Tunisia’s health indicators rank near the top in Africa, with life expectancy of about 74 years on average. The country’s diverse economy includes petroleum, tourism, agriculture and mining, and has produced average GDP growth around 5 percent annually for the past couple of decades. Major international firms such as Airbus and Hewlett Packard have opened manufacturing plants in the country. Tunisia’s wealth has produced a creditable health care system, albeit one in need of serious improvement in terms of quality and equity of care.
Tunisia has made major investments in infrastructure since declaring independence from France in 1956. The country has several major geographical features, despite its small size, which include the Sahel desert, the Atlas Mountains, as well as its rolling plains. Hence, major investment in infrastructure projects has been required to connect various parts of the country, as well as connecting Tunisia to the rest of Maghreb and Africa. Despite the presence of major highways connecting Tunisia to Algeria, air transport is the most often preferred mode of inter-city transport. Tunisia has at least thirty airports to serve the travel needs of its residents. The country’s rail network is relatively small by comparison, and the only streetcar system in the country is in the capital city of Tunis. Hence, from a medical point of view, air evacuation is generally favored in case of a medical emergency outside of Tunis.
Tunisia ranks near the middle of the United Nations’ Human Development Index (HDI), having made serious gains in education and health over the past few decades. Nearly all Tunisian children are enrolled in school by the age of 6, and illiteracy rates are dropping as Tunisian children make their way through the educational system. Of particular note is the improvement in the education of girls, which is at parity with that of boys. The Tunisian regime has made improvement in equality of the sexes a major priority. Access to clean drinking water and electricity has improved the standard of life, particularly in rural areas – and also improved the level of care provided in rural hospitals. Investment in sewer systems has led to about four-fifths of Tunisian households having modern plumbing, which has corresponded with a decline in the transmission of communicable diseases.
Pollutants from agriculture, manufacturing and mining have had a negative impact on Tunisia’s environment, but government authorities and business leaders are collaborating to halt and reverse this trend. Water use is always going to be a contentious issue in this desert country, so preservation and reduction of water use has become a matter of policy. Although Tunisia is rich in petroleum resources, it has also taken on groundbreaking work in solar and wind power. Soil erosion is also a major environmental issue as the desert encroaches on Tunisia’s limited arable land.
Tunisia’s efforts to curb and eradicate communicable disease have met with resounding success. Measles, tetanus, and polio have been mostly eliminated, as a result of a major immunization program. Schistosomiasis and indigenous malaria are mostly no longer an issue, although other diseases spread from animals and insects such as rabies, stings, and leishmaniasis are still serious health concerns in Tunisia. HIV / AIDS cases appear to have stabilized in the early 2000s thanks to greater awareness of risky behaviors, and improved testing of the blood supply.
Like many developing countries, Tunisia’s mortality figures have shifted towards non-communicable diseases associated with an unhealthy lifestyle. Circulatory, respiratory, diseases connected with nutrition, and various cancers are now the leading cause of death in the country. In response, Tunisia is introducing a number of preventative health measures and education programs in order to promote long life, such as smoking cessation and diet advice.
Maternal and infant health metrics have vastly improved since Tunisian independence. The country ranks among the top in Africa for maternal and infant health, with a marked decline in infant mortality. Unfortunately, high youth unemployment in Tunisia means a lot of time for risky behavior. Smoking and unprotected sexual promiscuity are major health concerns for the under 35 age group.
The Tunisian health care system is run by the Ministry of Public Health in Tunis. In the public sector, Tunisians have near universal access to basic health care, although access to specialist care in rural areas is more limited. Most of Tunisia’s top specialists in the public sector work at the country’s universities located in major cities. The public health care system is funded by taxpayer contributions, and is available to all Tunisians. Tunisia currently has a surplus of medical professionals; unfortunately, many are trained in out-of-date methods, and would require more training before emigrating.
As a result of Tunisia’s increasing wealth, as well as obvious strain on the public health care system, private practice health care is becoming much more prevalent. As a general rule, private clinics are of much higher quality than public hospitals, and often have better equipment and more qualified doctors and nurses. Most expatriates and visitors use private clinics, which are of similar caliber to top medical centers in Western Europe. However, these are a much more expensive option. International private medical insurance in advised.
Tunisia is one of the most modernized and stable countries in Africa. After gaining its independence from France on March 20, 1956, Habib Bourguiba became the first President of The Republic of Tunisia; he ruled the nation from 1957 to 1987. President Bourguiba set out to create a more open political and religious society by: reducing government control over the economy, allowing increased privatizations of state-controlled businesses, taking a moderate and non-aligned stance in its foreign relations which has allowed more international trading and lending to occur. Bourguiba gave women more rights and control in society than any other country in the Arab world when he outlawed polygamy, mandated that the Bicameral legislature include at least 20% women, and banned the wearing of the headscarf (Hijab). This has allowed Tunisia to focus more attention on improving its national infrastructures.
The general health care system in Tunisia is divided between the publicly (government) run and funded hospitals and clinics and the privately (profit and non-profit) run and funded hospitals and clinics The health care system has a strong government infrastructure and oversight, both the public and private health care facilities are closely monitored by The Ministry of Public Health (MPH). The Ministry of Public Health is the main health provider in the Public sector which consists of: primary care facilities (27% of MPH expenditures), secondary care (25%), and tertiary, which consists of university and specialist (50%). The Tunisian National Social Security Fund is the other public entity that was created so students, the self-employed and government, private sector and retired employees are afforded both a pension and health insurance based on the individual’s work history and earnings. The private health care sector consists of both for-profit and non-profit organization run hospitals and facilities. The private health care sector represents 12% of the total capacity in beds and 70% of the top range medical equipment in the country. Most of the private hospitals and medical facilities are located in the major cities and it employs over 50% of the doctors, 73% of the dentists, and 80% of the pharmacists. Tunisia's private hospitals have attracted foreign patients to travel to Tunisia in order to undertake specialized surgical operations in the fields of cardiology, gynecology, urology and cosmetic surgery. The medical tourism industry has become the second highest foreign currency earner and the second largest employer in the country.
Tunisia's health care system has become one of the most developed in Africa with medical standards that are equivalent to Europe. Since the introduction of a health insurance fund (Social Security) in Tunisia during the1950's there have been many dramatic improvements to the health of the population. Government expenditure on health care has remained at 5% of the GDP since 2006. The total health care expenditure per capita has increased from USD$72 dollars in 1990, up to USD$355 dollars in 2006. Coverage of the population by the health care system (inclusive of all public and private sector entities) has gone from 55% of the population during the 1980's, to over 80% of the population by 2006. Over 99% of the population has been vaccinated with the routine Expanded Program on Immunization. Infant mortality rates have gone down from 120 deaths per 1000 births to 23.43/1000 in 2008, which is the second lowest rate in Africa, behind Libya. The total life expectancy of the population has continually gone up from 47.1 during the 1960's to 75.78 years in 2008, ranking Tunisia 72nd worldwide. There has been an eradication of many communicable diseases, such as Malaria, Schistosomiasis, and Cholera, however there are still numerous health concerns posed in the country.
The goal of Tunisia's health care system is to provide the entire population, regardless of income, social status or place of residence, free and adequate health care. There have been many continuous efforts from the government to maintain and to improve on the health care system such as developing the social security fund as well as improving the accessibility of hospital in-patient and out-patient care. Tunisia has also focused on improving the management process to become more efficient by training staff on better communication skills and new computers in addition to the modernization of the billing system, which has allowed the mobilization of additional resources.
The public hospitals are becoming inadequate in providing the proper treatments that are needed. Hospitals have become under staffed due to lack of funds, which has caused highly trained doctors and nurses to leave the publicly run facilities. This has caused over crowded and long waits in the public sector. The shortage of additional funds to the public health care has caused the lack of technology and equipment that is needed in order to treat patients (remember that 70% of modern medical equipment is in the private sector) and the lack of hospitals and facilities outside of the major cities requires the ill to make an extensive journey for treatment. This has caused out-of-pocket spending from the population to rise within the last two decades (out-of-pocket is the expenditure coming out of the pockets of the citizens who either chose to go to a private facility or they have to, because the public centers do not offer the services needed).
This economic burden on the population is substantial, especially on the poor who are likely to spend a significant proportion of their income on the private health care even though many public services are available free of charge. In 1994, public health services imposed user fees in the form of co-payments. The objectives for these fees were to: increase funds going into the health care system and to encourage consumer responsibility through reducing unnecessary use of services. Patients covered by Social Security had to start paying 10% of the fee up front, on top of the regular fees for, examinations, x-rays, and various other medical procedures. In 1998, the up front fee was raised to 20%.
Unfortunately the public health care sector has proven to be unable to adapt to the growing needs of the population, which has experienced the dual impacts of rapid population growth and health affecting lifestyle changes. Government funding for public health care has been unable to keep up with the increased demand. The general population who have free health care in the government facilities have turned increasingly to the expensive private sector, paying out of their pockets to meet their health care needs. The out-of-pocket expenses from the population have increase to over 50% of total health care expenditures in the country. 79% of this out of pocket expenditure goes towards prescription drugs and out-patient services.
Tunisia's health care system has in many ways risen to the standards of many European countries, it has lowered the infant mortality rates, increased life expectancy, and has expanded its coverage to most of the population. Tunisians have been able to adopt lifestyles more regularly associated with modernized nations, where chronic non-communicable diseases such as diabetes, cardiovascular diseases, and hypertension are now the leading causes of death instead of malaria, cholera or tuberculosis.
While Tunisia is emerging as a modern Country, there are still many aspects of society that have yet to improve to the standards seen in fully and moderately developed countries worldwide. The health care system in Tunisia is one of these. As such there are many important factors to consider when traveling to the country in terms of the health care that is in place and what to expect from the medical service there. Emergency medical treatment in Tunisia is not readily available outside the main urban centers, and you may have to be taken to a major city for medical treatment. Rural medical facilities are not always of a standard expected in western nations. Treatment in private clinics and hospitals are highly recommended for adequate medical treatment but will be quite expensive and are limited to the major cities. Travelers and expatriates will be required to pay for the treatments up-front and It is therefore advised that you take out international medical insurance or a travel insurance plan that will cover you before arriving to Tunisia.