In the last two decades, the state of health in Iraq has witnessed serious setbacks. According to the World Health Organization (WHO), the country is dealing with a number of challenges. There is a double burden of disease, mostly attributed to injuries and non-communicable illnesses. Communicable diseases- including TB, measles, enteric fever, and hepatitis-remain a major health concern. As to the health system, the WHO reports scarcities in essential medicines, budget deficits, and shortages of human resources. The country “is one of the human resources for health (HRH) crisis countries with severe shortages of health workers.” Recent statements by USAID concur with those of WHO, as they state that in Iraq the health system “has deteriorated significantly.”
The Iraq Field Epidemiology Training Programs (I-FETP) has been able to address some of the public health issues in the country. The program- modeled on and supported by the US Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) program- aims to create a cadre of qualified field epidemiologists with the skills to collect, analyze, and interpret public health data and use it to make actionable changes on the ground. The I-FETP residents and graduates work in the field to fight infectious diseases, environmental hazards, and chronic illnesses.
Since its establishment in 2010, the I-FETP has graduated four cohorts. Between 2013 and 2015, the residents of its Fourth Cohort have made notable contributions to public health in Iraq. Its achievements have influenced the decisions of policy makers and have contributed to improving health status for the members of Iraqi communities.
Surveys for Improved Health
The residents conducted health surveys that served to help policy makers learn more about pressing issues in public health.
In June 2014, and in response to recorded polio outbreaks the I-FETP’s Fourth Cohort conducted a survey in collaboration with WHO and the national extended program on immunization (EPI). The survey was designed to assess the situation. The residents also did an independent assessment of the vaccination coverage administered in high-risk groups and hard-to-reach areas in Baghdad. The residents did two rounds of polio response activities in Najaf. These activities were conducted as independent reviews.
Additionally, and with aims to evaluate the status of infection control in hospitals, and especially hospitals’ capacities to respond to H1N1 cases, the I-FETP Fourth Cohort residents conducted a 10-month assessment that commenced in May 2014. In another respect, residents of the Fourth Cohort also led an assessment for the quality of data developed and transferred between different health systems’ levels in Baghdad. Responding to the request of UN agencies and the Iraq MoH, the Fourth Cohort did an assessment of the health services and health infrastructure in Abu Graib district following floods and displacement.
Investigations of Outbreaks Across Iraq
Throughout the two-year tenure, the Fourth Cohort residents conducted a series of outbreak investigations for the following diseases: Cutanious leishmaniasis; Measles; Mumps; Scabies; and H1N1.
The Fourth Cohort in Protocol-Based Projects
The I-FETP Fourth Cohort Residents were involved in a series of project protocols. The project protocols included an NCD surveillance protocol targeting IDPs residing in the Najaf province. Another protocol within the same area focused on vaccine management. From another angle, diarrheal diseases surveillance among IDPs was also highlighted within the third project protocol implemented by the residents. This protocol was implemented in the Enteric Diseases, Najaf Department of Health. In the area of NCDs, the Fourth Cohort also implemented a surveillance project protocol in collaboration with the chronic obstructive pulmonary disease (COPD) department within the Baghdad sentinel site.
Additionally, and in collaboration with the Iraq CDC, a project protocol was conducted on Hepatitis B and C among Thalassemic patients in Iraq. The Cohort also collaborated with the Iraq CDC to implement another project protocol focusing on Enhanced Electronic Infectious Diseases Surveillance (EEIDS).
Mass Gathering Project Protocols
A one-year project titled “Mass Gathering Project in Iraq” was implemented between September 2014 and September 2015 to strengthen the capacity of the Iraq Ministry of Health in dealing with public health aspects of mass gathering events in general and to ultimately reduce morbidity and mortality related to mass gathering events in Iraq. The project consisted of four main components namely; an introductory course to public health in mass gathering; field study projects funded by mini grants, a scientific writing training, and a national policy brief meeting featuring the attendance of policy makers and officials across Iraq. Together, these components were positioned to match the needs of Iraq FETP and public health programs while also addressing recommendations from the World Health Organization (WHO) Iraq’s Country Office Report previously published in October 2012.
Research in Public Health: The Residents’ Dissertations
The FETP Fourth Cohort residents implemented several dissertation projects. These projects cover a variety of topics, of particular relevance to health issues in different cities of Iraq:
• Colorectal Cancer
• Malnutrition Status of Children with Mental Disabilities
• Epidemiology of MDR TB
• Patterns Domestic Violence
• Patterns of Measles
• Trends of Viral Hepatitis
The Residents in Workshops and Conferences
I-FETP Fourth Cohort Residents participated in a series of workshops as part of their residency. Of notable mention is the Fourth Cohort’s achievement at EMPHNET’s Fourth EMPHNET Regional Conference. The Fourth Cohort’s participation was prominent in both oral abstracts and poster presentations.
The I-FETP celebrated the graduation of its Fourth Cohort in March 2016. Graduates of the Fourth Cohort will now join public health directorates across governorates in Iraq where they will further contribute to the well-being of the Iraqi public.