Forty years of Basic Health Care in Tunisia: From "Health for All" to "Universal Health Coverage"

Abstract

Introduction: The descriptor "Basic Health Care" (SSB), is the Tunisian name of "Primary Health Care" (SSP), implemented in Tunisia at the beginning of 1980. The objective of this reflection was to compare the practices of SSBs in Tunisia with the principles of the SSP vision.

Methods: Based on key conferences in the history of SSP, from the Alma Ata conference (1978), to the Astana conference (2018), including the Millennium Development Summit (2000), the Sustainable Development Goals (2015) and Universal Health Coverage (2017), the SSB policy has been reviewed, through its conformity with the vision of PHC and the relevance of its programs to current health needs.

Results: The PHC policy has been based on two fundamental statements. The first was that of Alma Ata, having clarified a vision of public health, based on social justice, the right to health, solidarity, the felt needs of the population, community participation and the intersectoral approach, as well as basic health programs including maternal and child protection, immunization, treatment of common diseases and provision of essential drugs. The second was that of Astana, who affirmed a commitment to PHC through four pillars: 1. Strengthening cumulative expertise. 2. Support for human resources, 3. Facilitation of access to healthcare and information technologies; 4. Funding reform, tackling financial difficulties. However, during the last four decades, the national SSB policy in Tunisia has been limited to a package of health programs, static, disconnected from the public health paradigm (equity, community participation, multisectoral approach) and facing an important problem of under-financing (scarcity of resources, access barriers, waste of expenditure).

Conclusion: The Tunisian SSB policy today needs a new range of programs, adapted to the global burden of morbidity, and inserted in a vision of social justice and in a socialized system of financing (health for all, leaving no one behind).

Figure 1. Les deux déclarations historiques en Santé publique, sur les Soins de Santé Primaires, d’Alma Ata et d’Astana

Figure 2. Les Principes des Soins de Santé primaires (SSP), selon la Déclaration d’Alma Ata (septembre 1078)

Figure 3. Les huit programmes des Soins de Santé Primaires (SSP), selon la Déclaration d’Alma Ata (septembre 1978)

Figure 4. Les huit Objectifs du Millénaire pour le Développement (Nations Unies, 2020)

Figure 5. Les 17 Objectifs de Développement Durable (ODD)

Figure 6. Les quatre fondements de la politique des Soins de Santé de Base/Primaires (SSB/SSP) en Tunisie