Health System Challenges of NCDs in Tunisia

A qualitative study on the health system in Tunisia, with a focus on the growing burden of non-communicable diseases

This qualitative study as part of the MedCHAMPs project is comprised of analysis of official documents, semi structured interviews with 12 key informants (health directors, researchers, NCD coordinators and NGO representatives)  and interviews with local practitioners in clinics.

The research revealed a very good knowledge about the determinants, burden and impact they have, and some political intent to manage NCDs via national programs to manage diabetes and hypertension as well as an NCD management unit. However evidence of any intervention of substance appeared to be minimal.

"It is clear that there is a gap between the political intention and the practice in the field" - NCD coordinator

There was a lack of funding in primary care, with the bulk of funds going towards University hospitals and specialist centres.


The growth of the private sector brought positives and negatives - providing a good quality of care and meeting needs public sector lacked the capacity to, but this came at the cost of widening health inequality, both economically and geographically. Regulation seemed to be minimal at best. (see second quote)

"For CVD and diabetes management, the duality of Public/Private practice is a real problem: the MoH guide;ines are not observed, regulation is weak. It is an abyss of money"

Pressure from the pharmaceutical lobby competed with MoH regarding the adherence to treatment guidelines, diluting the influence a governmental policy on NCDs would have had

Lack of a centralised information system was identified as a limitation in conducting the kind of health surveillance needed to monitor progress in tackling NCDs.

The article also speaks of the political transitional period, where one of the authors -Professor Habiba Ben Romdhane- became Minister for Health in Tunisia. At the time of writing, a strategy to integrate the four major groups of NCDs into primary healthcare had been agreed upon.


Please read the full paper, available open access:


Romdhane HB1, Tlili F, Skhiri A, Zaman S, Phillimore P. Health system challenges of NCDs in Tunisia Int J Public Health. 2014 Nov 16