Pandemic gravely affects private health clinics in Tunisia

Private clinics work at 20% capacity, which is insufficient to cover the wages of employees.
Monday 12/10/2020
A medical doctor examines a patient at the Hannibal International Clinic, a Tunisian private health clinic near Tunis.  (
A medical doctor examines a patient at the Hannibal International Clinic, a Tunisian private health clinic near Tunis. (

TUNIS--The emerging coronavirus crisis has cast a dark shadow on private health clinics in Tunisia, many of which are on the verge of bankruptcy due to a drop in medical tourism and a sharp decline in foreign patients, following the tightening of travel restrictions and the government’s focus on fighting the pandemic. While the public health sector has been fully mobilised, the repercussions on the private sector have largely been overlooked.

Pasteur private clinic in the Tunisian capital  (
Pasteur private clinic in the Tunisian capital  (

While public hospitals face difficulties with the increase in COVID-19 infections, private clinics are complaining of a shortage of patients, especially foreigners, and a financial recession that could accelerate their collapse.

The results of a study conducted by the Tunisia Health, a grouping which brings together Tunisian institutions active in the health sector, about the effects of the coronavirus crisis on private clinics, revealed that 97% of private clinics are operating at a loss and are no longer able to cover the costs of operation.


Drop in revenue 

According to Tunisia’s state news agency TAP, the study added that nearly half of private clinics are experiencing significant losses, rendering them unable to pay the wages of last May for workers and employees after the outbreak of the pandemic, and that only 2.5% of private health clinics were able to pay salaries up to August.

It suggested that their decrease in revenue is due to a drop in services, which have largely been limited to urgent procedures, and an almost complete stop of direct medical examinations and consultations due to confinement measures.

The study warned of a catastrophic situation for the private healthcare sector unless bold, effective measures are taken to save and revive private clinics in the short, medium and long term.

There are about 100 private health clinics in Tunisia established in all regions and governorates, employing some 17,000 people, with  a capacity of about 6,000 beds (20% of the national health sector capacity).

This sector represents a safety net for the country’s health sector in the event of a crisis that could overwhelm public sector capacity. Since the outbreak of the health emergency, private sector doctors have volunteered to support their colleagues in the public sector in providing care for patients, easing pressure on the health ministry.

Boubaker Zakhama, head of the National Chamber of Private Clinics, told The Arab Weekly that the pandemic  has had “a severe impact on private clinics, as it led to a decline in patients’ admissions.”

He said that “operations in most of the private clinics dropped by 80% during the coronavirus crisis, and their level of activity was estimated at only 20% of capacity,” which is insufficient to cover the wages of employees.

Boubaker Zakhama, head of the National Chamber of Private Clinics. (Facebook)
Boubaker Zakhama, head of the National Chamber of Private Clinics. (Facebook)

He attributed this crisis to the closure of borders and, consequently, the absence of foreign patients, pointing out that foreigners make up 50% of patients treated by private clinics. He indicated that 80% of patients in private clinics in Sfax, Tunisia’s second largest city, are Libyans, adding that these clinics’ work has stalled since borders closed, while the situation in the capital’s clinics is slightly better.

Zakhama dismissed the idea that clinics’ work is affected by geographical distance and their concentration in major cities. He said the problem lies in the ability to encourage specialised doctors to work in cities in the country’s interior, at a time when many prefer to emigrate. Brain drain has hurt the country’s entire health sector, leading to the flight of specialised technicians and nurses, not only doctors. Many specialised doctors in Tunisia prefer to leave the country and work abroad rather than work in interior regions, where medical supplies and equipment are often scarce.

As a result, 13 out of Tunisia’s 24 governorates have less than one intensive care bed for every 100,000 residents, according to a recent study focusing on the marginalisation of the country’s southern and central regions.

Private clinics are treating less patients with other diseases because of their lack of financial means and fear of contamination.

-Role of the state –

Due to Tunisia’s economic crisis and loss of purchasing power, the study expects a 30% decrease in local private clinics’ demand for health and treatment services in the near future, and a gradual return to international activity only in early 2021. It notes that for half of private clinics, no less than 40% of revenue comes from foreign patients.

As for the government’s plans to boost the health sector, which many doctors believe has been sidelined, Zakhama believes that the problem is not state support, as authorities continue to allocate funds, but in “shameful” mismanagement,

Zakhama complains of negligence and indifference on the part of some health sector officials as well as state resources being squandered.

Samir Chtourou, president of the Tunisian Syndicate of Private Sector Doctors, told The Arab Weekly that “the state does not provide the required support for private clinics that have been severely affected by the epidemic and are on the verge of collapse.”

Chtourou  said the decline in clinics’ work is due to restrictive measures imposed on foreign and local patients due to the coronavirus pandemic.

“The suspension of flights coming from neighbouring countries as well as the proliferation of procedures have made it more difficult for patients to come to Tunisia,” he said. To help mitigate the crisis, the medical syndicate urgently called on the government to open the country’s airspace, especially with Tripoli, Libya, as Libyan patients constitute a significant percentage of the patients in private clinics, according to Chtourou. “There are no planes that transport Libyan patients to Tunisia,” he noted.

Many Libyans travel abroad to receive treatment. Tunisia is the preferred destination for many of them to receive healthcare due to its geographical proximity.

Chtourou explained that most Libyan patients have chosen Istanbul as their new destination, as Turkey provides 8 planes per day from the country. He believed that “it is necessary to restore air traffic with neighbouring countries and ease measures, especially for countries that are witnessing an improvement in their epidemiological situation.”

A health protocol was put in place for foreign patients entering Tunisia to be treated during the pandemic. It directs them to undergo a compulsory quarantine period, either in their hotels or in clinics that ensure their treatment, in addition to compulsory tests.

Experts have called for the government to draft an emergency plan to reduce the financial burden on clinics, as well as a plan to help revive and develop the sector based on dialogue and joint action between public and private health institutions. Such plans, however, seem difficult to implement due to numerous challenges hindering health sector development in the country.

Ezzahra private clinic near the Tunisian capital, Tunis. (
Ezzahra private clinic near the Tunisian capital, Tunis. (

The COVID-19 crisis exacerbated the health sector’s troubles, especially in poorly equipped institutions where doctors denounce a lack of equipment and means of prevention and demand their renovation.

According to the health ministry, field hospitals are scheduled to be established in several cities. But there is concern about of the limited number of health workers, especially in intensive care units. Public health institutions have so far resorted to private clinics, which were eager to cooperate at the beginning of the health crisis. Some have accused private clinics of profiting from the crisis by raising the price of coronavirus examinations.