Abstract
BACKGROUND: Field Epidemiology Training Programs (FETPs) are a core element of applied epidemiology capacity worldwide. FETPs in the Middle East and North Africa (MENA) region, have repeatedly demonstrated their value during public health emergencies. However, their long-term impact is still doubtful. This study is an attempt to view how FETPs are positioned within national health systems in the MENA region, explore why sustainability challenges persist despite clear programmatic success, and identify potential pathways for institutionalizing FETPs. METHODS: A conceptual analytical approach was applied, relying on published evaluations of FETPs, global health system, workforce governance and international health security principles. RESULTS: The study shows that FETPs almost consistently strengthen disease surveillance and outbreak response capacity across the region. However, these gains are frequently episodic rather than institutionalized. Sustainability can be constrained by weak alignment between FETP training outputs and national workforce governance structures, limited policy and financing embedding, and the health security action is probably reactive instead of the preferable proactive preparedness. These challenges can further be intensified by the political and epidemiological situations of the MENA region. CONCLUSIONS: Sustainability challenges facing FETPs in the MENA region may stem primarily from structural misalignment rather than programmatic weakness. The proposed "FETP-to-System Integration Model" provides a potential strategic proposal for strengthening sustainability. Repositioning FETPs as long-term system investments, rather than episodic emergency response assets, is believed to be essential for enhancing health system resilience and regional health security.