Health system challenges of NCDs in Tunisia.
OBJECTIVE
The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs).


METHODS
Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process.


RESULTS
Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void.


CONCLUSIONS
This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.
CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia.
Habiba
H
Ben Romdhane
Faten
F
Tlili
Afef
A
Skhiri
Shahaduz
S
Zaman
Peter
P
Phillimore
D002908:Chronic Disease / Q000628:therapy*; D003266:Continuity of Patient Care / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D011050:Policy Making; D011320:Primary Health Care / Q000458:organization & administration; D017149:Private Sector; D017150:Public Sector; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D014416:Tunisia