Evaluation of the Primary Health Care policy in the Maghreb. Feedback from Expert-Leaders in Tunisia.

Introduction: The Basic Health Care Policy (BHC), the Maghrebian version of WHO's Primary Health Care, is celebrating forty years in Tunisia. The aim of this paper was to contribute to the evaluation of BHCs in Tunisia, by listening to the testimonies of experts / leaders who have led their journey during these four decades.

Methods: The experts / leaders included in this testimony were invited via email and throu gh the use of the Delphi technique to report the acquired lessons and the errors. The collected qualitative data was analyzed through a process of categorization which classified them into: assets (strengths and opportunities) and handicaps (weaknesses and threats).

Results: Four experts / leaders took part in this call for testimonies, including two consultants to international organizations, a trade union doctor and a professor of Preventive Medicine. The main assets of the BHC in Tunisia, according to the participants, were: 1. The medical leadership initiated from the student phase;  2. The political commitment of public authorities ; 3. The academic support from the medical faculties and their Preventive Medicine departments ; 4. The institutionalization of the organizational framework of the Health Unit ; 5. The Academic training of professionals in integrated medicine. As for the handicaps of BHC in Tunisia, the experts / leaders particularly mentioned: 1. The weakness of community participation ; 2. The international attractiveness of accompanying national doctors; 3. The pressures of academic career imperatives ; 4. The lack of a National School of Public Health; 5. The context of privatization and hospital-centrism.

Conclusion: This feedback from the experts / leaders concerning BHC policies in Tunisia highlighted the perception of its performance "in tune" with WHO and "three years before Alma Ata". The new generation of BHC leaders have an obligation to safeguard their principles and adapt their practices to population expectations and new managerial approaches.