Field epidemiology training in Tunisia: achievements and gaps.

Introduction: National health security depends on a trained field epidemiology workforce. This study evaluates the Tunisia Field Epidemiology Training Program (T-FETP) from its launch in 2018 through 2024, with a focus on workforce capacity, geographic coverage, and structural barriers to program sustainability. Methods: We conducted a descriptive cross-sectional analysis of the national T-FETP graduate roster. Territorial coverage was assessed against the international benchmark of one Intermediate-level FETP graduate per 200,000 inhabitants. Density and capacity gaps were analyzed for each of Tunisia's 24 governorates. Results: A total of 103 professionals were trained across seven cohorts, including 50 at the Intermediate level. While national density reached 0.83 per 200,000 inhabitants, it decreased to 0.57 when restricted to regional and local levels. Only 25% of governorates met the recommended threshold, and six had no Intermediate-level epidemiologist. The estimated cumulative national shortfall was 43 professionals. Marked geographic disparities were observed, with lower coverage in densely populated areas. Among graduates, 75.7% were female and 70.5% were physicians. In 2026, the median age of Intermediate graduates was 54 years. Conclusion: Expanding training output alone has not produced adequate or equitable field epidemiology capacity in Tunisia. Geographic disparities, limited institutionalization, and the absence of sustainable domestic financing remain key constraints. Addressing these gaps requires sustained training, needs-based deployment, and formal recognition of field epidemiology as a distinct professional role within the public health system.