Building the Cadre of Disease Detectives in Tanzania

While it is impossible to see a virus enter a room or cross a border, the COVID-19 pandemic reminds the global community that emerging infectious diseases pose pandemic threats.

Fortunately, the US Centers for Disease Control and Prevention (CDC) works around the world to train epidemiologists and field workers to prevent, detect, and control new diseases through their flagship Field Epidemiology Training Program (FETP). For over 40 years, FETP has provided technical assistance and capacity building to field epidemiologist to prepare and mitigate disease outbreaks worldwide. To enhance effectiveness and accelerate disease detection, FETP includes three tiers:

• Advanced two-year training program
• Intermediate six-month training program
• Frontline three-month training program

Some countries, like Tanzania, integrated a laboratory training component, evolving FETP into the Field Epidemiology and Laboratory Training Program (FELTP). After program completion, graduates are known as disease detectives and act as boots on the ground responders to help track, contain, and eliminate outbreaks for diseases such as cholera, measles, Ebola, anthrax and now, COVID-19.

Tanzania began its CDC-funded FELTP program with the Advanced tier in 2008 in collaboration with the Ministry of Health Community Development Gender Elderly and Children, (MOHCDGEC) and Muhimbili University of Health and Allied Sciences (MUHAS). The Intermediate course was added in 2016. The Frontline course was added in 2015 through a partnership between CDC, MOHCDGEC, and the Defense Threat Reduction Agency (DTRA). Funding for the Advanced and Intermediate FELTP programs were supported through the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative.

Like elsewhere, Tanzania’s FELTP adopted a competency-based approach where trainees spend 25% of their time in class and the other 75% in the field. Additionally, Tanzania includes a “One Health” approach, focusing on the symbiotic relationship between human health, animal health, and the environment. Graduates support MOHCDGEC in disease outbreak investigations, surveillance activities, surveys, and operational research on national health problems.

To date, Tanzania’s FELTP program has graduated more than 750 residents across the three tiers. In 2018, the Advanced program was recognized for global standards by the Training Programs in Epidemiology and Public Health Interventions Network international accreditation. Tanzania is the 5^th country in Africa and 13^th worldwide to achieve this status.

FELTP Graduates Respond to COVID-19

The FELTP was instrumental in building the base for Tanzania’s COVID-19 response. When the first case of COVID-19 was identified in March 2020, the program immediately engaged residents and graduates in all MOHCDEGC’s technical response pillars. FELTP graduates and residents supported the Public Health Emergency Operations Center, provided laboratory support, assisted in points of entry screenings, and helped with overall coordination, risk communication and surveillance.

Graduates and residents also provided support at the sub-national level. Successes include:

• Supported adaptive surveillance at the regional level: In a region in central Tanzania, FELTP graduates and community health workers provided education about the spread, symptoms, and response to COVID-19 at various community sites. They provided education to 549 households, 40 religious leaders, six taxi stands, four mobile markets, two burial ceremonies, and other community sites to assure citizens are aware of how to protect themselves and the role they play in protecting others.
• Enhanced point of entry screening at international airports: FELTP residents assisted in the screening of passengers at Zanzibar’s Abeid Karume International Airport. COVID-19 can cross borders through travelers. Zanzibar, a semi-autonomous island off the coast of Dar es Salaam (a major city and commercial port), depends heavily on tourism. FELTP graduates helped to identify ill travelers and supported exit and entry screenings. Border screening is essential to keep Zanzibari citizens safe and stop the spread of COVID-19 on the island.
• Educated regional and district officials: In March 2020, FELTP graduates provided health education to members of the Kilwa District security committee and other council members. This helped communities prepare for a potential spread, alleviate fear and reduce rumors.
• Managed data and alerts: In Dar es Salaam, FELTP residents staffed the alert management desk at the Emergency Operations Center and analyzed data about the reported cases. This technical work is important for tailoring response efforts and utilizing resources in an efficient and effective manner.

Building Program Sustainability Through Government Ownership

Tanzania’s three-month FELTP Frontline course teaches district level disease detectives on public health surveillance, field investigation, epidemiologic methods, and communication. Since beginning in 2015, over 500 residents from all 31 regions in Tanzania and Zanzibar have graduated from the program.

With an emphasis on field work and direct exposure, trainees have completed:

• More than 8,000 weekly surveillance reports
• More than 1,500 Integrated Disease Surveillance and Response (IDSR) data quality audits
• More than 1,000 problem identifications and analysis
• 17 outbreak identifications and investigations

Successes of the program include:

• Improved timeliness and completeness of IDSR and Animal Disease Surveillance (ADS) reporting
• Addressing data quality audit problems at no cost
• Introducing a weekly reporting system for animal surveillance
• Submitting abstracts and presenting at national and global scientific conferences

As part of sustainability strategies, the Frontline FELTP course was transitioned to Muhimbili University of Allied Science (MUHAS) in May 2021. While CDC will continue to provide technical support, this critical transition helps to institutionalize the program and highlights a clear commitment between MOHCDGEC and MUHAS to continue educating the public health workforce.

COVID-19 reinforced the fact that public health emergencies affect more than people’s health – they can impact economies, destabilize geopolitical environments, and impact a country’s national security. FELTP graduates are equipped to prevent the devastating consequences of public health emergencies. In Tanzania, FELTP graduates and residents protect citizens from emerging and ongoing disease threats. These detectives use their training to investigate and identify invisible threats for the health and wellbeing of Tanzanians across the country.