In Tunisia, the healthcare system is divided between the publicly-run and funded hospitals and clinics and the privately-run and funded hospitals and clinics The healthcare system has a strong government infrastructure and oversight, both the public and private healthcare facilities are closely monitored by the Ministry of Public Health. The Ministry of Public Health is the main health provider in the public sector which consists of: primary care facilities, secondary care and tertiary, which consists of university and specialist. The Tunisian National Social Security Fund is the other public entity that was created so students, the self-employed and government, private sector and retired employees are afforded both a pension and health insurance based on the individual’s work history and earnings. The private healthcare sector consists of both for-profit and non-profit organisation run hospitals and facilities. The private healthcare sector represents 12% of the total capacity in beds and 70% of the top range medical equipment in the country. Most of the private hospitals and medical facilities are located in the major cities and it employs over 50% of the doctors, 73% of the dentists, and 80% of the pharmacists. Tunisia's private hospitals have attracted foreign patients to travel to Tunisia in order to undertake specialised surgical operations in the fields of cardiology, gynaecology, urology and cosmetic surgery. The medical tourism industry has become the second highest foreign currency earner and the second largest employer in the country.
Tunisia's healthcare system has become one of the most developed in Africa with medical standards that are equivalent to Europe. Since the introduction of a health insurance fund (Social Security) in Tunisia during the1950's there have been many dramatic improvements to the health of the population. Government expenditure on healthcare has remained at 5% of the GDP since 2006. The total healthcare expenditure per capita has increased from $72 dollars in 1990, up to $355 dollars in 2006. Coverage of the population by the healthcare system (inclusive of all public and private sector entities) has gone from 55% of the population during the 1980's, to over 80% of the population by 2006. Over 99% of the population has been vaccinated with the routine Expanded Program on Immunisation. Infant mortality rates have gone down from 120 deaths per 1000 births to 23.43/1000 in 2008, which is the second lowest rate in Africa, behind Libya. The total life expectancy of the population has continually gone up from 47.1 during the 1960's to 75.78 years in 2008, ranking Tunisia 72nd worldwide. There has been an eradication of many communicable diseases, such as malaria, schistosomiasis and cholera. However there are still numerous health concerns posed in the country.
The goal of Tunisia's healthcare system is to provide the entire population, regardless of income, social status or place of residence, free and adequate healthcare. There have been many continuous efforts from the government to maintain and to improve on the healthcare system such as developing the social security fund as well as improving the accessibility of hospital in-patient and out-patient care. Tunisia has also focused on improving the management process to become more efficient by training staff on better communication skills and new computers in addition to the modernisation of the billing system, which has allowed the mobilisation of additional resources.
The public hospitals are becoming inadequate in providing the proper treatments that are needed. Hospitals have become under staffed due to lack of funds, which has caused highly trained doctors and nurses to leave the publicly run facilities. This has caused over crowded and long waits in the public sector. The shortage of additional funds to the public healthcare has caused the lack of technology and equipment that is needed in order to treat patients and the lack of hospitals and facilities outside of the major cities requires the ill to make an extensive journey for treatment.
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