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

Tunisia
the regulations of the mutual benefit associations going back to 1954, and are in conformity with a
standard statute set up in 1961. Currently, there are 50 mutual insurance companies and 130 000
affiliated members. The resources of the mutual insurance companies come from contributions of
the affiliated members, which usually range from 1% to 7% of their gross salaries, and subsidies
from administrations and enterprises that vary according to cases.
Group insurance covers the personnel of enterprises in the public and private sectors on a
contractual basis. These companies are governed by the insurance code, and the resources also
come from the salaried employees and the employers’ contributions.
The contribution rate ranges from 6% to 15% according to the contracts. This rate is shared
between the employer and the employee. The employer’s share varies between 67% and 80% and
the employee’s share ranges from 20% to 33%. The number of affiliates reached 200 000 in 2001.
The extent of health coverage by mutual insurance and group insurance companies varies; it
depends on internal regulations for the mutual insurance companies and on the clauses of the policy
for group insurance.
Support to the health system
In order to ensure the proper functioning of the health care system and its sustainability,
Tunisia regards the development of support sectors considered to be strategic, particularly, the
sectors of education and of the pharmaceutical industry.
The medical education sector
At present, Tunisia has:
4 medical faculties, which provide basic medical and specialty education in more than 40 medical
specialties.
3 schools of science and technology which train senior health technicians in more than 10 specialties.
19 nursing schools, distributed throughout the country.
The pharmaceutical sector
This sector, which is considered to be strategic in terms of securing medicine supply and
reducing its cost, has greatly developed over the past 10 years. The number of units producing
medicines increased from 3 in 1987 to 27 in 1999; this resulted in an increase in the rate of
coverage of needs by local production from 7.6% in 1987 to 43.7% in 1999. Accompanying the
development of the pharmaceutical industry, was the establishment of infrastructure for quality
control, particularly the national laboratory for control of drugs and the drug monitoring centre,
which performs testing before licensing and at the marketing (systematic control of batches) and
post-marketing stages.
Other support actions
Apart from the education and pharmaceutical industry, several actions were carried out or are
being implemented as essential support to the system. These include establishing a computer centre
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