Interview: Saïd Aïdi

Which strategies have to be implemented in order to improve the medical coverage in Tunisia?

SAID AIDI: In Tunisia, there have been many achievements in terms of public health, but there are still major challenges. This is due, in part, to a result of demographic and sociological changes, which are contributing to the growth of non-communicable diseases.

To meet this new demand, the health care system needs to be modernised with a strategy based on five pillars. The first pillar emphasises prevention, of everything that may be connected to public health issues, ranging from health care education at school to road safety and smoking cessation. Frequent and early detection programmes can help stave off the spread of more severe cases of breast or cervical cancer. These sorts of initiatives are crucial to slowing the spread of chronic diseases, whether diabetes, hypertension or cancer. A key part of this is giving more responsibility to family doctors, and improving the efficiency of patient health plans.

The second pillar involves the re-organisation of the Tunisian health care system. Clinic and hospital networks should be re-organised into regional clusters, giving them full autonomy in terms of operational activities and, eventually, administrative and financial autonomy. The long-term objective is for more than 90% of clinical cases to be addressed in each of the territorial clusters. Each territorial cluster will need to have a full range of specialised establishments and doctors. This will reduce congestion, particularly for those patients suffering from severe pathologies.

The third pillar of the reform is innovation. This includes new pharmaceutical products, the implementation of telemedicine, the export of medical services to sub-Saharan countries, the export of geriatric care to Europe, and the creation of specialised treatment and research centres.

The fourth pillar deals with governance of the health care system. A National Institute of Accreditation has been implemented in partnership with the EU, with the objective of certifying 15 public and 15 private hospitals at a level of international accreditation.

The fifth pillar is the consolidation of the public medical sector, which must ensure health care to all Tunisians and the highest level of medical education.

How can rural staffing shortages be resolved?

AIDI: There is a need to incentivise doctors to work in isolated areas, which has led us to roll out a new strategy. The plan is to offer certain advantages, such as increased salaries, and the opportunity to regularly travel to conferences for those doctors who commit to spending between 10 and 15 years of their career in the public sector. Those doctors will have to settle in a designated location and would also be part of a rotation system, which means that they would have to spend a short part of their time, around one week per month, in a more isolated establishment. With this new system, the hospitals would not be providing permanent services in all areas, but would provide continuous services across a range of key segments. Obviously, some specialisations, like treatment of pregnant women, needs a full geographical coverage and will be available in every hospital at any time.

In your opinion, what potential is there for increased medical tourism in Tunisia?

AIDI: Medical tourism is a net positive for Tunisia, both at an economic and medical level, and the sector offers huge growth potential. Tunisia is already well positioned in this segment, especially for important specialisations like cardiology, oncology and geriatric medicine. The advantage is that Tunisia provides a strategic geographical position for European clients, alongside a high level of skill. For this reason, the Ministry of Health is looking at potentially encouraging both Tabarka and Tozeur – two cities that are close to an airport – to specialise in medical tourism.