The RFELTP is a 2-year training program in field epidemiology and public health laboratory practice. Established in 2010, the program is a collaboration among MOH, Ministry of Agriculture and Animals Resources (MoAA), National University of Rwanda School of Public Health (NURSPH), Treatment and Research in HIV/AIDS and other Epidemic Infectious Diseases (TRACPlus), the National Reference Laboratory (NRL), the Rwanda Animal Resources Development Authority (RARDA), the African Field Epidemiology Network (AFENET) and the United States (US) Centers for Disease Control and Prevention (CDC). The program has field epidemiology and laboratory tracks. The goals of the RFELTP are to develop self-sustaining, institutionalized capacity to train public health leaders in field epidemiology and field-oriented public health laboratory practice and to provide epidemiological services to the public health system at national, district and local levels. The program is currently hosted in NURSPH, located in Kigali. RFELTP is integrated with other NURSPH postgraduate programs, follows the university calendar, and utilizes subject matter experts from within the NURSPH, CDC, AFENET, MOH and others institutions as needed.

RFELTP targets graduate health professionals working within GOR institutions. Eligibility criteria for admission includes: a minimum of a bachelor's degree in a relevant field of study such as medicine, veterinary medicine, biomedical sciences, biostatistics, or clinical psychology; 3 years of professional experience in a health-related area; Rwandan citizenship; being an employee of GOR; and a letter of recommendation from an employer. For the first cohort, the selection was done by a panel comprising members of partner institutions. Validation of the process was done by the Quality Assurance Directorate of the National University of Rwanda.

In terms of governance, the ultimate decision-making of RFELTP is the steering committee with membership from MOH, TRACPlus, NRL, RARDA, NURSPH, AFENET, CDC and WHO. The committee is currently chaired by the Minister of Health and meets regularly to make decisions and review progress of the program. The program has an Epidemiology and a Laboratory Resident Advisor who provide technical expertise for program implementation.

Residents spend approximately 25% of their time in class for the didactic sessions and 75% in the field. The didactic component comprises five courses interspersed with field placements over the 2 years of the training. The laboratory and epidemiology tracks share 60% of the five courses. Residents begin with an intensive 6 week introductory course that covers basic concepts of biostatistics, surveillance, field epidemiology and public health laboratory techniques, followed by one-to-two-week short courses that cover other course content over the period of two years. During field placements, trainees are assigned to field sites within GOR where they carry out important public health activities, including a surveillance system evaluation, dataset analysis, and outbreak investigations. For the first cohort of 15 residents, all field placement sites were at national-level programs, where residents provide services to all levels of the health system. However, future cohorts will spend their first-year field placement at the national level, while the second-year field placement will be at the district level.

To create a critical mass of public health professionals at all levels of the health system with skills in field investigations, since 2009, the program has offered short courses on outbreak detection, investigation and response to district surveillance officers and laboratorians. So far, a total of 145 persons have been trained an average of three persons from every district. These short courses consist of 2 weeks of classroom teaching and three months of supervised field work, where the participants conduct applied learning projects (e.g., outbreak investigations data analyses) that enable them to become proficient. Short-course participants conduct their field work at their respective work station. This training has lead to an improvement in the timeliness and completeness of reporting of integrated disease surveillance and response (IDSR) priority diseases at district level.

Since its inception in May 2010 with 15 residents (Table 1), the program has already made positive public health impact in Rwanda (Table 2). The second cohort of 15 residents will begin the program in October 2011.

All 15 residents currently in the program are employed in the health system at the national level where they are able to apply the skills acquired while in training. Their response to a number of outbreaks in the country has also demonstrated the usefulness of the program (Table 3).

The residents have also been actively involved in various disease surveillance activities, including: review of IDSR guidelines, needs assessments, influenza sentinel surveillance, and development of a country epidemic preparedness plan.

The work done by residents has been, and will continue to be, disseminated both locally and internationally at various seminars and conferences. Three were accepted at two different international scientific conferences and plans are ongoing to publish the work of residents in health bulletins and peer-reviewed journals (Table 4).

The RFELTP has been primarily funded by the US President's Emergency Plan for AIDS Relief through CDC; however, the program has also secured some resources through the World Bank's East African Public Health Laboratory Network Project and intends to seek other funding sources. Moreover, the MOH has included the program in the National Human Resources for Health Strategic Plan, 2011-2016 and aims to ensure that the program is sustainable when donor funding ceases.

Currently, the program includes two tracks in field epidemiology and laboratory. There are plans to add a veterinary track in the spirit of a “One Health approach” in which human health, animal health, wildlife and disaster management professionals will be trained to work as one team. RFELTP also plans to expand to include residents from district hospitals in the third and subsequent cohorts to strengthen skills at decentralized levels of the health sector in order to improve timely outbreak detection and response and effective public health surveillance system and management at lowest level of the health system.

The program intends to utilize graduates of the first cohort as field mentors and instructors. This initiative should ensure that subsequent cohorts will have adequate supervision and support while in the field.