Open Access Research S ustainability of a field epidemiology and laboratory training programme: the Ghanaian story Delia Akosua Bandoh 1, Ernest Kenu1,&, Donne Kofi Ameme1, Samuel Oko Sackey1, Fredrick Wurapa1, Edwin Andrew Afari1 1Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana &Corresponding author: Ernest Kenu, Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology And Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana Key words: Sustainability, Ghana FELTP, Ghana Health Service Received: 26/06/2018 - Accepted: 22/08/2018 - Published: 29/05/2019 Abstract Introduction: Field Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme. Methods: we assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures. Results: as of July 2017, a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated. Conclusion: the assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities. Pan African Medical Journal. 2019;33:68. doi:10.11604/pamj.2019.33.68.16431 This article is available online at: http://www.panafrican-med-journal.com/content/article/33/68/full/ © Delia Akosua Bandoh et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Page number not for citation purposes 1 Introduction after its few years of existence. Sustainability has been one of the major challenges FETPs face [8]. One key aspect of sustainability is ensuring that programme services are maintained through the Sustainability of public health programmes is of much importance continuous provision of these services to the nation [8]. This can only since it helps in maintaining and improving existing health system be possible if sustainability strategies are in place. Sustainability of structures. Field Epidemiology Training Programmes (FETPs) are programmes has been found to go beyond just finances. Areas such described by Schneider and colleagues as functional ways of as human resource, political support, operating environment and strengthening epidemiology, surveillance and outbreak response infrastructure have been considered as key determinants of capacity in countries [1]. The main aim of FETPs is to build a public sustainability [9]. A number of strategies in these major areas seem health system which can rapidly respond to health threats as they to have been adopted by GFELTP over time through the changing assist in developing scientific evidence-based policies [2]. As an phases of the programme to enable its continuity. This paper essential public health strategy, existence and functionality of FETPs assessed the sustainability strategies embedded in the Ghana Field are key to solving the dynamic public health challenges that keep Epidemiology and Laboratory Training Programme. arising. Thus, there is the need to sustain FETPs to enable them meet their goals. FETPs in Africa were established to strengthen the public health workforce to implement and lead multi-disease surveillance Methods and response in Africa [3]. Sustaining these programmes in Africa in the face of dwindling donor support is therefore of much essence to FETPs in Africa and countries at large [4, 5]. The Ghana Field Study design: the study was conducted in the GFELTP secretariat Epidemiology and Laboratory Training Program (GFELTP) is the from March to June, 2017. A record review of database of residents Ghana Health Service (GHS) Field Epidemiology Training Programme and all programmatic documents was done. Interviews (key which started in 2007 in the University of Ghana School of Public informant interviews (KII) were also carried out. We grouped the Health. Together with Kenya, Uganda and Zimbabwe FELTPs, these information collected under four main categories; programmatic, four Field Epidemiology Programme (FETPs) are the founding financial institutional and political structures. All components of the members of the Africa Field Epidemiology Network (AFENET). programme which contributed to ensuring continuous provision of the AFENET has since developed into a robust network of FE(L)TPs in programme and its services were considered. over 33 countries in Africa. As the first FETP to be formed in West Africa [6], GFELTP has a vision of improving the health of the people Data collection: data collection was done with a data extraction tool in Ghana and beyond. The programme has a mission of contributing which covered information on residents' demographic characteristics, to addressing Ghana's public health needs and priorities through and available data on the indicators of sustainability we sought to training and service provision in applied Epidemiology and Public assess. An interview guide based on the indicators of sustainability Health Laboratory Management [7]. The GFELTP uses the One Health we sought to assess was used for the qualitative interviews. approach, ensuring teams of professionals from diverse backgrounds Questions on; how the programme has been funded since its at the national and sub-national levels develop the capacity to early inception, who the programme stakeholders were and the roles they detect, investigate and respond to outbreaks in their districts. Guided played, how the programme runs and political structures governing by the World Health Organization International Health Regulations the programme and the achievements of the programme since its (WHO/IHR) core capacity requirements, the program strives towards inception were asked. We retrieved and extracted data from a building and strengthening national and local capacity to effectively database of residents enrolled onto the program from 2007 to 2017 respond to public health emergencies and mitigating their impact. and examined data on resident demographic information such as GFELTP began with initial funding from the US CDC. The impact of gender, nationality, and place of work before enrollment into the the programme during its initial years proved that it was a great idea programme and their current places of work. All programme and could indeed strengthen the nation's public health systems. documents including the FELTP curricula, reports on residents, However, after five years, the funding from US CDC could not be programme activities, and programme support files and continued. The programme had to identify other ways of running administrative documents of the GFELTP from its inception were considering its contribution to solving public health issues in Ghana reviewed and information extracted. To understand the funding of the Page number not for citation purposes 2 program, we reviewed the financial records and reports on funding Residents of the programme were from all ten regions of Ghana activities and extracted needed information. We interviewed key (Table 1). informants such as the Foundation Director of the programme, Past Dean-School of Public Health, Director of Public Health-Ghana Health Performance of the programme: overall, 100 outbreaks have been Service, CDC, WHO, Programme Directors past and present, Field investigated. In all, 141 oral and poster presentations have been Coordinator, Programme Coordinator and administrator. These made by residents and alumni of the programme at national and interviews were done to give a more detailed understaning of the international conferences. The presentations were made at AFENET structures the programme has in place. and Training Programmes in Epidemiology and Public Health Interventions Network (TEPHINET) and other national and Data processing and analysis: we generated frequencies and international conferences. A total of six awards were won during proportions of residents' demographic characteristics. Recorded these conferences (Table 2). interviews were transcribed. We assessed sustainability by the following indicators: programme funding, programme evaluation, Positions occupied by Alumni of the programme: Nearly 30% (20/70) organisational capacity, institutional structures, political support, of the alumni occupy positions as Directors of Public Health Service in partnership and planning [9,10]. Documentation showing the the Ministry of Health, Ghana Health Service, and Veterinary Services presence and structures of the various indicators were extracted Department. Twenty percent (14/70) also head various departments during the record review and clarity on their functionalities were in the health facilities. However, 20% (14/70) have still not been triangulated by the interviews transcribed. In this paper, we defined placed by the Health Service after completion of the programme donor, stakeholder and sustainability in the following ways. Donor: (Table 3). organisations which provide funds to solve specific health related challenges, in this case, those which provided funding to support the Evaluation: the GFELTP secretariat conducts monthly faculty programme mainly with funds for a specific period [11,12]. meetings to evaluate the progress of the program. There were Stakeholder: institutions which have a stake in the impact the records of bi-annual evaluation of the programme, faculty and program makes and partner to ensure the day-to-day smooth running residents. These evaluations were conducted by residents. Likewise, of programme activities such as the Ministry of Health, Ghana Health the programme also evaluates residents enrolled in the programme. Service, University of Ghana and AFENET [13,14]. Sustainability: the Though the programme is still in its preparatory phase of finalising a availability of human, financial, programmatic infrastructure and strategic plan, the AFENET strategic plan had been modified and organizational resources to plan and provide services to meet needs adopted for their use. The programme was preparing to take up the and attain results on an ongoing basis to carry out core functions of TEPHINET accreditation when this review was done. WAHO also the programme independent of individuals or one-time opportunities conducted a quality assurance evaluation of its partnership with the [2,15]. programme following a two-year collaboration. This process included review of documentation by the programme, interviewing of residents and faculty of the programme. Results Financial structure Funding of the programme: the first four years of the programme was fully donor-funded by United States Centers Programme structure how the programme is run and its for Disease Control and Prevention (CDC). The funding of the entire performance from 2007-2017: GFELTP runs a two-tier training programme was taken over by stakeholders when funding ceased programme; frontline which is a three-month course and advanced during the fifth year. Subsequently, funding from different donors which is a two-year training course which offers an MPhil degree. As over the years have been in the form of partial support for programme of July 2017, the frontline course had trained seven cohorts and the activities and assistance for residents training. The Dean of the School advanced ten cohorts. of Public Health supports some outbreak investigations with other projects overheads and residents' self-support. Other donors who Residents trained by GFELTP: the programme has trained 350 people have supported the programme include; The Presidential Malaria mainly from the Health Services with 94% (329) being Ghanaians. Initiative of the USAID which supports some residents annually in Page number not for citation purposes 3 conducting malaria-based researches; US President's Emergency Plan Veterinary Services Department), University of Ghana, School of for AIDS Relief (PEPFAR); and West Africa Health Organization Public Health and AFENET. They play an intertwined role in providing (WAHO). The World Health Organization (WHO) also supported the resources (human, materials and funding). These stakeholders and training of frontline health workers among others. Overall, most partners collaborate in supporting the smooth running of all activities programme activities have been funded with resources provided by of the programme. The programme works with both local and stakeholders. international partners such as CDC Ghana Country Office, WHO Ghana Country Office, WAHO and Food and Drugs Authority (FDA), Funding of residents training: over the years, the advanced course among others. These organisations collaborate with the programme has been funded by donors, stakeholders and residents. Stakeholders in implementation of its activities. Stakeholders provide various played a key role in funding of residents over the years, providing resources in the form of human resource for field supervision, support to half (50/100) of the residents. The following were some of outbreak investigation, teaching and mentoring of residents and the ways identified: residents who were mainly supported by provision of financial resources for running of other programme stakeholders paid their tuition whiles the cost of field work, outbreak activities. investigations and attendance of conferences was borne by stakeholders of the programme. The Dean of the School of Public Faculty of the programme: in addition to university staff on the Health also supported some outbreak investigations done by residents programme, stakeholders also provide lectures in veterinary, with overhead costs generated from other projects running in the laboratory and epidemiology in accordance with the One Health school. Also, the Government of Ghana granted residents study leave Approach. Periodically, alumni teach some didactic sessions of the during the training and paid their salaries throughout the FETP courses. training (Figure 1). Self-support has been introduced for residents who do not have any additional support except for Government of Alumni trained to become faculty: for continuity and availability of Ghana Study leave with pay. They self-support their field work and staff, alumni are encouraged to pursue academia so that they can tuition. The programme also offers service provision to other take up teaching appointments offered by the programme. A total of organisations as a source of revenue generation. However, the 4 graduates have completed their upgrade from MPhil to PhD with 10 frontline FETP programme which has trained 200 frontline health currently enrolled unto PhD programmes. These alumni offer support workers in the country was fully funded by the WHO in 2015. to the programme and other programmes in other African countries such as Liberia, Sierra Leone and Namibia through teaching and Institutional structures of the programme Organizational mentorship of residents. capacity: the programme is run by the School of Public Health, University of Ghana on behalf of the Ministry of Health/Ghana Health Field supervision and mentorship of residents: the programme has a Service. The programme operates with the same principle used to strong alumni network which serves as a pool of experts for the operate the School of Public Health. As a university based programme. Supervision during field work/mentorship is done mainly programme, faculty of the university form the core faculty of the by alumni at the districts, regional health directorate and national programme and are assigned to teach most of the courses. The levels. Alumni work closely with the residents and supervise their University serves as a teaching site whiles the acquisition of skills and knowledge, commonly referred to as bound National/Regional/District Directorates and facilities of Ghana Health volume competencies, with the assistance of Ghana Health Service Services (GHS) and Veterinary Service Directorate (VSD) serves as staff. Some of the university faculty members periodically conduct field sites for the residency training. As a competency based field supervisory visits to the residents especially those from other programme training with the one health approach, various West African countries such as Liberia and The Gambia. stakeholders provide technical expertise to teach the residents. Each year, guest lecturers from partner institutions such as CDC and WHO Political support: the programme was established under the visit the program to deliver lectures. mandate of the Ministry of Health/Ghana Health Service and is engrained in the University of Ghana system. It therefore reports to Stakeholders and Partnership with the programme: the stakeholders the Director General of Ghana Health Service through the Director of the programme include; Health Service (Ghana Health Services and Public Health and to the Vice Chancellor of the University of Ghana Page number not for citation purposes 4 through the Dean of School of Public Health. The reporting structures system and provide solutions for improvement. Sustainability has also were agreed to through a memorandum of understanding signed been described by Schneider as a programmes ability to fund and between the two stakeholders. GFELTP has a steering committee that manage itself with no external support [1]. The main source of steers the affairs of the programme. The committee is chaired by funding of the programme was from stakeholders. Their support has Director of Public Health, Ghana Health Service. The steering been through contribution of materials, finances, human resource committee is made up of stakeholders and partners. This committee capacity and technical support. This has helped in saving the meets at least twice a year to plan and take major decisions for the programme the costs for these essential services needed for the programme. sustainability of the programme. The ability of stakeholders themselves to fund the activities of the programme is a sign of it being sustainable. Thus the GFELTP is on the track to achieving this goal of Discussion total independence and stability. After support from the initial donors ceased, the programme reached The GFELTP has been in existence since 2007. This paper sought to out to other organisations to build partnerships to supplement determine the sustainability structures embedded in the programme stakeholder efforts in training residents. Survival of the programme and other structures it has in place to ensure its smooth running. This during this time was of critical concern since sustaining grant-funded assessment found programmatic, organizational, institutional and programmes after funding ceases has been known as a major public political sustainability strategies in the operation structures of health challenge [16]. According to Adze and colleagues, exploring of GFELTP. The frontline training, introduced a few years ago as a other funding options as the programme did is essential in building means of reaching out to frontline health workers at district level; is collaborations with potential partners who can assist in developing a major sustainability strategy. This training provides frontline health the public health workforce capacity [8]. The programme expanded workers with requisite skills to detect, monitor and manage outbreaks its collaboration with partners over the years and this has been of effectively [16]. It creates an avenue for publicising the programme immense support to training of residents at frontline and advanced and showcasing its good works at district and national levels. This levels. Currently, this strategy is used by Central African FELTP [8]. visibility of GFELTP serves as a marketing strategy for the programme Resource mobilization towards training of the residents was done by sustainability [8]. A strategy which has helped the sustainability of all stakeholders. The various stakeholders were found to have the programme was the fact that the residents were mainly staff of contributed in diverse ways to make the training of residents possible. Ghana Health Services and the Veterinary Services Department. Self-support has been introduced for residents who do not have any Residents trained were from all the ten regions of Ghana, support from partners. These residents are allowed to use their own demonstrating the wide coverage of the programme. After training, resources for some of the field work. The Programme has embarked residents returned to serve in the ministry with the new competencies on active service provision to other organizations that require its they have gained. The key to success of public health systems is competencies as a means to generate additional resources for the availability of trained competent workforce. Therefore, as more health sustainability of the programme. Considering the current existing service staff are trained, the public health workforce which is critical structures of the programme, strong collaborations exist between to strengthening of the existing public health systems is reinforced programme stakeholders. A number of external partnerships are still [1]. GFELTP is the first port of call whenever an outbreak occurs in being developed by the programme. Introduction of self-sponsorship the country. Their experiences in handling outbreak investigations has and service provision (consultancies) to generate additional resources shaped the process of investigating outbreaks in the country. There suggest that GFELTP is gradually building a stable and solid was evidence of the various outbreak reports documented by the foundation in the country as a solution to developing a resilient public residents. Most of these had been turned into abstracts which had health response team. The GFELTP is a Ministry of Health/Ghana been presented at local and international conferences. The periodic Health Service programme run by the University of Ghana like every evaluations of programme activities by the GFELTP ensured the other graduate programme. This provides the programme the programme meets the required standard and gains recognition as a opportunity to make use of university resources such as staff and resource centre to help strengthen the public health system in the infrastructure. This strategy was proposed and adopted in 2010 by country. This has served as an opportunity to address gaps in the the then dean of the school. The programme was therefore engrained Page number not for citation purposes 5 in the university yet tied to a competence certification with over 70% Swaziland revealed that sustainability of a training programme field work. Thus, the programme can exist even in the face of little or requires consulting and involving all stakeholders of the programme very low financial support from donors. A university-run programme since this leads to the success of the programme [21]. We realized on behalf of the Ministry of Health/Ghana Health Service implied that the sustainability plan was extended to recruiting staff for the individuals apply for admission through the university's regular programme who can take over from the first generation of leaders system. Individuals also pay fees to the university just like every other who began the programme. This was seen from the number of alumni course is run. In addition, faculty of the programme who are lecturers in academia and those pursuing higher degrees after completion of in the university have their salaries paid by the university and the staff the programme. Furthermore, alumni being called upon to assist in from the Ghana Health Service paid by the Ghana Health Service. The teaching residents provides an avenue for them to demonstrate what core staff of the programme are therefore lecturers of the University they have been taught and build their confidence in becoming future of Ghana School of Public Health, the host institution and the rest faculty of the programme. Supervision of residents by alumni and GHS from the Ministry of Health/Ghana Health Service. This strategy is staff have introduced residents to practical experiences in the various similar to what is practiced in Chennai in India [17]. Having staff of settings of the stakeholders. Also, this serves as an avenue for the host institution as core faculty implies that there are key people residents to share knowledge from didactic trainings with field staff. who are always present to take major decisions on the programme This approach to handling the various health challenges of the as and when it is required. The variety of lecturers in the GFELTP country is innovative [22]. Mentors are experienced epidemiologists exhibit the One Health Approach. This denotes the sign of a who guide residents during their fieldwork. Mentors serve as role competently trained multidisciplinary public health workforce able to models ensuring that residents receive a well-rounded and complete respond to health emergencies. This finding is confirmed by similar training experience and competencies in the programme [1]. The works done by others on FETP trainings in various parts of the programme places premium on mentorship thus alumni serve as world [3,18]. Incorporation of lecturers from different institutions mentors to guide residents and ensure they acquire the right skills leads to building of stronger ties between stakeholders, another and competences. The alumni network is a pool of resources the sustainable approach to keep the programme running. programme leverages for mentorship of the residents. This is in consonance with Subramanian and colleagues finding that FETP Should funds for the programme run out, the overhead cost of the graduates are generally the first port of call for mentorship of the programme are absorbed by the university through funds from other residents [20]. Selected graduates serving as mentors show their projects it runs. This has been one of the greatest sustainability existing relationship with the programme after completion of training. strategies which has kept the programme running over the past years. This is a sustainability strategy using available human resource Over the years, GFELTP has weathered the storm of financial capacity of the programme. The programme has a strong political challenges using this strategy and was saved from this major setback support because it is engrained in the university system and was in its early years. This innovative idea adopted at the inception of the established under the mandate of the Ministry of Health/GHS, the programme is in line with the principle that implementation and highest health delivery authority in the nation. The GHS chairs the sustainability go hand in hand. Therefore, ways of ensuring the GFELTP steering committee. The GHS being a key player in the longevity of a programme need to be in place during the initial stages management of the programme is a clear reflection of a solid of implementation [19]. Resources and administrative support the sustainability strategy embedded in the programme. The programme programme needed were mainly provided by stakeholders who work was sustainable but had some challenges. The main programme collaboratively, performing various complementary roles and challenges identified include; placement of residents after their providing sufficient resources to support the programme. The training and gaps in programme funding. The programme needs to programme collaborates with other organisations in order to carry out devise alternate ways of generating funds and other resources aside its activities successfully. Similar to other FELTPs in other parts of the the traditional way of relying on stakeholders. The programme should world, these collaborators provide both technical and financial invest more time into sourcing of projects from partners and writing support for the programmes activities [20]. The strength of their of project proposals which would lead to diverse ways of funding the partnership is seen in the makeup of the steering committee. The programmes activities. steering committee has representatives from all stakeholders of the programme on board. An assessment of in-service training in Page number not for citation purposes 6 Limitations: this review had a few challenges. Interviews were Competing interests mainly recall of events that had happened in the past ten years. To reduce recall bias, different people were interviewed and the The authors declare no competing interests. information obtained crosschecked for consistency with each other. Additionally, review of programme documents confirmed some of the interviews outcomes. Authors’ contributions Conclusion The idea of the manuscript was conceptualized by Bandoh Delia Akosua, Ernest Kenu, Donne Kofi Ameme, Samuel Oko Sackey, Fredrick Wurapa and Edwin Andrew Afari. Data collection was done The programme had evidence of stable sustainability strategies in all by Bandoh Delia Akosua, Donne Kofi Ameme, Ernest Kenu. Data structures evaluated, namely; programme, financial, institutional and interpretation was done by Bandoh Delia Akosua, Donne Kofi Ameme political. This assessment showed a strong collaboration between and Ernest Kenu. The manuscript was drafted by Bandoh Delia stakeholders who work hand in hand to ensure the programme runs Akosua, Ernest Kenu and Donne Kofi Ameme, review of manuscript smoothly. However, more sources of funding, broadening stakeholder was done by Bandoh Delia Akosua, Ernest Kenu, Donne Kofi Ameme, partnership and other essential resources need to be considered to Samuel Oko Sackey, FW and Edwin Andrew Afari. The final help the programme obtain a pool of resources for carrying out its manuscript was approved by all the authors. activities. What is known about this topic Acknowledgments  The Ghana Field Epidemiology and Laboratory Training programme trains health workers to build a resilient public health workforce in Africa; We would like to acknowledge Prof. Fred Binka (Former Dean of the  Most Field Epidemiology and Laboratory Training University of Ghana School of Public Health), Dr. Badu Sarkodie programmes rely mainly on donor support to run their (Deputy Director Public Health, GHS), Dr. Chastity Walker (GHSA- programmes and this could have implications on the CDC), and Dr. Sally Ann Ohene (WHO Ghana Country Office) and Ms. programmes if the funds run out; Gladys Antwi (Administrator, GFELTP) for their assistance during the interviews and data review.  Sustainability of Field Epidemiology and Laboratory Training programmes is essential and needs to be looked at by all programmes. Tables and figure What this study adds  In the face of financial challenges due to the reduction in Table 1: characteristics of residents enrolled in GFELTP, 2007-2016 donor support, the Ghana Field Epidemiology and Table 2: list of award winners and their topics Laboratory Training programme was able to continue its Table 3: positions occupied by alumni after completion of mandate of training health workers; programme  Aside donor support Field Epidemiology and Laboratory Figure 1: source of tuition funding for residents enrolled onto the Training programmes can explore other alternatives of advanced course of the Ghana Field and Laboratory Training securing resources to run their programmes; Programme, 2007-2016  The Ghana Field Epidemiology and Laboratory Training programme has innovative sustainability strategies integrated in its structure. Page number not for citation purposes 7 References 8. Andze GO, Namsenmo A, Illunga BK, Kazambu D, Delissaint D, Kuaban C et al. 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PubMed | Google Scholar Table 1: characteristics of residents enrolled in GFELTP, 2007-2016 Trainees Advanced (N=100) Frontline (N= 250) Characteristic of residents n(%) n(%) Gender Male 79(79) 110(44) Female 21(21) 140(54) Nationality Ghanaian 87(87) 250(100) Non-Ghanaian 13(13) 0 Track Epidemiology 38(38) 175(70) Laboratory 46(46) 30(12) Veterinary 16(16) 45(18) Workplaces of residents at enrollment Ghana Health Service 65(65) 195(78) Veterinary Service Directorate 16(16) 45(18) Other institutions 7(7) 10(4) International organizations 12(12) 0(0) Number of regions in Ghana trainees worked in at time of enrollment (N=10) Advanced Frontline Year n(%) n(%) 2007 3(30) - 2008 6(60) - 2009 3(30) - 2010 5(50) - 2011 7(70) - 2012 6(60) - 2013 7(70) - 2014 5(50) 1(10) 2015 7(50) 3(30) 2016 7(70) 3(30) Page number not for citation purposes 9 Table 2: list of award winners and their topics Conference/ venue Award Title TEPHINET 2010, South Best Oral Presentation Outbreak of Food Poisoning at a Salad Joint-Koforidua, Ghana, November Africa 2009. AFENET 2013, Ethiopia 2nd Runner Up for Oral Obesity Associated Hypertension among a Religious Group in the Akwapim Presentations North District of Ghana, 2012 AFENET 2017, Abuja 1st Runner up for Best Oral Outbreak of Cholera in Vea-Gunga, Bongo District of the Upper East Presentation Region, Ghana GFELTP 2017, Accra Best Oral Presentation Determinates of low birth weight in Neonates born in 3 hospitals in Brong Ahafo Region, Ghana- Unmatched case control study GFELTP 2017, Accra Best Poster presentation Geospatial variation of confirmed malaria incidence and related environmental characteristics in sub-districts of Upper East Region GFELTP 2017, Accra 1st runner up for oral Prevalence and determinants of preterm delivery in an inner city referral presentations hospital, Greater Accra Region, Ghana Table 3: positions occupied by alumni after completion of programme Position Frequency(N=70) n (%) Director of health services 20 (28.6) Disease control programmes 7 (10.0) FELTP faculty 5 (7.1) Heads of public health departments 14 (20.0) Academia 10 (14.3) Retained at positions before training 14 (20.0) Figure 1: source of tuition funding for residents enrolled onto the advanced course of the Ghana Field and Laboratory Training Programme, 2007-2016 Page number not for citation purposes 10