Starting AFENET was driven by the need to make field epidemiology training work together

Dr Peter Nsubuga is a physician and medical epidemiologist. He is one of the principal founders of the African Field Epidemiology Network (AFENET). In this interview, he reflects on the formation of AFENET and espouses the need for more field epidemiologists in Africa and beyond.

How did you get involved with the founding of the African Field Epidemiology Network?

I was working in the U.S. with the Centers for Disease Control and Prevention, and at that time I oversaw developing public health training programs. We had developed a Kenya program, and there were Public Health Schools Without Walls in Uganda, Ghana, and Zimbabwe. And we needed to network them and AFENET was the vehicle.

AFENET started as a continuation of four projects that we had in these four countries that were primarily for outbreak response. We had a project in Uganda headed by Professor William Bazeyo. We had a project in Tanzania, which at that time didn’t have a public health school without walls. We had a project in Ghana headed by Professor Frederick Wurapa. And we had a project in Zimbabwe headed by Professor Mufuta Tshimanga.

So those, plus the Kenya program which we had started, plus the South Africa program which was also started were the genesis of AFENET. But the issue was to network them so that they could work well together.

Did being very passionate about data and surveillance and your background with Epidemic Intelligence Service (EIS) training in a way influence your contribution to the formation of AFENET?

AFENET is a network of programs that do training that is similar to EIS. And EIS is Field Epidemiology Training, basically learning by doing, during the training. When you graduate, you’re able to work on surveillance and response and prevention of big or even smaller public health issues. So AFENET was needed to have a way to support these programs centrally.

USAID provided the initial funding support to network these programs to not only learn from each other but also support each other and have a way to develop new programs on the continent.

So, in a way, AFENET is only successful if surveillance and response are working well on the continent. If the continent doesn’t have good surveillance and response systems to public health issues, then AFENET is not successful.

There’s this cadre that you were looking at when you people were Starting AFENET. Did you achieve that?

We wanted to train people who could prevent, detect and respond to public health emergencies in all these countries. And train them in a unique way, whereby most of the training is in the field. And I think there’s been some successes, because the numbers have improved both in the two-year programs and the other shorter programs.

But as I mentioned, success is in what they do, not what they’re trained on. And that’s always going to be an ongoing issue. So, we must be able to monitor it to be sure that these people are doing what we train them for. You can have a lot of trained people who are doing nothing, so you are not successful. Therefore, we measure success, at least from my point of view, in what they are doing to prevent, detect and respond to public health emergencies, and other public health issues in their country.

Most of these field epidemiology training programs are donor funded. How can we get out of this trap?

They are donor started, to be precise. Because in as much as we started off with money from USAID or the US government or PEPFAR or others, the local governments also provided space, staff, electricity, and many other things. They were not costed, but they have value. But moving forward, the countries, and again this is another role that AFENET can play, is to ensure that they [countries] realize that this is their program. This is their own fire brigade. You don’t expect a donor to help you put out a fire in your own house. So, it’s going to always be work, to ensure that the countries realize that these programs are their fire brigade.

Something that detects, responds to public health emergencies and other public health issues in their country. Now, it’s not always going to be easy. Because even when you look at most countries, every year there are certain priorities of the country that are not funded by the national budget. That’s always the same, even in the US and it’s going to be an ongoing challenge that requires advocacy, political goodwill, and demonstrating what these programs are doing for the countries, so that then there is an internal demand to fund the programs. It’s really a wrong thing to see them as belonging to the foreigners.

Somebody came and educated your child. The child is still yours. You can’t say, okay you’ve educated my child, feed my child, and bathe my child. No. This is your child. Somebody helped you to educate the child. But after that, you look after your child.

At the inception of AFENET, was it a time-bound entity that you and colleagues were starting?

AFENET has been more successful than I thought it would be. There are many initiatives that people start but then when you look at the vision, it can never be achieved. It’s something always you’re seeking for. In our case, we didn’t say a healthy Africa, we said a healthier Africa. So, it’s not time-bound, right? But that doesn’t say that it won’t take work to continually improve, maintain, and look after AFENET. But it’s been more successful than I thought it would be, being probably one of the principal founders. But that was never time-bound. It’s something that was always going to be on the horizon that you are looking towards the horizon and moving forward.

Back in the early days of AFENET, what did you like doing most?

Well, I liked teaching. That’s the thing that I still do a lot of teaching. But I liked teaching in all these programs, talking to the young people who are going to replace us, making sure that they are firmly grounded on why we decided to do this. We always said that for any program to be successful, five things must happen. Surveillance is working. Response is working. Evidence-based decisions are available in public health. Fewer people are sick and fewer people are dying because of the program, and that program is networked internally and externally. And so, once those things happen, then we know it’s successful. And whenever I go to any program to teach, that’s the first thing I say.

Our religion of AFENET believes these five things. So, if you are doing something else, you are not within the confines of our religion. I’ve always liked teaching, looking at data, because the epidemiological data of whatever type can tell you a story that nobody knows.

Mental health, maternal health, of course outbreaks that we all talk about, road traffic crashes. In some countries now you are having these issues with garbage. All those are things that can lead to people falling sick and dying prematurely. But if somebody is collecting data, you know what’s the state of garbage in wherever? And then you look at it and then you can relate it to the occurrence of diarrheal diseases in the same area. And then you can see, you know, how one thing leads to another. And then the decision makers can say, oh, our voters are getting diarrhea because of this garbage. And they decide and get rid of it. So those kinds of things.

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