The development of health and health care in Tunisia Mejri wahida thésard à Paris1 Sorbonne ENeC. mejriw@yahoo.

fr
15ème colloque "Emerging New Research on Geographies of Health and Impairment (ENRGHI)"
PARIS 10 et 11 juin 2010 http://www.irdes.fr/Enrghi2010 - enrghi2010@irdes.fr -

14000 35000

Abstract 12000 Number of Paramedical staff 30000

Our study demonstrates the development of health and health care in Tunisia during the past two decades. 2. The improvement of the quality of care and the 10000 25000

This is reflected partly by improving health indicators and secondly by Evolution of health facilities in the public performance of the offer. 8000 20000

and private sectors with improving the quality of health care and performance of the bid. • Promotion of human resources. 6000 Number of physicians 15000
We also tried the rate of increase of number of doctors for different
But despite the remarkable development of this area there are recommendations to provide for better reform of the The number of doctors has develop almost 7 times 4000 10000
parts of the country to see if these programs were successful
health system. in the two last decade , about 10 times for the dentist and 2000 Number of Dentists 5000
in improving the regional balance. Map 1
0 Number of Pharmacists 0

Introduction We see that this evolution is not the same

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The health sector is at the top of the priorities of the State, taking into account its paramount importance in terms of for all of the governorate we distinct 4 types
sustainable development and welfare. The sector has known, since the last two decades, a remarkable development Fig 3: Evolution of health personnel between 1990-2009
which has embraced all areas in the public and private sectors.
It has resulted in many achievements. 400 8000,0
.
Objectifs 350
Num ber of population per 1 dentist

7000,0
1/ very imortant evolution Tunis and Sfax. The two biggest town in Tunisia
Dectec The development of health and health care in Tunisia during the last two decade 2/imortant evolution who are interested to third town Sousse and also Nabeul
300 Num ber of population per 1 param edical 6000,0
3/ medium evolution interssed the rest of coastal gouvernerate
Materials and Methods The number of population per personnel health decreases
250 5000,0
4/ low evolution for the rest remains governorates.
we have used for this study statistical series delivered by NATIONAL INSTITUTE OF STATISTICS and Ministry of also in this periode which shows the improved of health 200 4000,0
We can say even with these programs the coastal VERY IMPORTANT

areas is the most evolved and includes the majority of health

IMPORTANT

Public Health, about Healthcare infrastructure and Health indicators. these data are spread over the last two decade care fig4 but is it true for all regions of Tunisia ? 150 3000,0 MODERAT
LOW

and cover all governorates of Tunisia. 100

Num ber of population per 1 physician
2000,0 services and offers.
We use simple statistical function aand graphical representations to detect the development of this sector. 50 1000,0

with a map showing the geographical distribution of this development in the liberal sector. 0 0,0

Results 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Map 1:The rate of aug mentation of number of population
Fig 4 : Number of population per health personnel 1990-2009 per physician between 1997-2009
1. Improvement of health indicators and Evolution of health structures in the public and private sectors
• Improvement of health indicators
- A life expectancy at the birth of 74,4 years currently against 67,4 years in 1987. We can detect clearly the development of a health secteur in tunisia But is it true that tis development touch
- The infant mortality rate by 17‰ currently against 51,4‰ in 1985. all regions of Tunisia in the same way ? • Development of the advanced medicine
- A maternal mortality rate of the order of 35,5 for 100 thousand live births, against 69 for 100 thousand live births in we will take two years of number of liberal physician and the number of population per liberal physician - The creation of several facilities and services like the National Centre for Promotion of organ transplants,
1994. to do the comparison between 1997 and 2009 fig 5 and fig6. the National Center for bone marrow, the Centre for Emergency Medicine and Trauma Burn Ben Arous ,
- A rate of access of pregnant women to a prenatal consultation of 96%, against 72% in 1987. 1800
Center for neonatology in Monastir, the National Blood Transfusion Centre, National Laboratory for Drug Control,
- A rate of coverage of births in hospital who has reached 96%. 1600
the Department of Thoracic Surgery Ariana, Department of Cardiovascular Surgery at Rabta, in addition to
The improvement of these indicators of health is essentially to the evolution of health structures in the public and 1400
neonatal care in Tunis Sousse and Sfax, services carcinology in Sousse and Sfax and service of hereditary
private sectors and the increase of medical coverage at the level of human resources. 1200
diseases and genetic Charles Nicolle hospital in Tunis .
1000
- The development of the activity of organ transplantation in an evolutionary manner
• Evolution of health structures in the public and private sectors 800
(cornea, kidneys, heart , liver, bone marrow, members.
In order to approximate the health benefits of all kind of society and to ensure the availability in all regions, 600
- The introduction of new medical technologies and advanced technology skills through the National Medical
the structures under the health sector have developed considerably during the twenty years.fig 1 et fig 2 400
and effective cooperation with foreign medical teams
200
- The development of the local production of medicines on the plan quantitative and qualitative,
0 which has enabled cover 49% of the needs of the country in drugs against 7% only in 1987.

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Number of Public Hospitals
180
Number of Health Centers
2500
number of libral physician in 1997 number of bublic physian in 2009 Conclusion
so u rce IN S 2 009 The Health Sector in Tunisia has indeed many advantages. It is diverse, ranging from basic health care to more
2083 fig 5: Number of private physician in 1997 and 2009 sophisticated through the heavy conditions.But it must improve advantage on several routes, including the
175

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financing of the health and health insurance, the offer of care, the quality of care and the information systems..
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Number of health
25000,0
Center
1500
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20000,0

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B IB IL IO G R A P H IY
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Number of
Public Hospitals 10000,0

R e v ie w s P D F d cu
o m e n t o n th e Ine rn
t et
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5000,0 1 . T u n isie , e -Sa n té É ta t d e s L ie u x e te rsp

P e ctiv e s
145 0 H . Ach o u ri, Z .To u rk i
2 . L A CA R T E SA N ITA IR E Bo u sla m a M , Min istèr e d e la satén P u b liq u e
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
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Fig 1: Number of Public hospitals and health centers 1990-2009

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So u rce IN S 2 009 3. D a h m a n i B, 1 995 :Po p u la tio n , sa nté e t d év e lo p p e m e n t e n T u n isie , 5 4 0p a g e s

number of population per physician in1997 number of population per physician in 2009

Fig 6: Number of population per private physician in 1997 and 2009 4. Fo u ra ti M , 2 003 :Sa n té e t m éd e cin e e n T u n isie ,5 7 6 p a g e s
5. L a fif H , 1 980 :ST RU C T U R E D E S SO IN S M E D AICU X , Un iv e rsité d e Pa risI,34 9 p a g e s.
6. N O U IR A A ,1 983 :SYST E M E D E SA N T E P U B L IQ U E E T A ET T D E SA N T E E TN U N ISIE , 7 2 8 p a g e. s
Zaghouan
1%
Ariana
7% Béjà
Ben Arous
6%
N e w sle tte r
The number of hospitals is thus increased from 156
3000
2747
we can clearly see the increase in number of private doctors between 1% Bizerte
4% 7. L A SA N T E P U B L IQ U E E TN U N ISIE , Sa n té In f o rm a tio n s N 35 varil 1 998. Min istèr e d e la satén, 2 8 p a g e s
1997 and 2009. The total number to increase is about the double. 8. L A T U N ISIE E N C H IF F R E S 2 0 0 8 N ° 4 6 1 IN 38S p, a g e s
Tunis Gabès
2500 26% 2%
in 1990 to 174 in 2009 and the number of health centers from Gafsa

1506 to 2083.
2000 The number of population per medecin 1%
Jendouba 9. R a p p o rt An n u e l su r le s In daicte u rs d 'In fr
a stru ctu re n ° 5 1 ,a n n ée 2 008, 34 8 p a g e s
decreases but we should see if this evolution in the health offre 1%

1 0. B u lle tin m e n su e l d e la sta

tistiq u e : n ° 1 4 ,IN S, 4 5 p a g e s
Health Structures in the private sector have also expanded. fig 2 1500 Kairouan
2%
is it same for all governorates Tunisia . Fig.7
1000 796 Tozeur
Kasserine
1% H o m ep a g e
Despite the programs established to bring services closer to citizens 0% Kébili

Dental offices also developed from 495 to 990,

500 Tataouine
0%
0%
1. w w w .in sp .n a t.tn
28
116
and to improve the regional balance as that of "Population and Family Health" Le Kef

2. w w w .o n fp .n a t.tn
Sousse 1%
0
8% Mahdia
hemodialysis centers from 13 to 100 and radiologists 1987 2008
and the project "to build support for reform of hospital management" Siliana 2%

from 60 in 1992 to 107 in 2008.

number of clinic number of beds
and "Creation of inter -some regional specialty "the development
0%
Sidi Bouzid
Monastir
4%
Manouba
2% 3. w w w.in s.n a t.tn
4. w w w .o rd re -m e d e cin s.o rg .tn /
1% Nabeul Médenine
Sfax 7% 4%
Fig 2 : Number of clinic and beds in 1987 and in 2008 of this sector is in favor coastal regions and the District of Tunis. 16%

so u rce IN S 2 008 Hence Tunis only has 26% of the number of doctor. Fig 7 : Distribution of doctor’s portion of serving governorate in 2009
so u rce IN S 2 009