突尼斯高血压和糖尿病的级联护理

Cascade of Care for Hypertensionand Diabetes in Tunisia February 2026 CONTENTS AcknowledgmentsAcronyms Executive Summary Section One: Introduction1.1Background1.11Context1.12Basic care cascade according to existing evidence1.2Objectives Section Two: Methodology2.1Quantitative Component2.11Information collected2.12Sampling Strategy2.13Sample Description2.14 Indicatordefinitions2.2Qualitative Component2.3Data Analysis2.4Limitations2.5 EthicalandDataProtectionOversight Section Three: Key Results3.1 PrimaryPreventionandPrevalence3.2Screening3.3Diagnosis3.4Treatment and Follow-up3.41Continuity of care3.42 Processquality3.5 Outcomes Section Four: Policy Implications and Recommendations 4.1Conclusions4.2 System-wideQualityImprovementProposals4.3 HypertensionandDiabetesCascade-specificProposals Appendix One: Sample Composition Details40Appendix Two: All Quality Indicators41References43 COntEntSii LIST OF FIGURES FigureES1Population-levelCascadeofCareforHypertensionandDiabetes1Figure3.1PercentageofPatientswhowereScreenedforHypertension(left)orDiabetes(right)(excludingthosewhowerealreadydiagnosedwithhypertensionordiabetes)20Figure3.2testsConductedorPrescribedDuringtheConsultationinWhichDiagnosistakesPlace22Figure3.3PercentageofPatientswhohaveMissedtheirLastScheduledFollow-upVisitbyaWideMargin(LosstoFollow-up)24Figure3.4PercentageofPatientswhoarePrescribedaFollow-upVisitWithintheRecommendedInterval25Figure3.5PercentageofPatientsWhoComplyWiththeFollow-upIntervalPrescribedbytheirDoctor(AmongPatientsforWhomaFollow-upDateisnotedintheMedicalRecord)25Figure3.6PercentageofHypertensionPatientsWhoseBloodPressurewasMonitoredandPercentageofDiabetesPatientsWhoseGlycemicStatuswasAssessedDuringtheMostRecentVisit28Figure3.7PercentageofPatientsforWhomanHbA1ctestwasPrescribedand/orConductedDuringtheLastSixMonths28Figure3.8PercentageofPatientsWithComorbidHypertensionandDiabetesWhosetreatmentAdherestotheFollowingRecommendedPractices30Figure3.9PercentageofPatientsWithDocumentedLifestyleCounseling31Figure3.10PercentageofPatientsAchievingDiseaseControlinatLeastOneoftheLasttwoVisits32 LIST OF TABLES table2.1SampleCharacteristics13table2.2IndividualPatientCharacteristicsbyFacility-levelCharacteristics,fortheFullSampleofDiagnosedPatients14table2.3BasicFeaturesofthePatientJourneyAmongSampledPatients15table3.1KeyIndicatorsAcrosstheCascadeofCare19table3.2AvailabilityofBasicInputsforScreeningActivities(accordingtothefacility-levelsurveyofCSBs)21table3.3PercentageofPatientsReferredtoaSpecialistintheLast12MonthsWhoseRecordsLackedInformationontheOutcomeoftheLatestReferral26table3.4PercentageofCSBsReportingthatEachMedicationwasAmongthetopFiveMostFrequentlyStockedOutintheLastMonth(left)andthatCitedatLeastOneMedicationinaClassasBeingFrequentlyStockedOut(right)29table3.5PercentageofDiagnosedPatientsWhoHaveAttainedControl(MajorRecentStudies)33table4.1SummaryofGapsAcrosstheCascadeofCare34 LIST OF BOXES Box 2.1 Tunisia’s Districts12Box2.2DefinitionofDiseaseControl17Box4.1System-wideHealthSystemQualityConstraintsIdentifiedintunisia35 ACKNOWLEDGMENTS thisreportistheproductofacollaborationbetweentheMinistryofHealth,theWorldBank,andkeytunisianpartners.Wegratefullyacknowledgethecommitment,insight,andpracticalsupportprovidedbycolleaguesacrosstheseinstitutions. thereportwaswrittenbyKatrielFriedmanandDenizhanDuran.WorldBankcolleaguesincludingHabibaBenRomdhane,QuentinBaglione,nicoleFraser-Hurt,AhmadHegazi,andYassineKalboussiprovidedinvaluableanalyticalcontributions.RabieRazgallahconducteddataanalysisand,alongwithYassineKalboussi,ensuredsmoothcollaborationbetweenthestakeholders.WethankRaminZiwaryandZaraShubberforservingaspeerreviewers. WethankthenationalleadershipoftheMinistryofHealthforsustainedstewardshipofthestudyandforfacilitatingaccesstofacilitiesanddata.Inparticular,weacknowledgeAbderrazakBouzouita,Dr.InésAyadi,DrAhlemGzara,KaoutherHarabech,ChekibZedini,SalsabilRejaibi,KaisGuezmir,nédiaBoudriga,andRaoudhaLadjimi.Wealsothanktheregionalhealthdirectorsofall24governoratesfortheirfacilitationofthefieldwork. WethankRidhaDhaouiandFouedBouzaouacheoftheOrderofPhysiciansfortheiroutreachonbehalfofthestudytodoctorsinprivatepractice,aswellasexcellentpracticaladvice. FieldworkwouldnothavebeenpossiblewithouttheorganizationalandlogisticalexcellenceofAssociationBEDER.WethankAsmaBenBrahamandChediMhedhebifortheirleadershipofthequalitativedatacollectionandanalysis,andManefSlamaandKhaoulaSlitiforprojectleadershipandmanagementofallelementsofthefieldwork.A10-memberteamofenumeratorsdiligentlyensuredthereliabilityofthequantitativedata.Weareindebtedtothephysicians,nurses,medicalsecretaries,andpharmacistsineveryparticipatingfacilitywhoopenedtheirregisters,sharedtheirexperience,andkeptservicesrunningsmoothlywhilethestudywasunderway.Weofferoursincerethankstothe135patients,generalpractitioners,specialists,paramedicalstaff,pharmacists,andadministratorswhocontributedto14focusgroupdiscussionsacrosstunis,Sfax,Gabès,Jendouba,Kasserine,andSousse. Generousfinancialsupportw