Presenting its assessment of its activities in Tunisia from 2019 to 2023, the World Health Organization (WHO) stated that these were organized according to biennial work plans, but without being guided by a formal Country Cooperation Strategy (CCS).
In budgetary terms, the WHO’s planned contribution amounted to USD 28,782,261, of which USD 22,783,263 had been implemented as of October 20, 2023.
It should be noted that the Contingency Fund for Emergencies (CFE), used for the COVID-19 response, represented 59% of the total budget executed during the evaluation period.
As part of its biennial planning, WHO in Tunisia focused primarily on improving access to quality essential health services, reducing financial hardship, and improving access to essential medicines, vaccines, diagnostics, and devices, in the context of health system reforms aimed at achieving universal health coverage (UHC).
This translated into strengthening preparedness, detection, and management of health emergencies; improving epidemic and pandemic prevention; and addressing the determinants of health, reducing risk factors, and applying a “Health in All Policies” approach to improve the health and well-being of the population.
In addition, WHO adapted its efforts in Tunisia to address emerging challenges, such as the COVID-19 pandemic, with immediate crisis responses and follow-up measures during the 2020-2021 and 2022-2023 biennia.
During the evaluation period, major public health issues in Tunisia, such as noncommunicable diseases (NCDs), received renewed attention.
This included promoting a multisectoral approach to risk factors, addressing mental health, and improving medicine supply. Advocacy and community engagement played a crucial role in these advances, leading to lasting changes, notably in tobacco control.
While significant action was initiated to advance universal health coverage, these efforts are still ongoing and remain highly dependent on contextual factors and the development of medium-term strategic partnerships.
Moreover, WHO interventions did not sufficiently address the structural changes needed to improve essential public health functions or consolidate the foundational elements of the health system.
The COVID-19 response
WHO’s support for the national COVID-19 response included rapidly activating national response mechanisms, providing essential scientific information, coordinating efforts, and strengthening certain capacities within the national health system.
Much of the emergency assistance provided during the pandemic was later converted into strengthening regular health services and building capacity to respond to future crises.
However, inefficiencies were noted in supporting the national response, particularly in building and operationalizing hospital services, providing biomedical equipment, and ensuring the rapid rollout of the national vaccination strategy.
In both the global and national contexts, WHO’s strategic role is clear — notably in its capacity to support the production, dissemination, and application of knowledge, an area where it holds significant comparative advantages.
Its mission, normative leadership, and role as a source of information for health actors are well established. However, these advantages are somewhat offset by a lack of visibility and a lack of awareness among key health stakeholders in Tunisia regarding WHO’s priorities and collaboration opportunities.
Strong scientific leadership
Key issues such as governance, financing, human resources (HR) in health, and the impact of climate change on health were less developed, despite their importance for building resilient health systems.
Actions were planned or initiated on topics such as violence against women and children, care for the elderly, nutrition, and generating evidence from health information systems — but these appear to have lacked follow-up.
WHO’s action during COVID-19 in Tunisia contributed significantly to mitigating the impact on the national health system, its professionals, and the population.
In particular, WHO demonstrated strong scientific leadership, effective political and institutional engagement, and robust support for the national coordination of the response. Its technical assistance in areas such as cold-chain management and laboratory capacity was especially commendable.
