Dear Dr. Ben Mesmia, could you please introduce yourself?
My name is Hela Ben Mesmia and my current position is the President of the Management Unit for the societal dialogue for health system reform in the Ministry of Health of Tunisia. When I joined the Ministry of Health in Tunisia in 2015, I worked in various departments leading the projects in the fields of public health, strategic planning, health policy, quality, patient safety. I have a long track of experience in working with all type of stakeholders: governmental departments, international partners, civil society, academia and unions.
Prior to that, I worked on clinical research, HIV management in various humanitarian settings with NGO “Doctors without borders”. I have PhD in Public Health from the University of Sousse, Tunisia and degree of PharmD specialized in public health from University of Monastir, Faculty of Pharmacy (Faculté de pharmacie de Monastir)
What is the commitment of the Tunisian government to achieve the Universal Health Coverage (UHC)?
Tunisia is a country in the Maghreb region of North Africa with a population of 11 million people. Our government was traditionally centralized and autocratic but it committed to work in a collaborative and participatory manner following 2011 revolution. The WHO is working closely with the Ministry of Health of Tunisia to re-orient the health sector towards primary health care, taking into accounts the needs of vulnerable population, and improving both quality of care and efficiency of the health system. This effort has also led to the establishment of ‘dialogue sociétal’ – public dialogue in health sector – a large-scale consultation to better capture population’s views, needs and expectations. With the second phase launched in 2017, a key expected output is the development of a new national health strategy towards 2030 and the Universal Health Coverage (UHC).
How you present this initiative to stakeholders and organized stakeholder engagement?
The process of the Public Dialogue for health system reform is a process that was launched in a post-revolutionary context in 2012. It is an inclusive process and constitute a large platform for a multidisciplinary participation. Its aim is to elaborate health policies, strategies and plans within a participatory approach. It has been an opportunity to share and exchange between various actors: communities, civil society, health professionals, and government. The Societal Dialogue process created many participatory spaces: Citizen’s Meetings on Health, Open Mic sessions, focus groups, Citizen’s jury, National Health Conference.
We consulted 1199 citizens, 65 associations, 1557 health workers and 207 experts/volunteers and established 130 Steering Committees representing various stakeholder groups.
What is the current situation with healthcare PPP projects in Tunisia?
In the National Health policy 2030 developed within the phase 2 of the societal dialogue the health system consider the health system as a one piece that include both public and private sectors. The complementarity and collaboration between the public and private sectors to achieve public health objectives is crucial. The Ministry of health must ensure a better-regulated private sector to be aligned with public health missions.
In fact, the health system’s responses to the needs of citizens of different regions are optimized through the organization of a functional network of interregional health clusters taking into account the public and private sectors. Besides, both private and public providers of family and local health are responsible for coordinating the care process.
Investments in public-private partnerships (PPPs) have not started yet, as the last legal obstacle has only just been lifted by the Transversal Law on investments in June 2019.
In Tunisia, PPPs are governed by a number of legislative texts. In November 2013, two decrees (Decree N° 2013-4630 and 2013-4631), creating a concessions monitoring unit and providing more detailed guidance on the preparation and roll-out of concession procurement procedures, brought greater clarity and transparency to the overall regime of Concession Law No. 2008-23. The Decrees govern procurement of all PPP concession projects in Tunisia, except where there is a sector specific law and there is no special law in the health sector.
The institutional framework for concessions and PPPs in Tunisia is currently laid out under the November 2013 Decree on Concessions (n° 2013-4631 of 18 November). The main body mandated to coordinate, provide advice on and monitor PPPs and concessions is the Unité de suivi des concessions (or concessions tracking unit, USC). Established under the Prime Minister’s Office (PMO). The USC is responsible for providing support to public entities throughout the procurement process, including the preparation of guidelines and model specifications, capacity building, and encouraging concession projects in Tunisia’s regions.
It is important to note that the concessions and PPP regime in Tunisia is separate from the public procurement regime (régime des marchés publics), which is governed by the 2014 Decree on Public Procurement (n° 2014-1039 of 13 March 2014). Accordingly, public procurement that does not involve concessions or PPPs is managed by a separate set of institutions.
Where do you see PPPHealth4All platform could be instrumental in achieving UHC in Tunisia?
It is difficult to achieve UHC without proper investments in the healthcare infrastructure, medical services and equipment. Healthcare PPPs could be instrumental in helping us to achieve UHC in Tunisia and PPPHealth4All could assist in sharing best practices and assist in preparation of sustainable and people-centered healthcare PPPs.
This participation on a large scale is linked to the willingness of the actors to join a project of change to participate in the establishment of an efficient and equitable health system within a consensus. This will is the basis of the commitment and the ownership.
However, this commitment has not been well maintained over time. This is the cause of the constraints mainly related to the political stability. But the motivation of a core group of experts established since the first phase of the Societal Dialogue and which continue to this day was very crucial to the sustainability of this process.