The role of contractual arrangements in improving health sector ...

Tunisia
Health care is provided by public, parapublic and private health care facilities. The public
health facilities are usually classified according to three levels: primary, secondary and tertiary.
Primary level comprises basic health centres and district hospitals. Basic health centres provide
preventive care and curative health care services as well as health education for:
Treatment of common diseases
Mother and child care, including family planning
Prevention and control of communicable and infectious diseases, particularly through immunization
Pre-school, school and university medical services
Dissemination of hygiene principles and practices and rules relating to environmental protection
through health education
Collection and use of epidemiological and statistical health data.
At the end of 2000, there were 1981 basic health care centres throughout the country with a
national average of 1 centre per 4826 population.
District hospitals, beside the services similar to those of the basic health centres, also provide
general, maternity and emergency services, and have hospital beds. At the end of 2002, there were
106 district and maternity hospitals with a total capacity of 2711 beds.
The secondary level comprises regional hospitals that provide specialized medical and
surgical care, in addition to those services mentioned for primary, or first-line, facilities. Every
county town has one or two regional hospitals, which makes a total number of 32 hospitals and
5126 beds for Tunisia as a whole.
The tertiary level comprises the university-oriented health facilities which, while sharing
some attributes with first-line and second-line facilities, have as their primary objective to provide
high specialized care, graduate and post-graduate education of health personnel as well as to
develop research in the medical, pharmaceutical and dental areas.
Almost all of these third-line institutions have the legal status of public health institutions, as
specified in the Health Organization Law and defined in detail in a specific decree issued on
2 December 1991, granting autonomy to these facilities in their administrative and financial
management, as with public facilities. They are 20 such institutions. The number of departments in
these teaching hospitals is 177 with 40 specialties totalling 8305 beds (2002).
In total, there are 167 public health facilities under the supervision of the Ministry of Public
Health with a capacity of 16 142 beds (1.69 beds per 1000 population).
Another component of the public sector, although often called parapublic, comprises
ambulatory care centres that are under the supervision of public bodies for their affiliated members
or salaried employees. These are mainly the private general hospitals of the National Social
Security Fund (six private general hospitals).
The development of the public health care provision system is guided by the “health map”
established by the Ministry of Public Health. This map, which is updated at the beginning of every
national development plan, determines the territorial areas and health sectors where health care and
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