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Tunisia: what policies to counter the inequalities in access to healthcare ?


The African Development Bank (AfDB)’s latest report analyses the inequalities in access to health care across Tunisia. The findings are clear: despite the progress that were made, significant disparities remain in the use and consumption of healthcare products. The report also highlights major differences in levels of well-being between regions:

In 2009, the national average for life expectancy was of 74.5 years. It is of 70 years in Kasserine and Tataouine, but reached 77 years in the governorates of Tunis and Sfax.

The report has also unveiled a decrease in health spending inequalities. This is due to a better access to healthcare products as well as a wider network of pharmacies throughout the country. However it also noted a rise in disparities in the treatment of long-term illnesses and surgical procedures.

Dental care remains characterised by exceptionally high inequalities affecting the disadvantaged populations.

Key recommendations were made to improve the delivery of health services in Tunisia, including the use of incentives to facilitate doctors relocating into less densely populated areas. Public and private partnerships were also identified as key in expanding and diversifying the delivery of healthcare.

The report stresses the need to reduce financial blockages in accessing healthcare, particularly targeted at the disadvantaged populations who benefit from free medical care.

However, the analysis shows that inequalities in health spending declined between 2000 and 2010, taking advantage of better access to pharmaceuticals through better national coverage by pharmacies. However, inequalities have worsened, with regard to treatments for long-term diseases and surgical procedures. Dental cares are characterized by unusually strong inequalities and problems of access for disadvantaged classes.

For the supply side of health care, the report recommends to revitalize basic health services and to rethink specific incentives in place - after having assessed them - to encourage doctors to settle in the remote areas. To expand and diversify the supply of health care, public- public partnerships, and possibly public- private, could be established.

For the demand side, the report stresses the need to reduce financial barriers to access to care, through better targeting of disadvantaged population groups who benefit from free medical assistance.

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