A two-tier health system
While Tunisian private clinics are thriving and attracting patients from across Africa and beyond, the public health system in Tunisia is in dire straits.
Tunisian public hospitals are facing serious structural problems. Under-equipment, an exodus of medical staff, a shortage of medicines and dilapidated infrastructure are the daily lot. In 2019, tragic incidents had already highlighted the failures of the system: the death of 15 infants in a public maternity ward or the following year, the fatal fall of a young doctor in a dilapidated elevator at the Jendouba hospital, thus illustrating the poor state of Tunisian hospitals.
Tunisians often face long waiting times and poor quality of care. Health care is becoming privatized. Those who can afford it turn to private clinics, which are often inaccessible to the poorest due to high costs.
A report “The Right to Health in the Time of the Covid-19 Crisis” by the Tunisian Forum for Economic and Social Rights (2021) highlights the deep inequalities in access to care. Nearly 2 million Tunisians have no social coverage for health, and among the poorest, more than 77% were unable to consult a doctor when they needed one due to lack of resources.
According to the same source, almost half of the medical equipment in the public health sector is broken and not operational. This chronic under-equipment of the public sector contrasts sharply with the modern equipment deployed in private clinics.
During several demonstrations, health workers have sounded the alarm about the deterioration of hospitals and the disengagement of the State in matters of health. Due to a lack of resources, they are leaving the country en masse for France, Germany or the Gulf States, where they are offered better working conditions. “It is no longer only the young who are leaving, but also the elderly,” lamented Slim Ben Salah, president of the National Council of the Order of Physicians of Tunisia, in 2020. This brain drain is exacerbated by erratic management, illustrated by the instability of health ministers, with 17 changes since the revolution. All the more so since the situation is aggravated by governance problems and persistent corruption, making it difficult to implement a coherent health policy.
