Uganda public health fellowship program’s contribution to building a resilient and sustainable public health system in Uganda

ABSTRACT

Background: Low-income countries with relatively weak-health systems are highly vulnerable to public health threats. Effective public health system with a workforce to investigate outbreaks can reduce disease impact on livelihoods and economic development. Building effective public health partnerships is critical for sustainability of such a system. Uganda has made significant progress in responding to emergencies during the past quarter century, but its public health workforce is still inadequate in number and competency.

Objectives: To reinforce implementation of priority public health programs in Uganda and cultivate core capacities for compliance with International Health Regulations.

Methods: To develop a competent workforce to manage epidemics and improve disease surveillance, Uganda Ministry of Health (MoH) established an advanced-level Field Epidemiology Training Program, called Public Health Fellowship Program (PHFP); closely modelled after the US CDC’s Epidemic Intelligence Service. PHFP is a 2-year, full-time, non-degree granting program targeting mid-career public health professionals. Fellows spend 85% of their field time in MoH placements learning through service delivery and gaining competencies in major domains.

Results: During 2015–2018, PHFP enrolled 41 fellows, and graduated 30. Fellows were placed in 19 priority areas at MoH and completed 235 projects (91 outbreaks, 12 refugee assessments, 50 surveillance, and 60 epidemiologic studies, 3 cost analysis and 18 quality improvement); made 194 conference presentations; prepared 63 manuscripts for peer-reviewed publications (27 published as of December 2018); produced MoH bulletins, and developed three case studies. Projects have resulted in public health interventions with improvements in surveillance systems and disease control.

Conclusion: During the 4 years of existence, PHFP has contributed greatly to improving real-time disease surveillance and outbreak response core capacities. Enhanced focus on evidence-based targeted approaches has increased effectiveness in outbreak response and control, and integration of PHFP within MoH has contributed to building a resilient and sustainable health system in Uganda.

KEYWORDS:

• Field epidemiology
• resilience
• sustainability
• health systems
• Uganda

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

We give special thanks to the leadership of the Ministry of Health for offering the support that has enabled us make these great achievements. We thank the US-CDC for supporting the Uganda Public Health Program activities and Makerere University School of Public Health for providing program leadership and management of the funds. We are highly indebted to Dr. Bao-Ping Zhu and Dr. Julie Harris, US Centres for Disease Control and Prevention, for technical guidance during the entire implementation period of the program thus far. We would like to thank the African Field Epidemiology Network (AFENET) for availing us several opportunities and support to showcase our program contribution to building a resilient and sustainable health system in Uganda. I thank all the Advanced Field Epidemiology Fellows who have made tremendous contributions to enable the program achieve greater horizons.

Author contributions

ARA - Led the writing process after collecting program data, did analysis, interpretation, drafted and coordinated manuscript writing and wrote the first draft; LB, BK, DK, SNK participated in data collection, analysis, writing and revision of many drafts; PT and RKW revisited the first draft critically for key intellectual content, read and gave approval of the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

This an initiative of the Uganda Ministry of Health, a joint program implemented in collaboration with US Centers for Disease Control and Prevention and Makerere University School of Public Health. The authors of the paper are staff of the Uganda Public Health Fellowship Program, who have been granted permission to access data and publish any works that may seem befitting to share with the global world. Authority was granted through the office of the Director General Health Services, Ministry of Health.

Paper context

PHFP has contributed greatly to improving the real-time disease surveillance and outbreak response core capacities of the Uganda Ministry of Health within a 4-year span. The enhanced focus on evidence-based targeted approaches has increased effectiveness in outbreak response and control, and the integration of PHFP within the MoH has contributed to building a resilient and sustainable health system in Uganda.

Additional information

Funding

Funding is by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention Cooperative Agreement number GH001353-01 through Makerere University School of Public Health to the Uganda Public Health Fellowship Program, Ministry of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the US Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry, the Department of Health and Human Services, Makerere University School of Public Health, or the Ministry of Health.