Evaluation of the Primary Health Care policy in the Maghreb. Feedback from Expert-Leaders in Tunisia

Abstract

Introduction: The Basic Health Care Policy (BHC), the Maghrebian version of WHO's Primary Health Care, is celebrating forty years in Tunisia. The aim of this paper was to contribute to the evaluation of BHCs in Tunisia, by listening to the testimonies of experts / leaders who have led their journey during these four decades.

Methods: The experts / leaders included in this testimony were invited via email and throu gh the use of the Delphi technique to report the acquired lessons and the errors. The collected qualitative data was analyzed through a process of categorization which classified them into: assets (strengths and opportunities) and handicaps (weaknesses and threats).

Results: Four experts / leaders took part in this call for testimonies, including two consultants to international organizations, a trade union doctor and a professor of Preventive Medicine. The main assets of the BHC in Tunisia, according to the participants, were: 1. The medical leadership initiated from the student phase; 2. The political commitment of public authorities ; 3. The academic support from the medical faculties and their Preventive Medicine departments ; 4. The institutionalization of the organizational framework of the Health Unit ; 5. The Academic training of professionals in integrated medicine. As for the handicaps of BHC in Tunisia, the experts / leaders particularly mentioned: 1. The weakness of community participation ; 2. The international attractiveness of accompanying national doctors; 3. The pressures of academic career imperatives ; 4. The lack of a National School of Public Health; 5. The context of privatization and hospital-centrism.

Conclusion: This feedback from the experts / leaders concerning BHC policies in Tunisia highlighted the perception of its performance "in tune" with WHO and "three years before Alma Ata". The new generation of BHC leaders have an obligation to safeguard their principles and adapt their practices to population expectations and new managerial approaches.

Pr. Kamel BEN SALEM

Photo 1 : Pr Zouheir Essafi : Faculté de Médecine de Tunis (9 mars 1975)

Dr Abdelwahed EL ABASSI

Photo n° 2: Une partie de l'équipe de Soliman lors d'une cérémonie à laquelle était présent le Pr Raouf Ben Ammar

Dr Belgacem Sabri

Photo n°3 : Dr Belgacem Sabri, de la coordination du projet de médecine intégrée à Mjez El Bab, au management de la direction du renforcement des systèmes de santé à l'OMS/EMRO.

Docteur Moncef BELHAJ YAHIA

Photo n° 4 : «Des programmes qualité ont certes été mis au point par la Direction des Soins de Santé de Base (DSSB), mais ils ont été tardifs et n'ont pas été appliqués» Dr Moncef BelHaj Yahia

Professeur Omar BRIXI

Photo n°5: Omar Brixi, Professeur de Santé Publique, dont intérêt s'est porté vers les Soins de Santé Primaires (Tunisie, Maroc, Djibouti, Vietnam)