Tunisian documentation of «Public Health» in post revolution, with a taste of freedom. For a fair, participatory and efficient National Health System

Abstract

Context: Following the Tunisian revolution of 2010/2011, a new Public Health literature emerged, by the ministerial departments as well as the civil society, which was marked by the transparency and the comprehensiveness of the approach.

Objective: To identify the key ideas of the new Tunisian Public Health discourse, reconciling the principles of a globalizing paradigm with the health problems of a country in transition.

Methods: During this qualitative research, a selected series of three Tunisian reports of Public Health, published in the first quinquennium of the revolution, was read by an independent team of experts in Public Health, not having contributed to their elaboration, to identify the consensual foundations of the new Public Health discourse. These documents were: the "2011 Health Map" of the Department of Studies and Planning of the Ministry of Health, the "Societal Dialogue Report on Health Policies, Strategies and Plans" (2014), and the "Report on the right to health in Tunisia" (2016).

Results: The reading of this sample of the Tunisian Public Health literature of the post-revolution brought out three consensual ideas: 1. The constitutional principle of the "right to health" (article 38 of the constitution) with its corollary the State's obligation to ensure access to comprehensive, quality and secure care; 2. The challenge of social "inequalities" of access to care, reinforced by a regional disparity in the distribution of resources, particularly high-tech (specialist doctors, university structures); 3. Advocacy for a National Health System, based on a universal health coverage for its funding and citizen participation in its governance.

Conclusion: The new Tunisian Public Health literature, in post-revolution, calls on all stakeholders in Preventive and Community Medicine to replace their segmental, technical and hospital practices with a new approach, centered on the implementation of a National Health System that is based on a socialized financing of care and citizen participation in its management.