The inequalities reduction through healthcare decentralisation in low-middle income countries: The case of Tunisia

Healthcare decentralisation is a model of public service management founds on the wider distribution of the decisional power about healthcare. The decision power is split by central government also with the local health authorities. Since the 1980s, at worldwide level this reform has being applied for guaranteeing equity, efficiency, quality and financial sustainability in the healthcare services provision. In the last years, healthcare decentralisation is happening especially in low-middle income countries. With regard to the analysis of the effectiveness of decentralisation in healthcare, the obtained results are mixed. This study aims to investigate the contribution of management in the first steps of decentralisation's implementation for reducing health inequalities in Tunisia. To have the management's point of view, a survey was sent to all directors of the Tunisian regional hospitals. Health management was able to offer operative and timely solutions to the homogenisation and the improvement of healthcare services supply in Tunisia. For healthcare managers the guarantee of an equal and effective Tunisian healthcare system is into the application of a differentiated decentralisation. The differentiated decentralisation of healthcare system allows to resolve regional issues in Tunisia. These interventions permit to obtain consistent positive results about the satisfaction of Tunisian population health needs. The differentiated decentralisation of healthcare system could also be useful for similar countries, for example, of MENA are of low-middle income countries.