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Health system challenges of NCDs in Tunisia

International Journal of Public Health

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The objective of this study was to present a qualitative ‘situation analysis’ of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs).


Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson’s framework (1994) for policy analysis was used: content, actors, context, and process.


Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void.


This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

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The research on which this article is based was conducted as part of MedCHAMPS, a project funded by the European Commission under the Framework 7 Programme (Grant No. 223075). We would like to acknowledge the contributions of Julia Critchley, the Scientific Coordinator of MedCHAMPS.

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Correspondence to Peter Phillimore.

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This article is part of the supplement “The rising burden of non-communicable diseases in four Mediterranean countries and potential solutions”.

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Romdhane, H.B., Tlili, F., Skhiri, A. et al. Health system challenges of NCDs in Tunisia. Int J Public Health 60 (Suppl 1), 39–46 (2015).

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