Status quo in India (for policy notes)
Show / hide status quo framing text
Benchmark need: around 1 trained field epidemiologist per 200,000 population (IHR / Global Field Epidemiology Roadmap framing). With population of about 1.3 billion, this implies a long run need of approximately 6,500 Intermediate/Advanced field epidemiologists.
Supporting point: the CDC India country profile reports India needs over 7,000 epidemiologists to meet IHR targets.
Current stock used in STEPS: approximately 3,300 trained across EIS and FETP tiers (programme estimate), implying a gap of roughly 3,200 Intermediate/Advanced equivalent graduates needed by 2030.
Existing architecture: India runs a three tier cascade under NCDC stewardship: Frontline (~3 months), Intermediate (~12 months), and Advanced/EIS (2 years). India’s EIS was established in 2012 as a 2-year, mentorship-based in-service programme, complemented by Intermediate and Frontline.
As of 2024: India has multiple hubs and trains a few hundred annually, but this is below the implied annual flow of about 450–500 Intermediate/Advanced graduates per year needed to close the target by 2030.
Status quo summary: strong architecture and experience, but insufficient volume and uneven distribution, especially at Intermediate and Advanced.
What STEPS does
STEPS helps policy makers and partners explore options for scaling Field Epidemiology Training Programmes in India. It links three core inputs:
- Preferences and willingness to pay (Perceived programme value) estimates from a preference study using a discrete choice experiment with stakeholders.
- Cost components and templates that combine submissions from WHO, NIE and NCDC for Frontline, Intermediate and Advanced programmes into a single structure for each tier.
- Simple epidemiological multipliers that translate training scale up and faster outbreak response into indicative health benefits.
Perceived programme value is the approximate rupee value stakeholders in the preference study place on a configuration. Mixed logit is a regression model that allows these preference weights to vary across stakeholders.
Disclaimer: The cost savings from averted outbreaks were not provided by field epidemiologists. Instead, we use estimates drawn from the current literature that are based on endemic conditions. The tool can be adapted and tailored to reflect the needs and resources identified by key stakeholders, partner organisations and decision makers.
How to use the tool
- Go to the Configuration tab and choose programme tier, career incentive, mentorship intensity, response time, delivery mode, number of cohorts, cohort size and cost per trainee per month.
- Keep the cost slider within the range used in the preference study (75,000 to 400,000 rupees per trainee per month).
- Click Apply configuration. The model from the preference study then calculates endorsement and Perceived programme value values for the chosen design.
- Use View results summary to open a concise scenario summary.
- Save promising scenarios in the Saved scenarios tab and download them as Excel or a policy brief export for reporting and documentation.
- For sensitivity checks, use the National simulation and Perceived programme value / Sensitivity tabs to see how results change with cohorts, endorsement and benefit definitions, and use the Settings tab to adjust multipliers.
Attributes and levels in the FETP preference study
The preference study (discrete choice experiment) asked stakeholders to choose between alternative FETP programme designs and an opt out option. Each programme was described by the attributes below.
Programme design attributes
Intermediate (12 months)
Advanced (24 months)
University qualification
Government career pathway
Medium (3 to 4 fellows per mentor)
High (maximum 2 fellows per mentor)
Fully in person
Fully online
Detect and respond within 15 days
Detect and respond within 7 days
Opt out and cost components
The opt out constant captures the tendency to choose no FETP option. STEPS uses this when predicting overall endorsement of any FETP configuration versus opting out.
Settings and key assumptions
Use this panel to adjust core multipliers for this browser session. Changes feed into the Results, National simulation and Perceived programme value / Sensitivity tabs.
Use these settings when aligning STEPS with updated national estimates or partner discussions. You can change the indicative value per outbreak, the planning horizon used in benefit calculations and the INR per USD rate for display.
Settings log for this session
This log records changes made to settings during the current browser session. It can be used to document assumptions for workshops, annexes and discussions with ministries and partners.
Background
The University of Newcastle is developing a business case for strengthening and scaling FETP programmes in India. STEPS is one of the tools in this work. It provides a structured way to test scale up options and explain cost, benefit and Perceived programme value implications in policy discussions.
For full details, including model specification, estimation outputs, formulae and worked examples, refer to the technical appendix. Open the technical appendix in a new tab.
Prepared by Mesfin Genie, PhD, Newcastle Business School, The University of Newcastle, Australia. For questions or clarifications please contact mesfin.genie@newcastle.edu.au.
Configure an FETP scale up option
Use this to test different cohort sizes.
Max feasible cohorts in horizon given sites: -
Cohorts are constrained by tier duration, planning horizon, and available training sites/hubs (Settings).
All endorsement and Perceived programme value results in STEPS are based on a mixed logit preference model estimated from the preference study. The model is applied automatically to the configuration you select.
All calculations are in INR. USD values use a simple exchange rate for display only and can be adjusted in the Settings tab.
Where the cost configuration has opportunity cost, this adds it to economic costs.
Current configuration at a glance
Headline recommendation
Apply a configuration to see a concise recommendation that combines endorsement, Perceived programme value, costs and indicative benefits.
Briefing text (copy into emails or reports)
Once a configuration is applied, this box will provide a short narrative summary that you can copy into briefing notes or meeting minutes.
Endorsement and opt out
The percentage of stakeholders likely to support funding this training option.
The percentage of stakeholders predicted to choose the opt-out option rather than support the configured FETP option.
Willingness to pay and economic outcomes
The estimated monthly amount stakeholders are willing to pay per trainee. Higher values mean higher perceived value.
The estimated total value stakeholders place on the programme for one cohort, not an actual budget.
The direct cost of delivering the programme to one cohort, not including the cost of trainee time.
Mentor support cost per cohort (base × mentorship intensity multiplier).
Direct cost per cohort (programme + mentor support), excluding opportunity cost.
Existing (template-based) opportunity cost component.
Additional salary-based opportunity cost component.
Programme cost plus opportunity cost where applicable. This is the main cost figure used in benefit cost ratios.
This shows whether the health benefits from better outbreak response are greater than the costs for one cohort of trainees.
A comparison of outbreak benefits to costs for one cohort. Values above 1 mean benefits outweigh costs.
Epidemiological implications
Estimated number of graduates produced across all planned cohorts, adjusting for endorsement and completion rates.
Approximate number of outbreak responses that could be supported per year once all graduates are in post under this configuration.
An estimate of the value of better outbreak response from one group of trainees, based on assumptions in the model.
Cost structure and sources
Cost components in STEPS are based on harmonised submissions from WHO, NIE and NCDC and are combined into a single cost template for each tier. The template covers direct cost categories such as salary and benefits, training, equipment, travel and trainee support, plus indirect cost categories and explicit opportunity cost.
When the opportunity cost switch in the Configuration tab is on, components marked as opportunity cost are included to form total economic cost. When the switch is off, results focus on financial costs only. The costing table summarises how much each component contributes to programme cost and to total economic cost for the current configuration.
Cost components for this configuration
| Component | Share of programme cost | Amount per cohort | Amount per trainee per month | Notes |
|---|
National simulation and sensitivity
This tab scales the current configuration to the national level using the number of cohorts you have selected. To see how results change, adjust cost, cohort size, number of cohorts or the epidemiological multipliers in the Settings tab and explore the Perceived programme value-based benefits and outbreak benefit definitions in the Perceived programme value / Sensitivity tab.
Baseline vs scenario (incremental appraisal)
All impacts are reported relative to the baseline (business-as-usual) parameterisation defined in the Planner tab.
| Baseline | Scenario | Incremental (Scenario − Baseline) | |
|---|---|---|---|
| Total FETP graduates (all tiers) | - | - | - |
| Intermediate graduates | - | - | - |
| Advanced graduates | - | - | - |
| Frontline graduates | - | - | - |
| Intermediate + Advanced graduates | - | - | - |
| Remaining to reach target (Intermediate + Advanced) | - | - | - |
| Total economic cost (INR) | - | - | - |
| Epidemiological benefit (INR) | - | - | - |
| Net benefit (INR) | - | - | - |
| Benefit–cost ratio (BCR) | - | - | - |
National economic picture
This shows the combined value that stakeholders place on the training programme across all trainees and cohorts. It reflects how much the selected training configuration is valued, alongside the expected benefits from improved outbreak response.
These totals are calculated by scaling up the per-cohort costs and benefits to include all cohorts. While the overall costs, benefits, and total willingness to pay increase as the programme scales up, the benefit-cost ratio remains the same.
National epidemiological impact
The numbers shown already reflect national totals, taking into account programme size, number of cohorts, and expected outbreak impacts. To see how results change, you can adjust the number of cohorts, try different programme tiers, or change assumptions in the Settings tab.
Capacity and feasibility checks
This panel translates the selected scale and mentorship intensity into an indicative requirement for mentors (and optionally training sites/hubs), and flags whether the scenario appears feasible under the current capacity inputs.
Within capacity indicates the required mentors (and sites, if used) are not above available capacity.
Computed as ceil(trainees per cohort ÷ mentor capacity), where mentor capacity depends on mentorship intensity.
Required mentors per cohort × number of cohorts.
User input in Settings (Capacity and costs).
If positive, indicates additional mentors required (or scale/intensity adjustment) for feasibility.
Text summary for business cases
Once a configuration is applied, this section will summarise national graduates, total economic cost, total indicative epidemiological benefit, net benefit, total Perceived programme value and annual outbreak responses in plain language that can be dropped directly into concept notes or project documents.
Perceived programme value-based benefits and sensitivity summary
This tab brings together preference based benefits from the preference study, outbreak related epidemiological benefits and cost measures. All benefit values are indicative approximations.
Benefit definition and stakeholder view
Switch between pure preference based benefits, combined preference and epidemiological benefits, or a view that scales Perceived programme value by endorsement.
These options adjust the indicative outbreak cost saving used in benefit calculations for this tab.
After changing the dropdown, click Apply value to refresh the sensitivity calculations and charts for the selected outbreak value.
When this switch is off, the epidemiological outbreak benefit column shows that outbreak benefits are not included and cost benefit indicators reflect Perceived programme value only.
Leave this empty to rely on the endorsement rate from the preference model. Enter a value to test alternative endorsement assumptions for ministries of health, finance or partners.
The export buttons download the sensitivity table exactly as displayed on screen so that results can be pasted directly into concept notes, annexes or briefing materials.
Headline Perceived programme value-based benefits and cost benefit metrics
| Scenario | Cost (INR, chosen horizon) | Total economic cost, all cohorts (million ₹) | Net benefit, all cohorts (million ₹) | Total Perceived programme value benefit (INR) | Perceived programme value from outbreak response capacity (INR) | Endorsement rate used (%) | Effective Perceived programme value benefit (INR, endorsement-adjusted) | Benefit–cost ratio (Perceived programme value only) | Net present value (Perceived programme value only, INR) | Benefit–cost ratio (endorsement-adjusted Perceived programme value) | Net present value (endorsement-adjusted Perceived programme value, INR) |
|---|
Detailed sensitivity matrix
The detailed matrix below retains the full set of core columns for the sensitivity view. It can be used alongside the headline table above to cross check results and document alternative model specifications or stakeholder group assumptions.
| Scenario | Model | Endorsement rate | Cost per cohort (INR) | Total Perceived programme value benefit per cohort (INR) | Perceived programme value benefit from response capacity (INR) | Benefit–cost ratio (Perceived programme value only) | Net present value (Perceived programme value only, INR) | Benefit–cost ratio (endorsement-adjusted Perceived programme value) | Net present value (endorsement-adjusted Perceived programme value, INR) | Effective Perceived programme value benefit per cohort (INR, endorsement-adjusted) |
|---|
Endorsement adjusted effective benefits multiply the benefit measure by the endorsement rate for that scenario.
Interpret scenarios with Microsoft Copilot
This tab prepares a combined interpretation prompt so that Microsoft Copilot can produce a structured policy briefing. The STEPS tool never sends data automatically. You review the full text, copy it when you are ready and paste it into Copilot in a separate browser tab.
How to use Copilot with STEPS
Define and apply a scenario in STEPS, then move to this tab to generate an interpretation prompt with the latest scenario for Microsoft Copilot.
Prepare and copy the interpretation prompt
When you click the button, STEPS refreshes the Copilot prompt using the latest configuration, attempts to copy the full text to your clipboard and opens Microsoft Copilot in a new tab. If automatic copying is blocked, you can copy directly from the panel below and paste it into the new Copilot window.
Top options snapshot (Top 5)
| # | Scenario | Endorsement | Economic cost | Net benefit | Feasibility |
|---|
Planner
Targets and gap
Pathways are generated deterministically from the baseline and target inputs and saved into the Saved scenarios tab. They are auto-pinned (up to the pin limit) and appear in briefing prompts.
Baseline (business as usual)
Frontline
Intermediate
Advanced / EIS
Baseline is the counterfactual (business as usual). Scenario results and prompts are expressed as changes relative to this baseline.
Saved scenarios for comparison
Use this table to compare FETP options and support the business case. Saved scenarios are also used for downloads.
Top options (Top 5)
This panel ranks your saved scenarios to help decision makers quickly spot promising options. Rankings do not change any model calculations; they only sort what you have already saved.
| # | Scenario | Endorsement | Perceived programme value | Economic cost (total) | Epidemiological benefits (total) | Net benefit | BCR | Feasibility | Mentor shortfall | Actions |
|---|
| Shortlist | Pin | Scenario name | Tags | Programme tier | Career incentive | Mentorship intensity | Delivery mode | Response time | Cohorts | Trainees per cohort | Cost per trainee per month | Preference model | Endorsement (%) | Perceived programme value per trainee per month | Perceived programme value per cohort | Total perceived programme value (all cohorts) | Mentor cost per cohort | Total mentor cost (all cohorts) | Direct cost per cohort | Total direct cost (all cohorts) | Economic cost per cohort | Total economic cost (all cohorts) | Epi benefit (all cohorts) | Net benefit (all cohorts) | BCR (national) | Feasibility status | Mentor shortfall | Actions |
|---|
Export options
Enablers preview
Risks preview
Use the brief export for a two-page meeting-ready summary. The standard export includes all saved scenarios.