One Field Epidemiologist per 200,000 Population: Lessons Learned from Implementing a Global Public Health Workforce Target

Abstract

The World Health Organization monitoring and evaluation framework for the International Health Regulations (IHR, 2005) describes the targets for the Joint External Evaluation (JEE) indicators. For workforce development, the JEE defines the optimal target for attaining and complying with the IHR (2005) as 1 trained field epidemiologist (or equivalent) per 200,000 population. We explain the derivation and use of the current field epidemiology workforce development target and identify the limitations and lessons learned in applying it to various countries' public health systems. This article also proposes a way forward for improvements and implementation of this workforce development target.

Keywords: Epidemic management/response; Field epidemiology; Global health security; Workforce development.

Figure 1.

Public Health Functions Needing an Epidemiologic Workforce

Figure 2.

Joint External Evaluation (JEE) and International Health Regulations (IHR, 2005) target of 1 epidemiologist per 200,000 population (dotted diagonal line) and epidemiologists trained (■) for CDC’s 17 Global Health Security Agenda (GHSA)-supported countries, 2018 (reference #19). Panel A shows the 11 countries with populations <60 million, whereas panel B shows the 6 countries with populations ≥60 million. Overall, the number of epidemiologists trained in FETPs is small relative to the country’s population and varies minimally over 3 orders of magnitude (between 5 and 1,300 million population). Accordingly, the gap in epidemiologic workforce difference between epidemiologists trained and target is highly related to the population size. Of the 17 countries, 3 have achieved their 1 per 200,000 target (Panel A). One has the smallest population (5 million) and 2 have population of 41 and 50 million with FETPs operational for 20–30 years.