1- As part of the project started in July 2015 to improve access to care for migrant populations in Tunisia, Médecins du Monde has developed a two-pronged strategy:
- The first involves medical action in the field (in a broad sense, including the psychological component) in partnership with the actors (institutional, associative) already working with these populations and healthcare providers.
- The second considers institutionalization and advocacy actions for the migrants rights to access to care.
More concretely: direct assistance takes the form of medical-psycho-social assistance to vulnerable migrants. This is done either directly by MdM, or via a referral to structures, non-governmental or civil society, more able to meet the identified needs. Consultations in general medicine and psychology are provided in this context. A broad awareness-raising component for migrants is also put into place.
MdM is also developing a referral system to medical-psychological service providers. These providers, previously identified from the public and private sectors, will be linked by MdM acting as a focal point, with migrants. The latter will thus benefit from a dynamic network of providers and health structures and have access to adapted services.
By setting up such a system, MdM ultimately aims to improve the capacities of institutional and private actors at levels of organization, networking, training, partial care, and more. Again, what does it mean to respond to the needs of migrants?
Médecins du Monde Belgium has set up since February 2015, a "mental health" station for the migrant population of Greater Tunis.
2- The right to healthcare is at the heart of the "SEHATY" project developed by Médecins du Monde Belgium (MdM BE) and its partners: Mourakiboun, CIDEAL and COSPE. The Tunisian constitution of 2014 enshrines the right to healthcare. Despite remarkable achievements, the Tunisian health system (STT) seems to have run out of steam. Disparities between regions / localities and socio-economic groups are widening, and the inequities of access to care are worsening, hindering an achievement of universal healthcare access, especially for the most vulnerable populations.
The overall objective of the project is as follows: "The health of the population in the targeted areas, especially the most vulnerable groups, is improved through better access to quality front-line health services and better knowledge of human rights and responsibilities by local communities. " The specific objectives are:
• SO1: Promote dialogue at the local level between civil society, elected representatives and other public and private actors in the health sector, for better governance of the health system.
• SO2: Strengthen the structure and capacity of Civil Society Organizations (CSOs) in targeted areas for more effective local health-focused intervention.
Our approach is part of the opportunities offered by the principles of decentralization and participatory democracy enshrined in the January 2014 constitution and in the new local government code. It is based on a community-centered approach and that of healthcare democracy: i) the development of public consultation, ii) the improvement of the participation of health actors, iii) the promotion of the individual and collective rights of users.
The intervention will be conducted at the level of at least 13 health districts that will be identified in the 13 areas targeted by the health sector support program "Essaha Aziza", according to predetermined criteria. Operational details & security context
The operational and security context of the project can be described as follows:
- The project "Migrants" is implemented in Greater Tunis, Sfax and Medenine in the South of the country. The "SEHATY" project, co-financed by the EU, is being set up in 13 governorates and seeks to develop a participatory approach to health democracy.
- MdM has operational bases in Tunis, Sfax, Medenine, Sidi Bouzid and plans to set up in Jendouba as part of the project co-financed by the EU.
- Deployments in the country are possible, without major stipulations for security. Areas to avoid are the South and the border areas with Libya.
- There is little crime in Tunis where the headquarters of MdM is based.
Health - Covid19:
In its management of the Covid-19 crisis, Tunisia has taken measures to restrict and control borders for countries identified as being at risk. A constant watch is therefore kept by the mission. MdM-Belgium has already put in place measures, with a systematisation of barrier gestures and a contingency plan in the event of re-confinement of the area (teleworking, provision of protective equipment, etc.). At the present time, movements have returned to normal.