slide 1: Country Profile Presentation
Presented by
Rajendra Lamichhane
MPH 2014 Batch.
6/4/2015 1
slide 2: Tunisia in Map of Africa
6/4/2015
slide 3: 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.
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slide 4: 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
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Mosque of Uqba in KairouanTunisia
slide 5: 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
slide 6: 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
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slide 7: 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
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slide 8: 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
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slide 9: 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.
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slide 10: 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.
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slide 11: Organization of Health care structure
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slide 12: 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
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slide 13: 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.
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slide 14: 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
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slide 15: 6/4/2015 15
slide 16: 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.
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slide 17: 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.
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slide 18: 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
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slide 19: 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
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slide 20: 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
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slide 21: 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
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slide 22: Distribution of causes of death in children under-
5 children in Tunisia 2010
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slide 23: Programme of the MoHP
• National Immunization Programme
• Maternal and infantile programme
• Reproductive health programme
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slide 24: 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.
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slide 25: 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
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slide 26: 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.
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slide 27: 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
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slide 28: 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
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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
slide 29: 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 .
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slide 30: 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
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slide 31: 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
slide 32: 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
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slide 33: 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
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slide 34: 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
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slide 35: 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
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