The document discusses the establishment of an Epidemic Intelligence Service (EIS) program in India, modeled after the US EIS, aimed at enhancing the country's epidemiological capacity. It outlines the program's objectives, training methods, eligibility criteria, and key milestones since its inception in October 2012. The initiative emphasizes the importance of building competent field epidemiologists to address public health challenges through a collaborative effort between the US and Indian health authorities.

2. EPIDEMIC INTELLIGENCE SERVICE
PROGRAMME
Dr.Mahboob ali khan Phd

3. The Changing Paradigm of Health
• A nation in transition; major improvements
in last 50 years but progress uneven
• Old and new challenges (epidemiological
transition); factors driving ill-health
(poverty, inequities) persist; also new
opportunities (partnerships, technology)
• National capacity building & international
collaboration are critical for responding to
these challenges

4. Global Disease Detection Network
CDC-Funded Global Disease Detection Regional Centers

5. GDD partnership
India – USA
President Barack Obama hosted Indian
Prime Minister Manmohan Singh at the
White House in November 2009. Letter
of Intent to establish a GDD center in
India signed.
Dr. L.S. Chauhan and Dr. T
Frieden sign MOU during
President Obama’s visit to
India, November 2010.

6. GDD India Centre (GDDIC)
National Centre for Disease
Control Delhi, India
•NCDC
•Centre Staffing
CDC
NCDC
GDDIC
• Priority areas:
- Epi training (EIS)
- Foodborne diseases
- Acute encephalitis syndrome
- Research

7. What is EIS?
EIS = Epidemic Intelligence Service
• In the US, it’s a competency-based
training in epidemiology; an on-the-job
service-based learning (shoe-leather)
• Mentors play a key role
• Trainees called “EIS Officers”
• Approved as Super Specialty programme
for Epidemiology Training

8. US Epidemic Intelligence Service (EIS)
• Vision of Alexander Langmuir
to provide
“ adequate epidemiologic facilities to
investigate outbreaks of disease
in strategic areas.”
• Initiated in 1951
• More than 3000 trained already
• Apprentice program analogous
to postgraduate residency

9. US model
• The EIS training, based at the U.S. Centers
for Disease Control and Prevention (CDC), is a
2-year program
• EIS Officers engage in outbreak investigation,
design and analyze epidemiological studies,
evaluate surveillance data, and make
scientific communications

10. • Personally recognize it as one of the
best training programs in epidemiology

11. “Significant and Consequential”
Epidemiology
• Significant: refers to the analytical rigor of
the public health approach and the validity
of the results
• Consequential: reflects the practical
application of the results, trying to make
a difference in health outcomes
Ref: Koplan and Thacker, Am J. Epid. 2001

12. US Model Adapted for India
• Only country outside of US
to initiate an EIS Programme
• The India Programme
modeled after the U.S.
Programme, but adapted to
the situation in India
• Will help further strengthen
epidemiological capacity
presently lacking in most states
• Run by NCDC, Delhi in close
collaboration with US CDC

13. Objectives
• “To create highly competent field
epidemiologists within the public health sector.
• To produce a critical mass of graduates that
meet national needs for public health officers.
• Strengthen public health system through rapid
outbreak response throughout the country.
• To facilitate a more integrated approach to public
health practice through integration of field and
laboratory component”

14. Key Milestones in Developing India EIS
• Steering committee headed by Secretary Health
& Family Welfare approve the model in July 2011
• Series of consultation meetings spearheaded
by NCDC
• Letter from Secretary Health to his counterparts
in states
• Advocacy meetings held with State Health
Secretaries/ Director Health Services
• Course announced in June 2012

15. India EIS First Cohort, 4th October 2012
(announcement for the 2
nd
batch soon)

16. Eligibility Criteria
• MBBS and MD (Public Health) or
MBBS and MD (Clinical or Para-Clinical) with
2 years experience in Public Health
AND
• Age 25–45 years at time of
application AND
• Presently working* for the Central or State
Government, PSUs e.g ESI or Railways; Municipal
Corporations, Local Bodies, etc (state sponsored)
* non-Government employees can also apply

17. Desirable Characteristics of the
Candidate
• Meets eligibility criteria
• Committed to career in public health in India
• Flexible re: assignments and work conditions
• Able to work independently (self-motivated)
• Can work in team, responsive to supervision
• Quantitative and problem-solving aptitude
• Has computer skills

18. Training Methods
• Mostly experiential (on-the-job)
• Mentoring essential
• Classroom courses (≤10 weeks out of 104)
• Weekly seminar (attendance mandatory)
• Annual India EIS Conferences
• Other (i.e workshop on
surveillance, scientific
writing, leadership/management, communic
ation etc)

19. Core Activities of Learning (“CALs”)
1. Field investigation
2. Epidemiological analysis
3. Surveillance analysis, evaluation
4. Oral scientific presentation — long
5. Oral scientific presentation — brief
6. Visual/graphic aids
7. Scientific manuscript for a peer-reviewed journal
8. Public health update — concise and timely
9. Scientific abstract(s)
10. Presentation(s) to non-scientific audience, media.
11. Other services to agency

20. Two-Year Schedule
First Year

Inception course (4 wks)



Placement



Month 4 – surveillance
workshop


Month 7 – scientific writing



Month 10 – India EIS
Conference

Weekly Tuesday Afternoon
Seminars
Second Year

Month 13 – leadership
workshop


Month 16 --
communication training


India EIS Conference


International Conference if
abstract accepted


Visit to Atlanta for upto 4
weeks


21. Inception Course (4 weeks)
• Topics:
– Descriptive epidemiology
– Outbreak investigation
– Surveillance
– Analytic epidemiology (some)
– Epi Info
– Public health systems of India
• Methods
– Lecture, exercises, case studies
– Field exercise (data
collection, analysis,
presentatio n)
• Approach
– Hands-on, interactive

22. Placement Sites
• Primarily in government sector
• Placement sites: national Programs or in
the State Health Dept
• Officer will not be placed in sponsoring state
or program (should go some where ‘new’!)
• Cluster of support: mentor for technical
guidance 24/7, placement supervisor (for
administrative support) and a NCDC co-
mentor

23. Evaluation
• Six monthly jointly by Mentors
and Supervisors
• Candidates will be evaluated for
knowledge, skills and services rendered
during the training period
• Certificate at the end, after successful
completion of training, given jointly by US
CDC and NCDC

24. Why Invest in the EIS Programme?
• An investment for public health in India;
analytical approach & generating evidence
that could drive policy and programme
• After 2 years, India EIS graduate will return:
• As a highly skilled epidemiologist
• Potential mentor for future EIS Officers
• Networked to other practicing epidemiologists
throughout India
• Someone who can raise visibility of the programmes
• A ‘brand’ name recognition

25. The Future
Vision and a road map
-- One EIS officer in each state in 3-4 yrs
-- One EIS officer in each district in 10 yrs
• Success will depend on:
-- Commitment from the governments
-- Collective effort (by all partners)
-- Communication
• For public health impact, quality and
sustainability will be critical issues!

26. For details, please see:
www.ncdc.nic.in
Thank you

27. Global Disease Detection Components
Systems Approach to Capacity
Building in Six Primary areas:

Disease surveillance, detection and
outbreak response

Training in field epidemiology and
laboratory methods

Influenza and Pandemic
preparedness

Zoonoses: Human health-
Animal health interface

Health Communication and
Information Technology

Laboratory systems and
biosafety

28. Global Disease Detection
Program Mission

Building a network through collaboration
with ministries of health, multilaterals, U.S. agencies

Integrating activities
Surveillance
Training
Pathogen discovery
Outbreak response

Establishing and connecting Regional Centers
in all regions

Strengthening global systems
through the WHO Collaborating Center

29. Timeline followed
• 13 June: Notice in newspapers
• 4 July: Deadline for applications
• 31 July: Screening of applicants completed
• 10 Aug: Interviews completed
• 15 Aug: Finalists chosen, notified
• 20 Aug: Placements decided
• 4 Oct: Inception course commenced
• 30 Oct: Meeting of mentors, placement
supervisors, & co-mentors

30. Application & Selection Process
• Following announcement, candidate submits
• Online application, including essay
• Screening process to eliminate applicants
who do not meet eligibility criteria
• Final selection made by the India EIS Selection
Committee, final decision by Director, NCDC
• 176 candidates applied, 12 selected,
8 enrolled for 1
st
cohort
* 2 slots available for non-sponsored candidates

31. Criteria for Placement / Assignment
Assignments chosen on the basis of

Access to surveillance and programme data to analyze



Each EIS officer will be supported by a placement
supervisor, mentor and a co-mentor


Mentor who has time and can commit to
technically support the EIS programme


Placement supervisor will provide an enabling
environment with adequate administrative support
for EIS officer


32. Q. Is EIS a training program or a
service program?

33. Q. Is EIS a training program or a
service program?
A. Yes
First International Health Management Seminar, SRM University, Chennai, 9-10 Jan 2013

34. Service-based Learning
• Provides epidemiological service/support in
his/her placement and addresses placement’s
priorities in order to
• Develop applied epidemiology skills in:
• Public health surveillance
• Epidemiologic field investigation, e.g., outbreak
• Study design
• Data analysis
• Epidemiologic judgment
• Communication, oral and written

35. Conclusions
• EIS programme: a India-US collaborative project
designed to augment epidemiological capacity
• Training to fulfill 11 core areas of learning or CALs
• Learning skills mostly by practicing on the
job, under guidance
• Mentors and supervisors have key role; focus
on quality & striving for excellence
• Will help creating a cadre of well-trained field-
oriented epidemiologists serving in key central
and state health departments (in 3-4 yrs) and
at district level eventually (in 10 yrs)

36. Context
• Health work force crisis:
Density: 0.6 doctor per 1000 popn
1.3 Nurse per 1000 popn
Mostly in urban areas, and in private sector
• Training and retaining
• Public health capacity especially
epidemiological skills critical for generating
evidence!