The FETP in Vietnam was started in 2009 to address a recognized need for disease prevention and control and public health interventions through the expansion of trained human resources in preventive medicine staff in applied epidemiology. The need became acute following the SARS and H5N1 epidemics. The initial funding for the program was provided via the “Joint Government – United Nations Program
to fight highly pathogenic avian influenza” which had funds from United Nations organizations such as WHO, FAO, UNDP, UNICEF and a number of countries including Australia, Canada, Finland, Luxembourg, Netherlands, Sweden and UK. Further funding support has come from USCDC and USAID. Vietnam has 63 provinces/cities and 4 regions with from 4 to 28 provinces/cities. Each province has a provincial preventive medicine center (under department of health), as does each region a regional institute. The 4 institutes (2 Institutes of Hygiene and Epidemiology and 2 Pasteur Institutes) oversee public health activities in their respective regions. Priority for the FETP has been given to staff of the General Department of Preventive Medicine (GDPM), Ministry of Health and the regional institutes. The program is managed by GDPM and the Vice Director of GDPM serves as the FETP program director. The FETP program consists of at least 10 required training modules (8 compulsory and at least 2 elective) of 1 week each with the remainder of the time spent in field work or in elective training modules. The instructors include the FETP adviser, other international experts from U.S. CDC and WHO in Vietnam and the region, as well as national faculty from faculties of Hanoi School of Public Health and Hanoi Medical University. In addition to lecture notes, guidelines and scientific articles used during training modules, the principal books provided for fellows are Field Epidemiology (by M. Gregg) and Control of Communicable Disease Manual (by D. For the first 2 cohorts, the fellows all remained in their place of employment for their field placements and thus can only do FETP as part-time. For the 3rd cohort, all fellows are expected to be in Hanoi. All fellows are required to complete at least 2 outbreak investigations, a surveillance project, and an applied epi/operations study. They are also required to have at least one presentation accepted to an international conference and to prepare a manuscript for submission to a peer-reviewed journal. The program tracks the completion of all the tasks prior to certifying program completion. Fellows are officially supervised by their actual work supervisors, however, for technical FETP activities they are primarily supervised by the FETP adviser and since 2011 have also been supervised by a first cohort graduate who was hired by WHO to support the program. In addition, for specific activities (such as preparing protocol, abstracts and conference presentations) they may receive technical support from subject matter experts at USCDC and WHO in Vietnam or the USCDC regional FETP adviser (the latter only until October 2012). All fellows have reported on 2 outbreaks for the program but many fellows participate in a much larger number of outbreaks as part of their routine work. Generally they are accompanied on the outbreaks by colleagues from their institute and sometimes their field supervisor who is their supervisor at the institute. The FETP adviser has also provided support usually by phone or email during the time in preparation and in the field. At the National Institute of Hygiene and Epidemiology, the FETP fellows are perceived as key members of the outbreak teams and are expected to participate. Many of the fellows’ primary positions involve working with surveillance information in their jobs. They generally have good access to surveillance data from their institutions but need permissions to access surveillance data from other areas or to access clinical and laboratory data from outbreak investigations. They continue to do routine surveillance activities in their positions but are also expected to do a specific surveillance project for the program. This has usually been a surveillance data analysis. Currently several fellows are participating in a pilot of an Event-Based Surveillance (EBS) activity, funded by WHO. Some fellows are also reviewing the implementation of new surveillance guidance. All fellows prepare a research proposal and conduct the research as part of the FETP. The topics for these activities are generally determined in conversation with the field supervisor and the FETP adviser. The MOH has recognized the value of the program and trainees and in the past year has invited the program specifically to participate in high priority outbreaks of cholera, H5N1, pandemic H1N1, hand foot and mouth disease and an unknown illness (inflammatory palmoplantar hyperkeratosis). They have been asked to develop EBS, serve as experts for surveillance of H1N1 and provide short course epidemiology training (FESC) for preventive medicine staff at provincial and district levels. The FETP has been institutionalized with an organizational structure within the GDPM. This is an important starting point on which to build a sustainable program. However, three key challenges to ongoing development are in nurturing an assertive national champion for the FETP, coaching a Vietnamese expert into a lead technical position to coordinate the training activities, and ensuring funding with longer term funding cycles. In summary, FETP is a nascent and relatively fragile program in Vietnam. As long as the need for trained field epidemiologists remains high (ref to IHR and APSED) and FETP remains attractive to MOH and international partner agencies, the program continues to advance as the flagship leading the country’s efforts in strengthening surveillance and response capacity. However, in the medium term (for at least the next 3-5 years) Vietnam needs substantial technical and financial supports from international partner agencies before the country can fully self sustain an FETP of international standard.
