SKILLED CARE DURING CHILDBIRTH - Family Care International

Skilled Care During Childbirth: Country Profiles Tunisia
The National Perinatal Programme has established mechanisms for in-service training and supportive
supervision:
• A self-evaluation tool, called an “internship notebook,” was developed for midwifery students
during the internship (practical training) period to monitor their progress in meeting training objectives;
the notebook is reviewed by the internship supervisor, and at the end of the internship period is
handed over to the student who remits it to the training instructor.
• Refresher training was decentralised at the peripheral and regional levels of the health infrastructure.
The frequency and content of refresher training is therefore determined locally, based on needs identified
during supervision, as a result of evaluation findings, and at the request of health practitioners
during meetings.
• Supervisory guidelines were developed by the Ministry of Health as a standard tool for assessing
practioners’ performance. Supervision is decentralised at the peripheral and regional health levels,
and regional and peripheral teams are able to modify/adapt the tool according to local needs.
Standards and protocols: Standards for provision of care are developed in collaboration with
the National Perinatal Commission (as are the objectives and content of in-service training, and the
choice of service strategies). A number of laws have been passed regulating the use of medication and
attendance at delivery, including a decree by the Ministry of Public Health establishing the list of drugs
that midwives may possess and prescribe.
Similarly, “technical cards” on clinical management practices provide an official reference in defining
the scope of intervention by midwives and physicians in the provision of maternal care.
Community Outreach
The National Perinatal Programme conducts education and information activities (using printed
materials and audiovisual media) to highlight the benefits of maternal care for both maternal and child
health. Materials are distributed to women in health facilities or during group education sessions
organised and led by health workers. Raising community awareness about pregnancy complications
and risk factors, and encouraging women to use appropriate services, are of the highest priority,
especially in rural areas.
A 1997 study found that, in spite of all efforts, problems of cultural accessibility persist. For example,
60% of the women who delivered at home came from rural areas. Psychological and emotional
reasons motivated the choice for 40% of them. Lack of knowledge was also a factor; for example, of
the 46% of women who did not seek postpartum care, 73% said they were unaware of the schedule
for postpartum care.
Therefore, in collaboration with the National Solidarity Funds, which aim to improve living conditions
in rural areas, the National Perinatal Programme is promoting integrated family and reproductive
health in more than 800 underprivileged areas. A separate but related strategy is being developed to
improve the atmosphere and acceptability of peripheral maternities to encourage women to use them.
The National Perinatal Programme also works in coordination with the National Health Education
Committee, a consortium of groups that include NGOs (e.g. the National Union of Tunisian Women,
the Tunisian Family Planning Association, etc.), the majority political party (the Democratic
Constitutional Assembly) and the Scouts. The Committee organises IEC activities at both the national
and local levels.
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