Tunisia (Country profile)

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Country Profile of Tunisia

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Country Profile Presentation Presented by Rajendra Lamichhane MPH 2014 Batch. 6/4/2015 1

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Tunisia in Map of Africa 6/4/2015

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General Introduction about Country Tunisia Area: 64000 square Kilometer Bordered by:  Algeria to the west  Libya to the south east and  Mediterranean sea to the north and east  Mediterranean sea to the north and east  Geographically Tunisia contains the eastern end of the Atlas mountain and the northern reaches of the Sahara desert. Much of the rest of the countrys land is fertile soil. 6/4/2015 3

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Introduction contd. 2…. Population: 10.8 million  Male: 5443410  Female: 5494111 Sex Ratio: 100.93:100 Female :Male Female :Male 95 percent of Tunisians are Muslim 6/4/2015 4 Mosque of Uqba in KairouanTunisia

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Population pyramid  0-14 years: 23  65 years and over: 7.9 Dependent age group population population  30.9 Independent age grup population  69.1 Source: CIA World Factbook- Unless otherwise noted information in this page is accurate as of August 23 2014 5

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Health Care system • Health system also sometimes referred to as health care system is the organization of people institutions and resources that deliver health care services to meet deliver health care services to meet the health needs of target populations 6/4/2015 6

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History of Health care system of Tunisia Until 1980s decades the Tunisia health system moved on the basis of colonial heritage medical infrastructure especially hospital medical infrastructure especially hospital concentrated in the Urban 6/4/2015 7

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History of Health care system of Tunisia contd. Authorities have focused its efforts on improving health service supply and health coverage mainly devoted to:  Preventive programmes individual and collectives against communicable diseases financed only by the state  Geographical access to primary health care affordable to all population categories 6/4/2015 8

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History of Health care system of Tunisia contd.  Human resources development and training Medical and paramedical professionals with recourse to foreign professionals to satisfy population needs.  Progressive development of hospital to deal with the need to specialized care.  Early setting up of social insurance for a large proportion of population civil servant and employees of the formal sector. 6/4/2015 9

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Health Care system of Tunisia After 1990 decade authorities have started a new vision of health sector development based on a strategy that includes: − Continuously development of primary health care − Continuously development of primary health care through a consolidated supply programs. − Improving hospital care obtained by reforms of structural and institutional aspects of teaching hospitals. − Reforms of legislation of private health care supply. 6/4/2015 10

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Organization of Health care structure 6/4/2015 11

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Ministry of public health Health care provision Private sector Public sector Para public sector Out patient care Medical cabinet Pharmacies Teaching Hospital Ministry of defense Hospital service In patient care Pharmacies Medical lab Paramedical office Mono disciplinary clinics Multidisciplinary clinics Kidney dialysis centers Regional Hospital District Hospital PHC Center Ministry of interior and local development hospital Policlinics of national funds of social security 6/4/2015 12

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Brief description of overall health structure  Ministry of public health MoHP is responsible for formulating policies strategies plans programs and technical and administrative standards in health matter in order to guarantee the peoples constitutional right to health  Health policy is based on primary health care and has been endorsed at the highest official level.  In order to reach the entire population the service of the MoHP are decentralized and located in the 24 regions in to which the country is divided for administrative and political purposes. 6/4/2015 13

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Financing /Contribution  Tunisian health care financing system is a combination of social insurance general revenue and out-of-pocket payment.  State provide grants to ministry of public Health and other ministries ministries 6/4/2015 14

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Decentralization:  Generally the management of health sector is centralized even with the multiple attempts to decentralization at regional departments of public health or hospital level. It remains delegation of tasks than a real delegation of power.  In this approach the health sector doesn’t have any specificity when compared to other sectors and remains governed by the same legislation. 6/4/2015 16

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Health care provision in the public sector At the first level :  An extensive network of 2067 Primary Health Care Centers including maternal and child health centers dispensaries and health posts equally spread throughout the territory even in the spread throughout the territory even in the poorest areas.  District hospitals 118 based in the main city of rural area provide primary health care and maternity and general inpatient and outpatient care. 6/4/2015 17

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Health care provision in the public sector contd. 2 Second level • The second-referral level is made up of 34 regional hospitals located in the main city of each governorate. They provide specialized care in the fields of obstetrics gynecology pediatrics surgery orthopedics cardiology and other medical specialties surgery orthopedics cardiology and other medical specialties Third / Top level • At the top of the pyramid are 22 university hospitals divided in four geographic poles: Tunis Sousse Sfax and Monastir. They provide high technology health care for referred patients 6/4/2015 18

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Health related Indicators of Tunisia 1 Life expectancy at birth 2012 Male Total Female 74 Male 76Both sexes 78 Female 2 Neonatal mortality rate per 1000 live 10 2 Neonatal mortality rate per 1000 live births 2012 10 7-14 Both sexes 3 Under-5 mortality rate per 1000 live births 2012 16 14-19 Both sexes 4 Maternal mortality ratio per 100 000 live births2010 56 29-110 6/4/2015 19

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Health related Indicators of Tunisia contd.2 5 DPT3 Immunization coverage among 1-year old 2012 97 6 Births attended by skilled health workers 2006 94.6 7 Density of physicians per 1000 population 2010 1.222 8 Density of nurses and midwives per 1000 population 2010 3.29 6/4/2015 20

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Health related Indicators of Tunisia contd.3 9 Total expenditure on health as of GDP 2012 7 10 General government expenditure on health as of total government expenditure 2011 10.8 government expenditure 2011 11 Private expenditure on health as of total expenditure on health 2011 44.9 6/4/2015 21

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Distribution of causes of death in children under- 5 children in Tunisia 2010 6/4/2015 22

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Programme of the MoHP • National Immunization Programme • Maternal and infantile programme • Reproductive health programme 6/4/2015 23

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Strength  The national immunization program ensures high immunization coverage rates with a demonstrated impact on under-5 mortality rate. Measles polio and neonatal tetanus are in the eradication or pre-eradication phase. 6/4/2015 24

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Immunization Coverage 2012 99 99 97 97 96 97 97 60 70 80 90 100 0 10 20 30 40 50 60 BCG DPT1 DPT3 Polio3 MCV HepB3 Hip3 6/4/2015 25

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Strength • Population using improved drinking-water sources 100 in urban and 89 rural – Tunisia provides a good drinking water quality throughout the – Tunisia provides a good drinking water quality throughout the year. 7 – The quality of the water supplied bySociéte Nationale dExploitation et de Distribution des Eaux SONEDE a national water supply authority that is an autonomous public entity under the Ministry of Agriculture. 6/4/2015 26

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Strength  Infant mortality rate is the most important progress accomplished decreasing from 200 per thousand for the year 1956 to 16 per thousand currently country report for Tunisia 2012 Tunisia 2012 6/4/2015 27

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Trend of infant mortality Maternal mortality assisted childbirth and life expectancy 80 150 68.9 67.1 71.2 73 74.9 60 80 100 120 80 100 120 140 160 893 990 828 801 713 6/4/2015 28 51 31.7 27.6 25.8 22.1 20.3 16.7 54 45.8 0 20 40 0 20 40 60 infant mortality maternal mortality assisted childbirth life expectancy 560

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Strength  Article 38 of the new Constitution 2014 recalls that health is a human right. It highlights that the State should assure preventive and curative health services and provides sufficient resources to guarantee security and quality of services. The State guarantees free health care for poor people. It guarantees State guarantees free health care for poor people. It guarantees also social protection as stated in law . 6/4/2015 29

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Challenges • Progress in MMR has not been as sharp as expected and MDG5 is not yet achieved. Until 2008 progress in achieving the target of reducing by two thirds of maternal mortality was being insufficient and remains one of the biggest MDG challenges MDG5 Target for 2015MMR of Tunisia is 18.7 MDG5 Target for 2015MMR of Tunisia is 18.7 6/4/2015 30

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Challenges • Remaining gap of access to health services between poor populations and those with better living conditions • The emergence of chronic and non-communicable diseases which require lot resources to make available needed treatments treatments • the unbalanced development of the health system with a growing private sector contrasting with an institutional health sector less efficient and the remaining high level of Out-of-pocket expenses. Full Case Study: Monitoring and evaluating progress towards Universal Health Coverage in Tunisia Mohamed Kouni Chahed 1 and Chokri Arfa 2 31

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Conclusion  Health care is delivered through public Parastatal and private facilities  Indicators of Tunisia is highest among the Africa  The national immunization program ensures high  The national immunization program ensures high immunization coverage rates  Measles polio and neonatal tetanus are in the eradication or pre-eradication phase  Tunisia is facing a significant increase in NCD related to changes in lifestyle and increased life expectency 6/4/2015 32

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Conclusion contd.  Regarding Health risk protection The Tunisia’s government has been implementing a social protection system with two-tiered components of health insurance system with two-tiered components of health insurance and subsidized or free care. It’s funded through employee contributions and government-subsidized coverage for those who are poor and pro-poor population which can be adopted in the Context of Nepal to improve Health sector 6/4/2015 33

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References 1. heapol.oxfordjournals.org/content/early/2013/05/24/heapol.c zt029.full 2. www.unicef.org/infobycountry/Tunisia_statistics.html 3. www.indexmundi.com › Fact book › Countries › Tunisia 4. en.wikipedia.org/wiki/Tunisia Wikipedia 4. en.wikipedia.org/wiki/Tunisia Wikipedia 5. Health system profile Tunisia 2006 World health organization Regional health system observatory 6. http://www.who.int/countryfocus/cooperation_strategy/ccs_tun_en.pdf 7.http://www.who.int/countryfocus/cooperation_strategy/ccsbri ef_tun_en.pdfua1 6/4/2015 34

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8.Full Case Study: Monitoring and evaluating progress towards Universal Health Coverage in Tunisia Mohamed Kouni Chahed 1 and Chokri Arfa 2 Department of epidemiology and public health.Faculty of Medicine of Tunis. Tunis Tunisia National Institute of Labor and Social Studies. University of Carthage. Tunisia Corresponding author: Mohamed Chahed • Email: mchaheyahoo.fr 6/4/2015 35

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