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Since its independence, Tunisia has strived to implement new policies that improve access to health
services, especially focusing on the underserved groups of the population. Among these efforts are the
guarantee of free contraception for all, which was established during the 1960s, and free antenatal and
postnatal visits for all pregnant women, which was part of a new policy during the 1990s (Chahed et
al., 2014). Most of these policies were part of a publicly funded free-for-all health care system.
However, in the latest years demand for higher quality health care has shifted investment towards the
private sector. Demographic and lifestyle changes among others, have caused increased investment on
private hospitals that now complement the public sector with higher quality services. A significant
example of this shift was the International Finance Corporation’s (IFC) first investment in Tunisia’s
health sector with the goal of broadening access to quality health care for lower-income groups and
people in remote areas. IFC invested $8.2 million on the private clinic “Amen Sante“, which was part of
a plan to complement public investment, create more than 1,000 jobs and enhance the skills of the
private health sector (IFC, 2011).
One of the most recent andmost important actions that the government took was adopting the modern
Constitution of Tunisia, which was established in 2014 and reaffirmed health care as a fundamental
human right. Along these lines, the Ministry of Health established a 5-year plan (2016-2020), which
showed the government’s commitment to strengthen the current healthcare system and fighting
existing and emerging diseases across the country. Recently, Tunisia also announced a national
HIV/AIDS strategic plan along with a big campaign to raise awareness about the matter, support most-
at-risk groups and eventually eliminate HIV/AIDS prevalence. The plan is supported by the Global
Fund to fight AIDS, Tuberculosis and Malaria which also funds several NGOs that are contributing aid.
However, there is a lack of organised screenings, no routine testing during antenatal visits, no opioid
substitution (methadone) therapy and inefficient monitoring (WHO, 2015). The establishment of
standardised tests, the adoption of modern technology and improvements in efficiency are essential
for the success of the plan and the elimination of HIV/AIDS in Tunisia.
Overall, the Tunisian government shows strong political commitment to achieve Universal Health
Coverage (UHC) as specific goals have been set for the near future. According to WHO (2015), the
government seeks to maintain and improve its high achievements in maternal and child health, focus
on non-communicative diseases that are currently emerging, reduce regional inequalities, improve
pharmaceutical technology, create a nationwide HR programme and improve the training of medical
professionals to be on par with international standards.
Actors in Tunisia’s health sector
Most of the regulatory framework in Tunisia comes from the public sector and the Ministry of Public
Health (MoH), as these are the entities that regulate the national health insurance scheme and the
access to health for the poorest parts of the population. According to the World Bank (2013), the MoH
acts as the “main steward”, although its supervision on the private sector is limited.
As the Tunisian government is committed to achieve UHC as a member of the World Health
Organisation, a lot of the necessary reforms are designed and implemented with the help and/or
supervision of international organisations such as WHO and World Bank. The WHO has been
collaborating with the government of Tunisia for several years now to improve the health status of the
country and achieve Universal Healthcare Coverage (UHC) as part of the SDGs. Along these lines, the
World Bank has also launched the Universal Health Coverage Studies Series (UNICO Study Series)
which monitor and evaluate the process and the challenges towards achieving UHC for many countries
including Tunisia. These studies also help pursue Tunisia’s priority is to expand coverage of all parts
of the population, tackle diseases and improve the relatively low skills of medical professionals,
technology in equipment, and lastly updating information systems to today’s standards.
Civil Society Organisations have also become very active in the fight for the “rights of patients to access
quality care services without the financial burdens being placed on individuals and families, including
access to quality and affordable medicines, particularly for patients with chronic diseases and cancers”