{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:29:06Z","timestamp":1768217346717,"version":"3.49.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>National Public Health Institutes (NPHIs) are pivotal to health security, yet their performance could be constrained by complex, interlinked barriers. This paper examines these operational challenges, with a focus on the Eastern Mediterranean Region (EMR), and argues that strengthening NPHIs requires context-specific, cross-domain policy action rather than isolated technical fixes. Drawing on global and EMR-specific experiences, we undertook an evidence-informed narrative synthesis of selectively identified peer-reviewed literature, documented case studies, and regional reports, to map barriers and policy options across six interconnected domains: governance and organizational frameworks; financing and resource allocation; workforce and capacity building; data, surveillance, and infrastructure; and coordination, multisectoral collaboration, and communication. Each domain is further influenced by pervasive political, social, and cultural factors. Our synthesis indicates that in the EMR, where many countries face ongoing conflicts, economic instability, and governance fragmentation, these barriers collectively weaken national preparedness and response capacities. The paper highlights the need for targeted policy action to overcome these constraints, specifically, adopting robust legal frameworks that clarify and reinforce NPHIs' mandates, developing diversified and sustainable financing mechanisms, institutionalizing competency-based workforce frameworks, and embedding risk communication and community engagement into routine operations. Overall, strengthening NPHIs along these dimensions is not a technical luxury but a strategic investment in national security, economic stability, and regional health resilience. Our paper provides EMR governments and partners with a practical roadmap to move from reactive, donor-driven responses toward coherent, country-led public health systems capable of managing both current and future threats within increasingly complex risk and humanitarian landscapes globally.<\/jats:p>","DOI":"10.3389\/fpubh.2025.1745722","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:19:53Z","timestamp":1768205993000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Strengthening National Public Health Institutes for resilient health systems: evidence to inform policy and decision makers in the Eastern Mediterranean region"],"prefix":"10.3389","volume":"13","author":[{"given":"Tareq L.","family":"Mukattash","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dalia 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