Ben Romdhane Habiba, Tlili Faten, Skhiri Afef, Zaman Shahaduz, Phillimore Peter
CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia.
Int J Public Health. 2015 Jan;60 Suppl 1:S39-46. doi: 10.1007/s00038-014-0616-0. Epub 2014 Nov 16.
The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs).
Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process.
Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void.
This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.
本研究的目的是对突尼斯医疗体系进行定性的“情况分析”，该分析适用于心血管疾病（CVD）和糖尿病的管理。一个主要关注点是管理非传染性疾病（NCDs）的机构能力。
研究于2010年开展（分析官方文件、对关键信息提供者进行半结构化访谈以及在四家诊所进行案例研究）。采用了沃尔特和吉尔森1994年的政策分析框架：内容、行为者、背景和过程。
整合与协调问题加剧了资金压力。尽管初级卫生保健在突尼斯医疗体系中很重要，但它在管理非传染性疾病方面设备不足。由于资金有限，且没有转诊或健康信息系统，公共部门的工作人员士气低落。私立医疗保健成为填补空白的主要发展领域。
本研究突出了在实施全面的非传染性疾病应对措施方面的重大差距，这是该地区的一项紧迫任务。在战略规划中，对卫生系统的研究至关重要；但首先必须建立卫生部利用研究成果的能力，并致力于将政策变革建立在证据基础之上。
