Building epidemiological capacity to strengthen health systems: evaluating the advanced (extended) field epidemiology training program of Papua New Guinea

Abstract

Introduction: Papua New Guinea (PNG) has implemented a three-tiered Field Epidemiology Training Program (FETP) to strengthen their public health workforce. The first advanced (extended) level FETP (aFETPNG) commenced in 2019. This study evaluates the outputs, outcomes and impacts of aFETPNG. Methods: Guided by an FETP impact evaluation framework, a mixed-methods evaluation was conducted to assess program effectiveness and identify opportunities for improvement. Data were collected through an online survey of graduates and interviews with graduates and senior-level government managers and executives. Quantitative data were analysed descriptively. Qualitative data were analysed thematically; findings were triangulated and assessed using contribution analysis. Results: Despite disruption from COVID-19, 17 of 30 (57%) trainees graduated in 2022. Graduates reported high confidence in and frequent application of core field epidemiology competencies. All reported applying field epidemiology skills in their workplace. Graduates strengthened surveillance systems, investigated outbreaks, and implemented a range of public health interventions that contributed to stronger health systems and improved public health programs. Most graduates (82%, n = 14) used surveillance data to guide program planning and delivery. Fifty-five outbreaks were investigated (average of 1.8 per graduate per year). Many assumed leadership roles during the pandemic, and 47% received a promotion following graduation. Barriers to applying skills included unsupportive workplaces, heavy workloads, limited resources, security challenges and professional jealousy; enablers included active professional networks, supportive workplaces and communities, and recognition of the field epidemiology skillset. Senior managers confirmed that aFETPNG strengthened health system performance and recommended institutionalising and expanding the program. Graduates recommended more structured mentoring during and after training. Senior managers recommended formal qualification recognition and a pathway toward a master’s degree to support career progression. Discussion: aFETPNG made a substantive and credible contribution to PNG’s public health system demonstrating progress along the theory of change impact pathway. The program enhanced outbreak response, improved surveillance practice, strengthened public health programs and delivered tangible benefits at community and system levels. These achievements reflect the intentional design of the program and the sustained application of skills by graduates. Key recommendations include strengthening mentoring during and after training, expanding post-graduation professional development, and securing funding for graduate-led projects.