Strengthening Tunisia’s Healthcare System

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TUNIS — In the aftermath of the 2011 Arab Spring, Tunisia has experienced a rebirth in terms of its healthcare policies and public health. During 2014, the government drafted a new Tunisian constitution that placed national healthcare at a higher priority.

Article 38 of the new constitution proclaimed health as a human right and required national healthcare coverage for the poorest of Tunisians.

This greater interest in bettering care reflects an improving trend in Tunisia’s health statistics. In recent years, the life expectancy at birth has increased while non-communicable diseases accounted for 72 percent of deaths. In comparison, a merely three percent of deaths in Tunisia are as a result of communicable diseases.
Due to increased vaccinations among youth, Tunisia has witnessed a decrease in the under 5 years old mortality rate while also effectively combating a variety of deadly illnesses. These efforts have put Polio, Measles and neonatal Tetanus at the brink of eradication.

According to a WHO report, “regarding the HIV situation, while the number of new indigenous cases has remained stable and low, recent behavioral data confirmed a concentrated HIV epidemic in key populations, mainly in men having sex with men (13 percent) and in injecting drug users (2.5 percent).” Meanwhile access to improved drinking water and sanitation facilities has reached nearly 100 percent in urban areas. Yet, these figures drop off in more rural areas.

This uneven distribution of resources has become common in Tunisian life and especially with its healthcare system. Those in wealthier cities will almost always expect to receive significantly higher quality care.

Region by region data on life expectancy reveals these disparities. Poorer governorates like Kasserine and Tataouine have average life expectancies stands less than 70 years. In richer more urban governorates like Tunis, which contains the capital and largest city of Tunis, the life expectancy is 77 years old. The average life expectancy across the nation is 74.5 years old.

A variety of reasons can explain these wide inequalities.

First and foremost, the concentration of doctors in Tunisia is remarkably uneven. The three governorates of Sfax, Tunis and Medinine all had around 3.3 to 3.5 doctors for every 1000 people. This concentration is above average for OECD countries like the United States, the United Kingdom and Japan.

Yet in Sidi Bouzid, Kasserine and Tozuer the concentrations of doctors stand at 0.4, 0.4 and 0.2 respectively, while the average among Tunisian governorates is only 1.1.

Naturally, this spells serious consequences for the health of those living in more rural, poorer areas. In these regions only 55 percent of women will see prenatal services at least four times. In comparison, 75 percent of women from more wealthy urban areas will do the same.

This demographic is particularly vulnerable too; according to the WHO, “approximately 75 percent of maternal mortality was due to avoidable causes, such as monitoring and postnatal follow-up in Tunisia as of 2008 compared to 46 percent in France as of 2006.”

Other challenges like the nature of health spending also stem from inequality; Out of pocket pay for care accounts for 41 percent of Tunisia’s health expenditures. This means that the highest quality of healthcare is simply not affordable for many lower income households.

While only a year has passed since the creation of its new constitution, Tunisia has begun working toward revitalizing these flaws in its healthcare system. In cooperation with the WHO, the nation has identified areas in healthcare that require solutions.

Some, in fact, are being made on a local level. Through the ‘Social Dialogue Programme’ created in part by the WHO, Tunisia has reached out to communities to find healthcare solutions. It works by forming a volunteer committee that then advises the government on healthcare related decisions.

So far the program has succeeded in involving many Tunisians in the healthcare reform process; since its inception in 2012 more than 4200 people. According to a WHO update, “In September 2014 the National Health Conference agreed unanimously to use the Citizens’ Jury report in a formal declaration.”

For Tunisia’s healthcare system, success means incorporating the people’s needs into the process. With more input and progress it hopefully can match its peers from across the Mediterranean.

Sources: The African Development Bank, International Finance Corporation, The World Bank, The World Health Organization 1, The World Health Organization 2
Photo: Flickr

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