Description

Executive summary

The COVID-19 pandemic in 2020–2022 had a significant impact on primary health care (PHC) in Tunisia. This case study examines PHC – known locally as basic health care (BHC) – in the context of the pandemic between March 2020 and August 2022, with a focus on preparedness, response and resilience. The Astana PHC framework was used to analyse and report the findings. A literature review of relevant academic literature and policy documents was conducted, followed by stakeholder consultations with health care personnel able to offer reflections on the role of the national health system in the COVID-19 pandemic response. The health system pursued a vertical, hospital-centric approach in the pandemic response, relying particularly on emergency services. Nevertheless, several examples of community participation and multisectoral collaboration were observed. Civil society, professional organizations and official agencies were mobilized in support of health personnel. Pilot projects were initiated that aimed to integrate digital and technical innovations, personal protective equipment (PPE) was produced, oxygen concentrators were distributed, and resuscitation beds were installed. Despite the fragility and marginalization of PHC/BHC in the pandemic response, there was consensus among health care stakeholders that PHC/BHC contributed to preventing the collapse of the national health care system through inclusive participatory and collaborative practices. The Tunisian experience suggests that the COVID-19 pandemic response may have benefited from earlier and greater PHC/BHC involvement. Increased recognition and support for the core functions of PHC/BHC, including critical emergency management, will be important to build current and future pandemic preparedness and response capacity

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