Phase 1: Aligning citizen’s aspirations with the Tunisian health policy
Following the Jasmine Revolution in 2011, new opportunities arose for Tunisia’s civil society to take part in the political decision-making processes of its government. One of these opportunities materialised in the creation of the ‘Dialogue Sociétal pour les politiques, stratégies et plans nationaux de la santé, the Societal Dialogue for Health System Reform. This new form of dialogue constituted a large-scale consultation process between the government and its citizens regarding a variety of health topics designed to lead to informed policy decision-making taking citizens’ concerns into account.
Phase 1 of the Societal Dialogue, supported by WHO through the Universal Health Coverage Partnership, ended on a high note in 2014 in Tunis with the conclusion of the National Health Conference. Phase 1 saw constructive, but also heated, debates as well as intense civil society contribution to the question of how to reform the health system to ensure the right to quality health care for all Tunisians. The outcome of the National Health Conference was the adoption of the Tunisian White Paper for the Health Sector “White Book for a Better Heath in Tunisia”, which set out to align the Tunisian health system with the aspirations of its citizens.
Phase 2: An undeterred and re-invigorated Societal Dialogue for Health
Due to political and administrative instability in the Tunisian government, civil society pressure and reorganisation of the country’s political outlook, Phase 2 of the Societal Dialogue only started in July 2017. Phase 2’s objective is translating the recommendations of the White book into the first-ever participatory National Health Policy for 2030. The process is currently in full swing.
Civil society and citizen jury participants have been just as active and pivotal in Phase 2 as during Phase 1. The tireless involvement of Tunisia’s citizens’ participation in the Societal Dialogue is true testimony to the power of participatory governance, which can be harnessed for common objectives such as health sector reform.
Importance of the Societal Dialogue Inter-Regional Meeting Series
A key part of Phase 2 is the Societal Dialogue Inter-Regional Meeting Series in Tunisia. These meetings bring together government, citizen jury participants and other civil society representatives to discuss policy options for the National Health Policy. During summer 2018, 4 inter-regional meetings took place, such as the meeting in Monastir with focus on potential reforms in health financing in the future. In the spirit of the Societal Dialogue, 130 people, including non-governmental organizations, journalists, health professionals, parliamentarians and citizen jury participants, together assessed the existing health financing system and reflected on ways to make it more equitable and efficient in the future.
The positive, peaceful and productive process of the Societal Dialogue demonstrates that it is a critical tool in the development of the new National Health Policy, the first one post-revolution.
‘The power of inclusive and participatory processes such as the Societal Dialogue for Health must not be underestimated, on the contrary, it must be further encouraged. It shows that a more participatory, equitable and evidence-informed decision-making process can lead to strong policy options supported by and beneficial to all. The final outcome, a National Health Policy for Tunisia, should substantially improve the health status and the well-being of the Tunisian citizens.‘
Dr Yves Souteyrand, WHO Representative of Tunisia
‘During the inter-regional meetings one can feel how the atmosphere has changed thanks to the Societal Dialogue. Meetings like this would never have been possible before the revolution. Now, the room is buzzing, participants are committed and eager to find common ways to spur the progress. All participants are willing to own the new National Health Policy for 2030 and its implementation will be a success.’
Dr Hela Ben Mesmia, Ministry of Health, Tunisia
The way forward: what is next
The success of the process so far is illustrated by the fact that, since the beginning of Phase 2, 24 regional meetings will have been held before the end of March 2019. All of these meetings will collectively discuss key aspects of the draft National Health Policy through a true dialogue process including a wide range of stakeholders, including lay citizens. A National Health Policy for Tunisia and the successful completion of Phase 2 will cement an important step for advancing health for all in Tunisia.