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This case study examines country-level primary health care (PHC) systems in Tunisia in the context of the COVID-19 pandemic between January 2020 and August 2022. The case study is part of a collection of case studies providing critical insights into key PHC strengths, challenges and lessons learned using the Astana PHC framework, which considers integrated health services, multisectoral policy and action, and people and communities. Led by in-country research teams, the case studies update and extend the Primary Health Care Systems (PRIMASYS) case studies commissioned by the Alliance in 2015.
Minorities and indigenous peoples are among the most marginalized in terms of access to social and economic rights, and this is especially the case with health care. This report uses the availability, affordability, accessibility, adequacy and appropriateness framework to assess health services available to minority and indigenous communities in Egypt, Iraq and Tunisia. It combines research with interviews and focus groups with members of the communities and medical professionals to review the three health care systems. Covering the Coptic minority in Egypt; Yezidis in Sinjar in north-west Iraq; and, in Tunisia, the Black community in Djerba, Gabes and Sfax, the Jewish community in Djerba and the Amazigh community in Tatouine, the report identifies barriers to access to health care in a context of public health systems that have been weakened by Covid-19, as well as poor systems of governance and under-resourcing.
The Covid-19 pandemic exposed the weakness of right to health protections in Tunisia and particularly when it came to vaccine rollout programmes and the marginalization of historically underserved rural regions of Tunisia. Amnesty International conducted field research in Ghardimaou, one of the country's most marginalised regions located in a north-western mountainous area by the Tunisian-Algerian border and found many barriers preventing residents from getting their vaccines.
The COVID-19 crisis is expected to lead to a 46.4 percent decline in Tunisia’s GDP during the 2nd quarter of 2020 (April to June). The industrial sector will be hit hardest, with output falling by 52.7 percent, followed closely by services (-49.0 percent) and agriculture (-16.2 percent). These high losses are a result of the complete lockdown imposed in the country to contain the pandemic. Higher-income urban households will see the largest income losses, although lower-income urban households also will experience significant reductions in their income. As a policy response, social transfers towards poorer households will reduce the adverse welfare impact of these drops in household income. Government policies to support struggling businesses will allow economic activities to revive more rapidly when the lockdown loosens. Consequently, comprehensive planning by the Government of Tunisia to re-open the economy will be critical to reduce the pandemic’s adverse impact on the country’s economy in the longer-term, reducing losses of employment and income, especially in manufacturing and retail.
Abstract: During the outbreak of the global SARS-CoV-2 (COVID-19) pandemic, Tunisia, like many countries, prepared an emergency plan to shift to distance learning to salvage the academic year and ensure continuous learning. However, a shortage of digital materials coupled with the fact that many households did not have adequate Internet bandwidth made it virtually impossible to secure adequate digital learning. When in-person schooling was restarted in 2020/21, primary, pre-secondary, and secondary school pupils attended school on alternate days to avoid overcrowding. As a result of the pandemic, the curriculum has been lightened, and the fundamentals have been prioritized. Based on a content analysis of the Ministry of Education documents and a survey conducted by the Ministry on remote learning, we shed light on the different measures taken to curb learning loss during the spread of the pandemic as well as the challenges facing Tunisian students and the government. The consequences of ...
The COVID-19 pandemic has caused unprecedented disruption worldwide highlighting once again the interdependency of health and socioeconomic development, and the global lack of health systems resilience. Two years into the pandemic, most countries report sustained disruptions across service delivery platforms and health areas with a profound impact on health outcomes. The impact of these disruptions is magnified within marginalized communities and in countries experiencing protracted conflict. There is an urgent need to focus on recovery through investment in the essential public health functions (EPHFs) and the foundations of health systems with a focus on primary health care, and whole-of-government and -society engagement. The aim of this Research Topic is to gather, transfer and promote operationalization of key experiences from COVID-19 to inform global and country level recovery that better promote health; guide policy direction towards building health systems resilience; and thereby ensure economic and social prosperity. Experience with COVID-19 has demonstrated that traditional approaches to health system strengthening have failed to achieve the complementary goals of Universal Health Coverage (UHC) and health security with the divide between the most vulnerable and well-off only widening. Much of what had been learned from previous experiences such as Ebola in West Africa has not been widely applied. This has left health and economic systems vulnerable to 21 st century public health challenges, ranging from conflict and natural disasters to aging demographics and rising rates of non-communicable and communicable diseases and antimicrobial resistance. These challenges require intentional focus and investment as well as whole-of-government and -society engagement with health to build health system resilience. Greater action is needed to prevent the devastating effects of war and conflict on the health of the most vulnerable. This Research Topic will convene the knowledge and practices of leaders in public health, health systems, and humanitarian and development sectors. This is to ensure lessons from COVID-19 inform the recovery agenda and promote sustainable health and socioeconomic recovery for all. Lest we forget and find ourselves again unprepared and vulnerable in the face of an even greater threat.
No education system is effective unless it promotes the health and well-being of its students, staff and community. These strong links have never been more visible and compelling than in the context of the COVID-19 pandemic. A health-promoting school (HPS) approach was introduced over 25 years ago and has been promoted globally since; however, the aspiration of a fully embedded, sustainable HPS system has not yet been achieved, and very few countries have implemented and sustained the approach at scale. How can we make every school a health-promoting school, and how can we implement, sustain and scale up the approach at country level, particularly in low- and middle-income countries? All stakeholders involved in identifying, planning, funding, implementing, monitoring and evaluating the HPS approach will find some answers in this publication, which summarizes the experiences of eight countries spread across the world.
The Infectious Disease Vulnerability Index is intended to inform actions for preparedness and response to infectious disease outbreaks and foster greater resiliency of national health systems worldwide.