Globally, field epidemiology training programs (FETPs) are a core strategy for building a skilled public health workforce. FETP competencies enable epidemiologists to detect, investigate, and control outbreaks; enhance routine surveillance, and generate evidence for policy. More than 25,000 FETP “disease detectives” have been trained across more than 90 countries, with evaluations demonstrating positive impact on surveillance quality, timeliness of outbreak response, and leadership within national public health institutes.1 FETPs follow a “learning by doing” model, embedding trainees within service settings to apply epidemiologic methods to real-world problems under mentor guidance.2 In India, FETP is jointly supported by ICMR National Institute of Epidemiology (ICMR-NIE), the National Centre for Disease Control (NCDC), the Ministry of Health and Family Welfare, and state health departments with technical collaboration from International partners including the Centre for Disease Control and Prevention USA, Training Programs in Epidemiology and Public Health Interventions Network and South Asia Field Epidemiology and Technology Network. The World Health Organization (WHO) has engaged FETP graduates in national health-security and surveillance systems. Together, these partners help embed applied epidemiology within state public-health programs and strengthen outbreak detection, investigation, and response capacity.3 FIELD EPIDEMIOLOGY TRAINING PROGRAM IN INDIA: STRENGTHS AND GAPS FETP curricula emphasize competency-based learning through core activities of learning (CALs), including outbreak investigations, surveillance or program evaluations, data analysis, and epidemiological studies to inform decision-making.2,4,5 Although formal impact evaluations remain limited, global and regional evaluations consistently demonstrate gains in trainee skills, outbreak leadership, and surveillance quality.6 India’s FETP model prioritizes learning through fieldwork rather than classroom instructions alone, requiring trainees to address priority public health problems within their health systems. With mentorship support from ICMR-NIE and NCDC, CALs are integrated into routine work, enabling the development of a locally anchored epidemiology workforce.3 The One-India FETP Roadmap released by the government of India underscores the importance of a trained workforce for a resilient health system capable of responding to public health emergencies and routine surveillance needs. India’s experience with FETP spans over three decades, beginning with a 3-month field epidemiology course by NCDC in 1996. ICMR-NIE introduced the advanced FETP/MAE in 2001, which later evolved as the Master of Public Health programme, producing a cadre of skilled epidemiologists who led outbreak investigations, evaluated surveillance systems, and generated operational research for state health departments. NCDC subsequently introduced the 2-year Epidemic Intelligence Service. However, these advanced models required prolonged institutional postings, which many states found challenging given their limited epidemiology manpower at the district level.3 Despite expansion through ICMR NIE, NCDC, and WHO collaborations, the roadmap recognizes that existing training pathways remain insufficient to meet national needs, with persistent shortages of trained epidemiologists, particularly at district and block levels.7 IN-SERVICE AND IN-STATE FIELD EPIDEMIOLOGY TRAINING PROGRAM MODEL To address this gap, ICMR-NIE redesigned FETP in 2018 by introducing advanced and intermediate models with periodic contact sessions rather than full-time residential training. Trainees attend short modules and then return to their districts for field investigations under the guidance of a structured mentorship. ICMR-NIE subsequently partnered with state governments to launch in-state intermediate FETPs, where mentors travel to states to train an entire cohort through five 1-week contact sessions annually, while trainees continue their routine public health responsibilities, with state-supported logistics enhancing feasibility and sustainability. In Chhattisgarh and Odisha, where district program managers oversee both communicable and noncommunicable disease (NCD) programs, this program was adapted to strengthen skills across both domains, resulting in improved outbreak response, better surveillance practices, and stronger district-level decision-making. Building on this, India has expanded to multiple tiers (advanced, intermediate, and frontline) and thematic tracks, including a NCD – specific intermediate FETP.3,5 This decentralization approach aligns with the One India FETP Roadmap’s calls for institutionalization of FETPs within state health directorates through “phased implementation,” supported by national partners to ensure quality and sustainability.7 FROM TRAINING TO ACTION: INTERMEDIATE FIELD EPIDEMIOLOGY TRAINING PROGRAM IN CHHATTISGARH AND ODISHA We completed two intermediate in-service in-state cohorts in Chhattisgarh and Odisha between 2022 and 2025. Chhattisgarh, with 33 districts, and Odisha, with 30 districts, implemented this 1-year course comprising five in-person 1-week contact sessions conducted at the state headquarters. We identified program focus areas through consultations with state stakeholders and mentored the field projects for the trainees. The epidemiological study CAL was designed as a group project with a single protocol, with field data collection conducted at trainees’ field placements, followed by individual-level analysis and dissemination. Across the two cohorts, 28 officers were trained in Chhattisgarh and 39 in Odisha, resulting in 52 districts being assigned a trained field epidemiologist. Odisha became the first state to have a trained field epidemiologist in all its 30 districts. Each cohort had 5–6 mentors with a mentor-mentee ratio of 1:2–1:3. Following course completion, several system-level effects were observed. The trainees conducted high-quality outbreak investigations using standard case definitions, designed analytic studies, and produced actionable recommendations for the reported outbreaks, often collaborating across neighboring districts. FETP alumni in India and globally are recognized for leading outbreak responses, thereby improving timeliness and promoting evidence-based action.3,5 The routine surveillance was strengthened through improvements in data cleaning, reporting timeliness, and simple dashboards, improving data completeness and use at district and state levels, consistent with global FETP evaluations.4 Trainees also enhanced programmatic capacity for communicable diseases and NCD, such as hypertension, diabetes, tuberculosis, vector-borne disease, and sickle cell anemia. In addition, the FETP projects generated rapid operational research and policy inputs, including the analysis of the timeliness of IHIP data entry, measles immunization coverage, etc. LESSONS AND RECOMMENDATIONS FOR STATES Lessons learnt from implementing in-service FETP for states suggest embedding trainees within district or state public-health structures and assigning defined roles, such as surveillance lead or outbreak focal point, to ensure immediate application of skills to priority tasks. Strong supervisory linkages with ICMR-NIE mentors enhance investigation quality and accelerate learning, while establishing baseline indicators before training enables a meaningful assessment of improvements. Encouraging rapid briefs and presentations to state leadership facilitates translation of evidence into policy and operational changes. Ultimately, clear career pathways are essential for retaining trained epidemiologists and sustaining capacity. Despite these strengths, challenges persist. Competing workloads limit time for field assignments, mentoring capacity varies across states, and systematic monitoring of FETP outcomes is still evolving. Addressing these gaps by strengthening mentorship networks and protected time for field epidemiology will enhance the long-term impact. The experiences from Chhattisgarh and Odisha align with this vision, with FETP graduates serving as surveillance focal points, outbreak investigators, and NCD program analysts, thereby advancing the objectives of the One-India FETP Roadmap.7 It also recommends FETP conferences, inter-district outbreak collaborations, and continuous professional development to sustain capacity. State-specific intermediate FETP cohorts represent a strategic investment in India’s subnational public-health capacity. Early experiences, consistent with global FETP evaluations, indicate benefits in outbreak response, surveillance quality, and data-driven decision-making. To sustain these gains, states should implement routine indicator tracking, strengthen mentorship support, and publish their operational experiences to enable replication. The One-India FETP Roadmap envisions a pathway across frontline, intermediate, and advanced FETPs to ensure that at least one trained field epidemiologist is in every district. These experiences provide early evidence that in-state intermediate FETPs can serve as a scalable model to achieve these national goals.
Ganeshkumar et al. (Thu,) studied this question.