The development of health and health care in Mejri wahida thésard à Paris1 Sorbonne ENeC. [email protected] 15ème colloque "Emerging New Research on Geographies of Health and Impairment (ENRGHI)" PARIS 10 et 11 juin 2010

14000 35000

Abstract 12000 30000 Number of Paramedical staff

Our study demonstrates the development of health and health care in Tunisia during the past two decades. 2. The improvement of the quality of care and the 10000 25000 This is reflected partly by improving health indicators and secondly by Evolution of health facilities in the public performance of the offer. 8000 20000 and private sectors with improving the quality of health care and performance of the bid. • Promotion of human resources. 6000 Number of physicians 15000 We also tried the rate of increase of number of doctors for different 4000 10000 But despite the remarkable development of this area there are recommendations to provide for better reform of the The number of doctors has develop almost 7 times parts of the country to see if these programs were successful health system. in the two last decade , about 10 times for the dentist and 2000 Number of Dentists 5000 in improving the regional balance. Map 1 0 Number of Pharmacists 0

0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 0 0 0 0 I n t r o d u c t i o n 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 We see that this evolution is not the same The health sector is at the top of the priorities of the State, taking into account its paramount importance in terms of for all of the we distinct 4 types sustainable development and welfare. The sector has known, since the last two decades, a remarkable development Fig 3: Evolution of health personnel between 1990-2009 which has embraced all areas in the public and private sectors.

It has resulted in many achievements. 400 8000,0 . Number of population per 1 dentist 1/ very imortant evolution and . The two biggest town in Tunisia Objectifs 350 7000,0 Dectec The development of health and health care in Tunisia during the last two decade 2/imortant evolution who are interested to third town Sousse and also 300 Number of population per 1 paramedical 6000,0 3/ medium evolution interssed the rest of coastal gouvernerate Materials and Methods The number of population per personnel health decreases 250 5000,0 4/ low evolution for the rest remains . 200 4000,0 we have used for this study statistical series delivered by NATIONAL INSTITUTE OF STATISTICS and Ministry of also in this periode which shows the improved of health We can say even with these programs the coastal VERY IMPORTANT IMPORTANT 150 3000,0 MODERAT Public Health, about Healthcare infrastructure and Health indicators. these data are spread over the last two decade care fig4 but is it true for all regions of Tunisia ? areas is the most evolved and includes the majority of health LOW Number of population per 1 physician and cover all governorates of Tunisia. 100 2000,0 services and offers.

We use simple statistical function aand graphical representations to detect the development of this sector. 50 1000,0 with a map showing the geographical distribution of this development in the liberal sector. 0 0,0 Results 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Map 1:The rate of aug mentation of number of population Fig 4 : Number of population per health personnel 1990-2009 per physician between 1997-2009 1. Improvement of health indicators and Evolution of health structures in the public and private sectors • Improvement of health indicators - A life expectancy at the birth of 74,4 years currently against 67,4 years in 1987. We can detect clearly the development of a health secteur in tunisia But is it true that tis development touch - The infant mortality rate by 17‰ currently against 51,4‰ in 1985. all regions of Tunisia in the same way ? • Development of the advanced medicine - A maternal mortality rate of the order of 35,5 for 100 thousand live births, against 69 for 100 thousand live births in we will take two years of number of liberal physician and the number of population per liberal physician - The creation of several facilities and services like the National Centre for Promotion of organ transplants, 1994. to do the comparison between 1997 and 2009 fig 5 and fig6. the National Center for bone marrow, the Centre for Emergency Medicine and Trauma Burn , - A rate of access of pregnant women to a prenatal consultation of 96%, against 72% in 1987. 1800 Center for neonatology in Monastir, the National Blood Transfusion Centre, National Laboratory for Drug Control, - A rate of coverage of births in hospital who has reached 96%. 1600 the Department of Thoracic Surgery Ariana, Department of Cardiovascular Surgery at Rabta, in addition to The improvement of these indicators of health is essentially to the evolution of health structures in the public and 1400 neonatal care in Tunis Sousse and Sfax, services carcinology in Sousse and Sfax and service of hereditary private sectors and the increase of medical coverage at the level of human resources. 1200 diseases and genetic Charles Nicolle hospital in Tunis .

1000 - The development of the activity of organ transplantation in an evolutionary manner • Evolution of health structures in the public and private sectors 800 (cornea, kidneys, heart , liver, bone marrow, members. In order to approximate the health benefits of all kind of society and to ensure the availability in all regions, 600 - The introduction of new medical technologies and advanced technology skills through the National Medical the structures under the health sector have developed considerably during the twenty years.fig 1 et fig 2 400 and effective cooperation with foreign medical teams

200 - The development of the local production of medicines on the plan quantitative and qualitative,

0 which has enabled cover 49% of the needs of the country in drugs against 7% only in 1987. i l a ja s e s a a n e il f ia a e ir u x id a e e r is n n é u rt é s b a n b e d b in st e a z n s in u n a a o b f u u ri é K u n b f u a s u e u u ri B r ze a a o o e K h o e a S o ili u z o A i G d ir s e a n n a o o o T h A B G n a s L M a d o N B S ta T g n e a é M i S a a e J K M M id T B K S Z Number of Health Centers Number of Public Hospitals number of libral physician in 1997 number of bublic physian in 2009 Conclusion 180 2500 so u rce IN S 2009 The Health Sector in Tunisia has indeed many advantages. It is diverse, ranging from basic health care to more sophisticated through the heavy conditions.But it must improve advantage on several routes, including the 175 2083 fig 5: Number of private physician in 1997 and 2009

2000 financing of the health and health insurance, the offer of care, the quality of care and the information systems.. 174

170 Number of health Center 25000,0 1500 165 1506

20000,0

160 1000 15000,0

156 155 Number of Public Hospitals 10000,0 BIBILIOGR AP HIY 500

150 R ev iew s P D F dcument o on the Intern et

5000,0 1 . Tu n isie, e-San té É ta t des Lieux etersp P ectives

145 0 H. Ach o u ri, Z .To u rk i 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 0,0 2. L A CART E SA N ITA IRE Bo u slam a M , Min istèr e de la santé P u b liq u e f l a ja s e s a a n e ili e ia a e ir u x d a e e r is n n é u rt é s b a n b b in st e fa i n s in u n a a o e b f u u ri K d u b z a s e u u ri B r z a a o o e é e h o n a S u li u u z o A A i G d ir s K L a n e n a o i o o o T h B G n a s M a d o N B S S ta T g n e K a é M i a a so u rce IN S 2009 e J K M M id T Z Fig 1: Number of Public hospitals and health centers 1990-2009 B S B o o k So u rce IN S 2009 number of population per physician in1997 number of population per physician in 2009 3. D ah m an i B, 1 995 : Po p u latio n , santé et d év elo p p em en t enT u n isie, 54 0p ag es Fig 6: Number of population per private physician in 1997 and 2009 4 . Fo u rati M , 2003 : San té et m édecine en Tu n isie,57 6 p ag es 5. L afif H , 1 980 : ST RUCTURE DES SOINS MEDICA UX, Un iversité de ParisI,349 pages. 6. NOUIRA A ,1 983 : SYSTEME DE SANTE PUBLIQUE ET AETT DE SANTE ENTUNISIE , 728 pages.

Zaghouan Ariana Ben Arous N ew sletter 1% 7% Béjà 6% 1% 3000 2747 we can clearly see the increase in number of private doctors between 4% 7 . L A SANTE PUBLIQUE ENT U N ISIE , San té In f o rm ations N 35 va ril 1 998. Min istèr e de la santé, 28 p ag es The number of hospitals is thus increased from 156 Tunis Gabès 2500 1997 and 2009. The total number to increase is about the double. 26% 2% 8. L A TUNISIE EN CHIFFRES 2 0 0 8 N° 46 1INS 38 p, ag es in 1990 to 174 in 2009 and the number of health centers from 1% 2000 The number of population per medecin 9. Rap p o rt Annuel sur les Indicateurs d'Infrastru ctu re n ° 51 , année 2008, 348 pages 1506 to 2083. 1% 1500 decreases but we should see if this evolution in the health offre Kairouan 1 0. Bulletin mensuel de la statistiq u e: n ° 1 4 , IN S, 4 5 p ag es Health Structures in the private sector have also expanded. fig 2 2% 1000 796 is it same for all governorates Tunisia . Fig.7 1% H o m ep a g e 0% Kébili 500 Despite the programs established to bring services closer to citizens 0% 116 0% Le Kef 1 . w w w .in sp .n at.tn 28 Sousse 1% Dental offices also developed from 495 to 990, 0 and to improve the regional balance as that of "Population and Family Health" 8% 1987 2008 2. w w w .o n fp .n at.tn 2% hemodialysis centers from 13 to 100 and radiologists and the project "to build support for reform of hospital management" 0% Monastir number of clinic number of beds 4% 2% 3. w w w.in s.n at.tn from 60 in 1992 to 107 in 2008. and "Creation of inter -some regional specialty "the development 1% Nabeul Médenine Sfax 7% 16% 4% 4 . w w w .o rd re-m ed ecin s.o rg .tn / Fig 2 : Number of clinic and beds in 1987 and in 2008 of this sector is in favor coastal regions and the of Tunis. so u rce IN S 2008 Hence Tunis only has 26% of the number of doctor. Fig 7 : Distribution of doctor’s portion of serving governorate in 2009 so u rce IN S 2009