Boosting the Responsiveness and Resilience of the Tunisian Health System in the COVID-19 Context
UNICEF and Partners Keeping Tunisian Children and their Families Healthy
On a warm day in the month of Ramadan, in the desert town of Kébili in the south of Tunisia, motorcycles, cars and passersby swirl around the municipal hospital, and just across the street, a local primary health care center. Despite the small health center’s weathered exterior, inside there are bright, sleek new refrigerators humming with electric power. The refrigerators are part of UNICEF’s support to the national efforts to upgrade the cold chain infrastructure—a critical part of the country’s health system—in disadvantaged regions like Kébili. After all, prior to the onset of the COVID-19 pandemic, 98% of the Tunisia’s cold chain refrigerators were domestic refrigerators—far from medical quality standards.
In his office in the health center, Doctor Ali Tabbal, the center’s director, spoke about the importance of the cold chain.
“The cold chain comes down to vaccination. And the most important thing, from when the vaccine is produced to when it is administered, is the temperature. And since Kébili is a desert province and is more than 500 kilometers from the capital from where the vaccines are sent,” Doctor Tabbal said, “The cold chain is vital to maintain a stable low temperature to keep vaccines safe and effective.”
“This is why the assistance from UNICEF and the Ministry of Health—in the form of freezers, refrigerators, and temperature monitoring devices—is so important,” he said.
UNICEF has been supporting Tunisia’s COVID-19 response efforts since the global pandemic struck the country in 2020 – an effort going well beyond the objectives of its country programme in Tunisia, made in extraordinary times. Thanks to the generous support of its partners, UNICEF provided more than 18M USD in support to the Ministry of Health for COVID-19 response. This has included urgent medical equipment, such as respiratory therapy equipment, oxygen and respiratory systems, incubators, echographs, sterilizers, defibrillators, and more, addressing the urgent needs identified by the Ministry of Health in the national response plan. The COVID-19 response has also included medical disposable supplies, like masks, gloves, and COVID-19 tests.
UNICEF’s health intervention comprised the reinforcement of the national immunization system, including an improved vaccine registry system, vaccination communication campaigns and community engagement activities, and the procurement and delivery of more than 5.6 million doses of COVID-19 vaccines.
Further, it has provided urgent medical equipment to equip 4 specialized long-COVID units in the cities of Tunis, Ariana, Sfax and Sousse, to strengthen the treatment of long-COVID symptoms, which can last for months and even years after the initial infection with a negative impact on the physical and mental health of children and caregivers. Lesser known than its effects on adults, long-COVID can cause serious symptoms in children, invading the heart or the pancreas, and causing conditions such as pericarditis or pancreatitis where that particular organ becomes inflamed. In some cases, children have developed chronic problems such as asthma and hearing loss, and toddlers reverted in their development towards their ability to walk.
UNICEF’s contribution to fighting the COVID-19 pandemic in recent years is also having significant positive knock-on effects in other areas of health throughout Tunisia, such as neonatal care and providing routine vaccination to children for common but dangerous communicable diseases.
Amria Laghdaoui, a nurse in the children and mothers’ department at the primary health center in Kébili, has been working on the vaccination process hands-on, on a daily basis, since 2001.
“We work on the health clinics here 6 days a week, where we commit Mondays and Wednesdays to vaccinations,” she said.
“On those days, parents bring their infants to the center, we register their names and weight, record the date of vaccination, we vaccinate them, and then give them the follow-up appointment for the next scheduled vaccination,” she added, noting that she administers vaccines like the Hepatitis B vaccine, Pentavalent, and Polio vaccine.She pointed to the refrigerator in which she stores the vaccines after they have been distributed from the regional warehouse, noting that even when well preserved by state-of-the-art equipment, vaccines can only help when they are actually given to children, and given regularly.
“I recommend that parents keep their kids up to date with vaccines, because they protect children, and the society as a whole.”
Only a few blocks away, Ayadi Ounallah, the director of the Maintenance and Safety Department at Kébili Regional Hospital, stood in the hallways outside the hospital’s neonatal care unit, where babies slept peacefully inside transparent incubator boxes.
Despite the often spartan infrastructure situation faced by services like hospitals in some parts of Tunisia, the regional hospital in Kébili has benefitted from material assistance from UNICEF in partnership with the Ministry of Health based on the national COVID-19 response plan. Now the hospital is thriving, helping to fight COVID-19, support mothers and babies, as well as a host of other health challenges.
“UNICEF helped us with a lot of things, among them the incubators, resuscitation tables, echograph, and lastly, they provided us with the oxygen plant to support our response to the COVID-19 crisis,” Ounallah said.
He added, “But our oxygen equipment isn’t used just for COVID. We can use it for anyone who has respiration problems, and any treatment requiring intensive care.”
Indeed, just one floor below, in a green space between the various hospital departments, a brand-new structure houses rows of oxygen tanks fixed to the wall, and a large oxygen generator apparatus.
Ounallah said, “During the COVID crisis from 2020 to 2022 we had tons of problems, especially the fact that here we are very far from the center of oxygen production. The oxygen was delivered to us in tanks from Tunis, 550 kilometers away!” But he added with a little smile, “So now we find ourselves providing oxygen for our own needs. Now, any patient who comes into the intensive care unit has resuscitation respirators and anesthetic respirators which work from this oxygen generator that we have.”
The UNICEF and Ministry of Health’s interventions in Kébili were made possible through the generous support of the German Government through the German Development Bank KfW, the Government of the United States through the United States Agency for International Development (USAID), Gavi, and the Government of Japan.
The KfW Tunisia Director, Beate Richter, told UNICEF that, “KfW support aimed specifically at complementing existing equipment and enhancing overall capacities of the Tunisian health system, for example, with oxygen analyzers to improve the functionality of oxygen generators, improved cold-chain infrastructure for the storage and distribution of vaccines, and establishing a monitoring system for the national vaccination programme. That was accompanied with trainings to the health staff on how to use the new equipment properly. We are proud that this programme had also a positive effect on the medical health service in disadvantaged regions by upgrading the equipment in the hospitals and bringing specialized health service closer to the people.”
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