84
(GHW, 2015, p. 132). The T unisian Association Defending the Right to Health (ATDDS) also acts as a
link between the voice of CSOs and NGOs and the promotion and establishment of health as a right in
the constitution, as well as in new laws and policies through its engagement with members of the
constitutional assembly (Ibid.). Figure A2 in the Annex gives an overview on the main actors and fund
flows in Tunisia’s health system in 2010.
Tunisia’s health data and information management systems
Health information systems in Tunisia are outdated and poorly designed, which is mainly due to an
underinvestment in the sector. Even though the government has taken action towards the
development of electronic records and the institutionalisation of health accounts in the recent years,
routine administrative health facilities databases, which allow for subnational analysis, have been
reported to have problems with accuracy. The National Institute of Statistics provides with household
surveys while also disaggregates health expenses in wealth quintiles, which can prove to be very useful
for analysis of the lower income groups and comparisons with the rest. However, the same problems
of mild inaccuracies have been reported for NIS surveys as well.
The two main data sources for information about access to health in Tunisia are then the Demographic
and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). However, the most recent
data available on the subject is from 2011-12, which renders measuring progress since 2012 difficult.
Summary and Conclusions
Tunisia has shown remarkable progress in terms of health outcomes during the past few decades, but
improvements in certain aspects of its health system are necessary in order to achieve universal
healthcare coverage (UHC). The country is showing relatively high health indicators comparing to
other countries of similar income levels as well as high coverage in health services. The percentage of
the population that is covered by health insurance is approximately 90% and immunization coverage
is almost at 100%, while HIV/aids is almost non-existent and malaria has been officially eliminated.
Likewise, fertility rates are low and stable, maternal as well as infant mortality rates have decreased
and life expectancy for Tunisians has risen dramatically. However, there are still health inequities in
the country, as the private sector is growing rapidly along with higher out-of-pocket expenses that
come with this expanse, while the public sector is still responsible for 80% of the population but is still
relatively underfunded and inefficient.
Inequalities in health are also observed between different socioeconomic and geographic groups of
the population. The public sector is also providing a health insurance scheme that covers all health
expenses for the poorest and subsidises specific services for those with below minimum wage. This
health care system also provides with free contraception for all, as well as antenatal and postnatal
visits to health centres for pregnant women. However, one of the main problems that the Tunisian
system has to face is that the 8-10% of the population is still not covered by health insurance, which
also means that they are forced to pay very high out-of-pocket expenses to a rapidly growing and
expensive private sector. Furthermore, one of the challenges to be tackled in the future is the lack of
high-quality health infrastructure especially in western areas of the country. Medical equipment,
hospital beds, and even the number of medical personnel and doctors seems to be lesser, while health
information systems are generally deemed outdated and unreliable mainly due to the lack of funding.
Focus should be in improving these aspects of Tunisia’s healthcare system as well as addressing the
aging of the population and currently emerging non-communicable diseases (NCDs) such as cancer
and heart disease.
The government of Tunisia is currently collaboratingwith several different international organisations
and NGOs to take a step closer towards the SDGs of 2030 and achieving Universal Health Coverage.
The World Health Organisation, the World Bank, NGOs, Civil Society Organisations, the Ministry of
Public Health and many others are coordinating their efforts towards raising awareness of health
issues, establishing health as a fundamental human right and actively improving access to health
services for all people in Tunisia.