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No Foreseeable Remedy for Tunisia’s Ailing Healthcare Sector

Infested with rampant corruption, the public health sector finds itself in the hands of conspirators engaged in the theft and embezzlement of public money through dubious deals.

For decades, Tunisia has prided itself on the billions of dollars invested in building an advanced healthcare system that offers decent healthcare for its citizens, as well as Arab and foreign residents and visitors. However, that rosy image is being dissipated by the dark reality of accumulated ailments.

Nowadays, the shortage of medicines has become so commonplace. It indicates a huge disruption to the whole healthcare system and reflects the mishandling of the sector by the country’s political elite which is entangled in its own conflicts and divisions. It underscores the failure of the government’s policies to improve a sector that is suffering from corruption, just like the majority of the public-sector areas of the country.

We should remember that, for decades, people have enjoyed an unquestionable right to healthcare, as stipulated in article 38 of the Constitution. This very article demands that the state provide healthcare services that respect the dignity of its citizens regardless of their financial condition. To realize that this basic right is now being withdrawn exposes the size of the political and economic bankruptcy of the government.

Reports indicate that the shortage of medicine is mainly caused by the depletion of the stocks of the central pharmacy which has debts of over $ 330 million towards its suppliers. This debt adds to the bleak picture of the pharmaceutical sector that is already suffering from an unprecedented deterioration in service. In the meantime, some international providers are threatening to cut the supply of such medicines as those used to treat blood pressure or diabetes if their dues of $140 million are not settled.

All this is happening within a sector that is already suffering from infrastructure deterioration and shortage of equipment. The refusal of specialized doctors to work in remote areas can only add fuel to the fire. In spite of people’s grievances and heavy criticism in the local media, not much has changed. The government still insists that the advancement of the healthcare sector is one of the main development plans it is trying to implement. In the meantime, studies indicate that the massive debts incurred by hospitals and basic health centers, estimated at over $207 million, in addition to the deterioration of infrastructure and facilities, have made it impossible for the sector to recover and paving the way for corruption and dubious deals to take control.

Recent testimonies of past health ministers are indicative of the level of corruption. Two years ago, past minister, Mrs. Samira Merai, uncovered part of the healthcare corruption when she addressed the scandals of incriminated cardiovascular stents and the imported anesthesia products that were expired.

It is unlikely that the protocol recently concluded between the Ministry of Health and the National Authority for the Fight against Corruption to reduce mismanagement of public health facilities will have any impact, particularly with the existence of parties who are trying to obliterate it as it contradicts with their interests. The same applies to the tenders launched by the ministry of health for medical supplies and services. Recent statistics by the national authority for the fight against corruption have revealed that 25% of these tenders go into the pockets of corrupt individuals.

The whole government is responsible for this disastrous situation as they have the means to eradicate the problem but they refuse to act decisively. Holding conferences and allocating funds to develop the health sector are not enough in light of the total absence of a clear strategy to combat corruption and move forward in the right direction.

There is unanimity today that the health sector is very unhealthy and awaiting to be healed. It needs to start getting out of the vicious circle of ongoing crises that have cost the government and the tax-payer dearly and crippled all attempts to introduce reform.

It is probably time for the government to minimize its role as the main provider of healthcare while empowering the private sector to take the lead.  This is the case in many other countries where governments exercise a regulatory role only. The experience in these countries indicates a reduction in cost associated with improvement of services, on condition that corrupt practices do not get in the way.

TunisianMonitorOnline – Fathi Ben Mohamed (Translated from Al-Arab, article written by Riadh Bouazza)

Al-Arab, April 6, 2018

 

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