a clear focus on laboratory systems and laboratory networks to meet current and future clinical and public health laboratory workforce demands.

Keywords: FELTP; L-track; global health security; laboratory track; laboratory workforce.

Figure 1

Field Epidemiology & Laboratory Training Programs (FELTP) L-Track Implementation Timeline shows the implementation of Field Epidemiology & Laboratory Training Programs (FELTP) L-Track from 2004 to 2011, a total of 20 countries had either a national or regional FELTP program.

Figure 2

Challenges Identified in Implementing L-Track Curriculum. The main challenges facing the FELTP L-Track implementation as cited by FELTP 10 respondents. Majority stated that FELTP L-Track had structural challenges due to lack of clarity on its purpose. Other reasons included curriculum not viable, limited applicants and funding constrains.

Figure 3

Source Institutions for FELTP Laboratory Residents. The institutional recruitment sources of FELTP L-Track trainees. Majority of recruitments were sourced from national and regional public health or clinical laboratories. A small number were from Ministry of Agriculture, nongovernmental organization and academic institutions.

Figure 4

Cumulative Enrollment and Graduates of FELTP L-Track in 7 Countries. The cumulative number of laboratory residents enrolled in FELTP from beginning of each program up to the time of survey in April 2016. Nigeria has the highest cohort and continue to build their number of trained FELTP L Track residents.

Figure 5

Tanzania FELTP lab resident positions. (A) The employment position categories for FELTP residents prior and post enrollment in Tanzania. Majority of residents were laboratory scientists before joining FELTP but there was a big diversification of areas where residents were employed post enrollment. (B) Kenya FELTP Laboratory Residents Positions. The employment position categories for FELTP residents prior and post enrollment in Kenya. Majority of residents were laboratory scientists before joining FELTP but there was a big diversification of areas where residents were employed post enrollment, a majority becoming Coordinators.