See also: Ministry of Public Health (French )   HEALTH CARE IN TUNISIA Introduction Tunisia has a public and private hospital and health infrastructure, which has enabled it to extend health cover to all parts of the country. The Ministry of Public Health watches over the health of the population with the aim of ensuring a harmonious development of their physical and mental faculties as well as their adaptation to the natural and social environment of the country by fighting the causes of deterioration of physical or mental well-being which may affect them individually or collectively. Law 91-63 of July 29, 1991, relative to health organization stipulates in its first article that everyone has the right to health under the best possible conditions. Access to health care and free health care The population's access to health care is governed by the 1998 revision of the terms of setting the categories of beneficiaries of totally free treatment and of reduced rates in public health facilities under the Ministry of Public Health as well as of the terms of granting benefits and the rates to which such treatment is subjected. Regarding free medical assistance in the health structures of the Ministry of Public Health, it covers needy families, which number 160,900, i.e. 7% of the families living below poverty line as well abandoned children and severely handicapped persons. Moreover, reduced rates in the health structures of the Ministry of Public Health are granted to citizens who are not affiliated to one of the social security systems, whose situation does not permit such affiliation, and whose annual income does not exceed: an amount equal to the guaranteed minimum wage in the different trades if the family members do not exceed two. an amount equal to one and a half times the guaranteed minimum wage in the different trades if the family members are between three and five. an amount equal to twice the guaranteed minimum wage in the different trades if the family members are in excess of five persons. The efforts made in the health sector have contributed to improving health indicators as follows: Life expectancy increased from 68.3 years in 1987 to 73.3 years in 2005; Infant mortality dropped from 51.6 ‰ to 28.8‰ over the period 1987-2000; The rate of medical cover increased from 1 physician for 2384 inhabitants in 1990 to 1 physician for 1013 inhabitants in 2004; The rate of vaccine cover against the six diseases involved in the world vaccine program has extended to over 94% of children age up to one year; The number of basic health centers increased from 1506 in 1990 to 2067 in 2004. The number of hospitals increased from 156 in 1990 to 169 in 2004. Tunisia has been awarded several medals on an international scale for its efforts in the field of health: in 1996, the World Health Organization awarded President Zine El Abidine Ben Ali the "health for all" gold medal; in the same year, the President also received the medal of the World Federation of Blood Donor Organizations; on April 2, 1997, the Red Cross and Red Crescent Society awarded President Zine El Abidine Ben Ali the gold medal of its 7th Conference. The Gross Domestic Product allocated to the health sector is of 1.8% in 2005. The pharmaceutical industry made real progress over the past decade: the cover of national needs in locally produced medicines increased from 7% in 1987 to 43.7% in 1999. Demographic Evolution The Tunisian population increased from 3.8 million in 1956 to 8.8 million in 1994, 9.4 million in 1999, to 10.1 in 2006. Thanks to an avant-garde family planning policy, Tunisia has been able to reduce the natural growth rate. This rate, which was in the order of 2.58% in 1994, was reduced to 1.14% in 1999. Indicators 1956 1966 1975 1984 1994 1996 1997 1998 1999 2000 2004 population (in thousands) 3782.2 4583.2 5511.7 7033.8 8815.4 9089.3 9214.7 9332.9 9455,9 9.5 9.910,872 Natural growth rate (in %) 3.5 3.1 2.7 2.6 1.4 1.3 1.23   1,12 1.14 1.21 Infant mortality rate (in ‰) 200 120 76,9 51,4 31,8 29,8 28,9 27,8 26,2 25.8   Gross mortality rate (in ‰) 25 15 10 6.5 5.7   5.6 5.6 5.7 5.6   Life expectancy(yrs) 47 51.1 58.6 67.1 71.2 71.6 71.9 72 72,1 72.2 73.8 Population under 15 (in %) 42.5 46.5 43.8 39.7 34.9 34.1 33.4 32.7 30,9 30.4 18.6 Population density(inhabitants/km2) 24.5 27.7 36.2 45.1 56.7   59.3 60.0 60.8 61.5   Evolution of Medical, Juxta-medical and Paramedical Personnel of the Health Sector Year 1990 1995 2000 2004 Physicians 4424 5965 7339 9805 Dentists 809 1038 1319 1889 Pharmacists 1240 1499 1841 2069 Paramedical Personnel 23743 25874 27770 29584 Investment in human resources has enabled the health sector to avail of an ever-increasing quality nursing personnel. This increase has a beneficial effect on health cover throughout the country and on the ratio inhabitants/physician, which increased from 1825 in 1990 to 1320 in 2000. Evolution of the Health Infrastructure Years 1998-2003 Category 1998 1999 2000 2003 General Hospitals 10 10 18 21 Specialized Institutes, Centers and Hospitals 12 13 13 06 Regional Hospitals 31 34 32 33 District Hospitals 96 106 106 109 Basic Health Complexes 24 24 24 24 Basic Health Centers 1922 1951 1981 2058 Regional school and university health centers       09 Total       2263 Source : www.santetunisie.rns.tn Public hospitals that do not come under the Ministry of Public Health: 3 Military Hospitals 1 Hospital of the Interior Security Forces in Tunis. Besides this public infrastructure, there is a para-state infrastructure: Para-state infrastructure: Six Polyclinics of the National Social Security Fund (CNSS) providing outpatients health care of a general nature, specialized treatment and diagnostic services for social security affiliates. Public Health Infrastructure The public sector remains the main provider of health care particularly preventive and hospital care. It is based on three complementary resort levels: the first level is comprised of 2058 basic health care centers and 109 district hospitals; the second level is covered by 33 regional hospitals located in most cases at the level of the administrative center of each governorate in 2003; the third level is composed of 18 university hospitals with a total of 196 sections and 40 specialized medical fields. Private Health Infrastructure It is comprised of an outpatient network of general or specialized medicine, paramedical treatment and hospitalization facilities. This infrastructure consists of: 70 multidisciplinary or monodisciplinary clinics; 1260 dental practice; A capacity of 16142 beds as against 16 013 beds in the public sector; 3293 medical practice of which 50.9% are specialized; 1394 pharmacies: 1259-day pharmacies and 141 night pharmacies; 156 medical analysis laboratories: 147 medical biology laboratories and 9 anatomy biology laboratories; 56 hospital transport services; 100 homo-dialysis centers; 567 paramedical free practice.