Tunisia Country Brief
Community Health: Policy and Implementation Landscape Mapping in the Middle East and North Africa Region 2024
Highlights
Country Context
Tunisia is a country in North Africa, located between Algeria and Libya. Similar to other emerging countries in the South and Eastern Mediterranean, the country is undergoing rapid demographic and epidemiological change. The Tunisian health system, managed mainly by the Ministry of Health and its 24 regional directorates, is made up of a public sector, a private sector and a para-public sector.
The public health sector comprises three lines of care: the first line consists of basic health groups, basic health centres (CSB) and district hospitals; the second line comprises regional hospitals, generally located in the main towns of the governorates; and the third line involves university hospitals and specialist centres.
Over the last few decades, Tunisia has achieved remarkable results in terms of public health campaigns and programmes and health system performance. More specifically, three major reforms have shaped the health system and contributed to these results: the reform of basic health care in 1979, the reform of public health establishments in 1991, and the reform of the National Health Insurance Fund in 2004. However, despite these reforms, there are still major regional imbalances in terms of the distribution of human resources as well as accessibility problems. Notable public health campaigns include mass screening campaigns to combat tuberculosis in 1956, the Bacillus Calmette-Guérin vaccination programme launched in 1979, and public health programmes to combat HIV/AIDS and malaria.
Furthermore, in 2011, family medicine (FM) was defined as a strategic priority in Tunisia. This orientation resulted in the establishment of a vision aimed at promoting FM, including the integration of a dedicated sector within the framework of health coverage, the creation of a FM college, the reform of medical studies in 2011 as well as the placement of focal points at various levels of the health system.
Overview of Community Health
In Tunisia, the community health approach, though not formalized under a specific policy, is integrated into various health programmes, including PHC, Public Health, multisectoral collaboration, and Family Medicine. The comprehensive model implemented in Tunisia covers preventive, curative, and promotional health services. In addition, community health initiatives are currently being mainstreamed in the country’s health efforts and reforms. In fact, the country is currently revising its national strategic plan for risk communication and community engagement, emphasizing the need for stronger community involvement in health risk management.
Tunisia is currently implementing a national health policy for 2030, based on the constitutional right to health. This health policy is partly based on community involvement and strengthening community engagement.
The implementation of the National Health Policy, which is seen as the culmination of a long process of societal dialogue spanning 10 years and involving a broad-based participatory approach, began on 7 April 2021 and was based on a synergistic, complementary, and dynamic approach.
