Field Epidemiology Training Programs (FETPs) were adapted from the U.S. Centers for Disease Control and Prevention (CDC) Epidemiologic Intelligence Service (EIS) in 1980 to rapidly build epidemiologic capacity globally (1). These competency-based, “learning-by-doing” programs train health professionals in applied epidemiology through field assignments supplemented by classroom learning. Approximately 75% of the training period is dedicated to fieldwork under direct supervision, while the remaining 25% consists of formal didactic sessions (2). Graduates have measurably strengthened public health surveillance, outbreak response, and data systems (3–8). Their roles during COVID-19 underscore their value in health emergency management (8, 9). In the Eastern Mediterranean Region (EMR), FETPs operate at all three tiers (Advanced 2-year, Intermediate 1-year, Frontline 3-month) to build a skilled epidemiology workforce tailored to each country’s context. Through the Eastern Mediterranean Public Health Network (EMPHNET), the US CDC and partners support FETPs in 17 EMR countries. Collectively, EMR FETPs have produced thousands of graduates who have contributed to regional health security by improving disease surveillance and public health decision-making during crises.

Despite these achievements, FETPs in the EMR continue to face significant challenges in both institutionalization and sustainability. Institutionalization refers to the formal integration of FETPs into national health systems through legal recognition, administrative structures, and dedicated financial mechanisms. Sustainability denotes the long-term capacity of these programs to function effectively and adapt to evolving public health needs, supported by stable financing, quality assurance, and defined career pathways. Institutionalization is, therefore, a foundational step toward achieving sustainability. However, many programs remain heavily donor-dependent, lack formal integration within ministries of health or national public health institutes (NPHIs), and are constrained by unclear career trajectories and inadequate domestic budget allocations.

In the EMR, most FETPs remain financed predominantly by external donors, particularly in fragile or conflict-affected contexts such as Afghanistan and Yemen. Only a handful of countries—including Jordan, Iraq, Morocco, and Saudi Arabia—have institutionalized domestic funding through their ministries of health. Mixed financing approaches, such as university partnerships and service contracts, are emerging but are not yet widespread. With donor support expected to decline, prioritizing dedicated government budget lines has become a regional imperative for sustaining FETPs.

Previous literature emphasizes that institutionalization, political commitment, and funding are primary factors for FETP sustainability (10). The Global Field Epidemiology Roadmap also calls for formal career paths and workforce targets to ensure retention of skilled epidemiologists (11). This manuscript aims to explore and document the experiences, challenges, and strategies related to the institutionalization, sustainability and funding of FETPs in the EMR, and to develop actionable recommendations to strengthen their long-term effectiveness and integration within national public health systems.