[Hospital reform project, objectives, implementation, results and training].

Face to structural adjustments of the economy, the Tunisian public system of health, confronted with internal inefficiencies and to an inadequate financing, makes the object of a reform targeting teaching hospitals. Its objectives are to institute an autonomy of management and to exploit an integrated system of information that, associated to economic studies, will allow the Government to revise modes of financing of the health sector. This reform has modified the legal structure of university hospitals ending to a management of performances, based on the participation of the intervening, in an environment demarcated by the Government, by contracting multi-annual programs. By its impact, by reactions and surrounding opportunities, its viability and its sustainability are warranted especially if one minimizes potential risks linked to the exercise of the tutelage and to the adaptation to reforms of the other systems, notably the health insurance in order that a project of reform has been adopted and will be put in application soon. The strategy of implementation steady has allowed to reach convincing results to consolidate and to diagnose insufficiencies to fulfill, especially that an adapted extension of this reform is anticipated, to the level of regional hospitals, secondary care level.