caa a22 4500 606222200 CHVBK 20210128101132.0 cr unu---uuuuu 210128e20150101xx s 000 0 eng 10.1007/s00038-014-0616-0 doi (NATIONALLICENCE)springer-10.1007/s00038-014-0616-0 Health system challenges of NCDs in Tunisia [Elektronische Daten] [Habiba Romdhane, Faten Tlili, Afef Skhiri, Shahaduz Zaman, Peter Phillimore] Objectives: 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). Methods: 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. Results: 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. Conclusion: 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. Swiss School of Public Health, 2014 Tunisia nationallicence Arab health nationallicence Health system challenges nationallicence Non-communicable disease nationallicence Health nationallicence Policy nationallicence Romdhane Habiba CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia aut Tlili Faten CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia aut Skhiri Afef CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia aut Zaman Shahaduz Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK aut Phillimore Peter Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK aut International Journal of Public Health Springer Basel 60(2015-01-01), 39-46 1661-8556 60<39 2015 60 38 https://doi.org/10.1007/s00038-014-0616-0 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00038-014-0616-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Romdhane Habiba CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia aut NATIONALLICENCE 700 1- Tlili Faten CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia aut NATIONALLICENCE 700 1- Skhiri Afef CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia aut NATIONALLICENCE 700 1- Zaman Shahaduz Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK aut NATIONALLICENCE 700 1- Phillimore Peter Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK aut NATIONALLICENCE 773 0- International Journal of Public Health Springer Basel 60(2015-01-01), 39-46 1661-8556 60<39 2015 60 38