Strengthening Indonesia's Field Epidemiology Training Programme to Address International Health Regulations Requirements/ Renforcement Du Programme De Formation Indonesien a L'epidemiologie De Terrain Pour Repondre Aux Exigences Du Reglement Sanitaire International/ Fortalecimiento del Programa De Formacion En Epidemiologia Practica De Indonesia Para Cumplir Los Requisitos del Reglamento Sanitario Internacional

Introduction Many countries are strengthening their public health workforce capacity to meet the core requirements of the International Health Regulations (IHR) by establishing field epidemiology training programmes (FETPs). (1,2) These programmes aim to build capacity in public health epidemiology for disease surveillance, disease programme management and outbreak response by training personnel in applied epidemiology. (3) The emphasis of FETPs on intervention epidemiology and outbreak response increases the human resources available to detect and respond to public health events of international concern) FETPs are unique in that they prioritize "learning by doing" in which trainees complete formalized coursework along with field projects in public health offices. Establishing and sustaining FETPs is a challenge because they are a resource-intensive training model. (4,5) Indonesia's recent revitalization of its FETP provides innovative solutions for countries that wish to establish or review their own programmes. This article describes the processes used to build and strengthen Indonesia's FETP, and focuses on issues such as managerial and financial sustainability and quality assurance in the outputs. History of Indonesia's FETP The Indonesian FETP started in 1982 as a two-year full-time non-degree programme conducted by the Directorate General of Disease Control and Environmental Health of the Ministry of Health and assisted by consultant tutors from the United States Centers for Disease Control and Prevention. Experience showed that the non-degree programme could not compete for brighter candidates with two-year master's degree health programmes offered by universities. The first innovation, implemented in 1990, consisted of a collaboration between the Directorate General of Disease Control and Environmental Health and two universities to award a master's degree. This set-up was initially coordinated by a Secretariat within the Directorate General, but as funding decreased the Secretariat was disbanded and the Ministry of Health's oversight of the programme weakened. Universities continued to offer FETPs, but training became increasingly university-based because of lower access to government structures and less funding for field projects. Revitalizing Indonesia's FETP In February 2007, the Directorate-General of Disease Control and Environmental Health established a team to determine public health workforce needs, develop a long-term vision and devise a strategy to implement the vision. The team comprised the Ministry of Health Planning Bureau, the Health Workforce Development Bureau, the World Health Organization (WHO), the universities and representatives from provincial health offices. Because of Indonesia's extensive territory (encompassing 17 000 islands), decentralized government structure and large population (228 million), designing a vision for a public health workforce was a challenging process. As emphasized in the IHRs, Indonesia's public health workforce needs to be prepared for events with potential international ramifications. The workforce must also face an increasing national burden of non-communicable diseases and a high burden of routine infectious diseases such as tuberculosis and malaria. Although the number of graduates from the FETP was small, the team decided that the FETP should continue because of the specialist public health skills gained by graduates. The team also decided that another programme could help cover epidemiology workforce needs. One-month short courses were developed to train a cadre of assistant field epidemiologists who support FETP graduates in data management and programme implementation. This strategy was considered the most feasible way to meet the needs for Indonesian public health personnel during the next 10 to 15 years. Workforce needs were estimated as one technical public health officer per 100 000 population; a total of 500 field epidemiologists and 1000 assistant epidemiologists need to be trained in the next 15 years. …