突尼斯高血压和糖尿病治疗连锁成本

Costs of Hypertension and DiabetesTreatment Cascade in Tunisia February 2026 CONTENTS Acknowledgments Executive Summary Section One: Introduction1.1Context1.2Objectives Section Two: Methodology2.1Approach2.2Prevention and Screening Section Three: Results3.1Prevention and Screening3.11Cost per person sensitized3.12Cost per person screened3.13Annual outreach costs at the population level 3.2Outpatient Treatment Services at PHC Facilities3.21Cost per year per patient3.22Cost per patient per year disaggregated3.23Cost of yearly treatment as per the national program and INEAS guidelines 3.3Inpatient Services at Hospitals3.31Costs per hospital admission at the CHU3.32Costs per hospital admission at regional hospitals (HRs)3.33Costs per hospital admission at circonscription hospitals (HC)3.4Total Costs Section Four: Policy Implications and Recommendations4.1Strengthen prevention and screening4.2Improve case management of outpatient care4.3 Improvetheefficiencyofinpatientcaremanagement4.4Reform provider payment mechanisms Appendix One: Final List of Diagnoses for Hospital Admissions in CHUAppendix Two: Cost Estimates of Facility Admissions LIST OF FIGURES Figure 3.1 Sensitization and Detection of Positive Cases per Day in a Sample of CSB in 2023Figure 3.2Comparative Cost per Patient per Year at PHC level (TD)Figure 3.3Cost per Patient per Year for CNAM and AMG Patients in Public CSBs (TD)Figure 3.4Cost per Patient per Year in Urban and Rural Areas in Public CSB (TD)Figure 3.5Gap BetweenStandardCosts and Actual Costs (Excluding Medicines) LIST OF TABLES Table 2.1 Data Collected and Sources for Prevention and ScreeningTable 2.2 Distribution of the Number of Outpatients in the SampleTable 2.3 Data Collected and Sources for Primary CareTable 2.4 Distribution of Inpatient Admissions in the SampleTable 2.5 Data Collected and Sources at HospitalsTable 2.6 Population Estimates for TunisiaTable 3.1 Cost per Person Sensitized During Open-doors and Awareness Campaign Events (TD)Table 3.2 Cost of Screening (TD)Table 3.3 Total Estimated Costs of Prevention and Screening at Population LevelTable 3.4 Average Cost per Patient per Year in Public CSBsTable 3.5 Average Cost per Patient per Year in Public HCs (Consultations Only)Table3.6AverageCostperPatientperYearinPrivateMedicalOffices(PMOs)Table 3.7 Estimated Population Treated and Costs of Management at Primary CareTable 3.8 Cost Variations Between Controlled and Uncontrolled PatientsTable 3.9Comparison of Standard Cost per Patient per Year with Actual Practice in CSBs (For Four Visits) andBreakdownTable3.10ComparisonofStandardCostperPatientperYearWithActualPracticeinPrivateOfficesTable A1.1 Hospital Stays by Main Diagnosis all CHUs (2023) ACKNOWLEDGMENTS This report was drafted by Quentin Baglione (Consultant, HMNHN) and Denizhan Duran (Senior Economist, HMNHN). It isthe product of a close collaboration between the MinistryofHealth (MoH), the WorldBank, and key Tunisian partners. Wegratefully acknowledge the commitment, insight, and practical support provided by colleagues across these institutions. We thank the national leadership of the MoH for sustained stewardship of the study and for facilitating access tofacilities and data. In particular, we acknowledge, AbderrazakBouzouita, InésAyadi, ChekibZedini, NédiaBoudriga,RaoudhaLadjimi,RamziMejri,TaoufikBorgiandNejouaBenAmara. Fieldwork would not have been possible without the organizational and logistical excellence of Association BEDER.WethankManefSlamaandKhaoulaSlitiforprojectleadershipandmanagementofallelementsofthefieldwork.A World Bank colleagues including HabibaBenRomdhane, Kat Friedman, NicoleFraser-Hurt, AhmadHegazi, andYassineKalboussi provided invaluable analytical contributions. Rabie Razgallah conducted data analysis and, along withYassine Kalboussi, ensured smooth collaboration between the stakeholders. Peer reviewer comments from Zara Shubber GenerousfinancialsupportwasprovidedbytheJapanPolicyandHumanResourcesDevelopmentTrustFund. Anyerrorsoromissionsaretheresponsibilityoftheauthors.Thefindings,interpretations,andconclusionsexpressedinthisreportdonotnecessarilyreflecttheviewsoftheMoH,theWorldBank,orotherpartnerinstitutions. ABBREVIATIONS AND ACRONYMS ABCActivity-based CostingALOSAverage length of stayAMGAssistance médicale gratuite(Free medicalassistance)APCIAffection Prise en Charge Intégralement(Fully supported conditions)CHUCentre hospitalier universitaire(CentralUniversity HospitalCNAMLa Caisse nationale d’assurance maladie(National Health Insurance Fund) EMRElectronic medical recordHCCirconscription hospitalHTNHypertensionMoHMinistry of HealthOOPOut-of-pocketPCTPharmacie Centrale de Tunisie(CentralPharmacy of Tunisia)PMOPrivatemedicalofficesPNSPolitique nationale de santé(National Health EXECUTIVE SUMMARY Hypertension and diabetes are the most prevalent diseases in Tunisia and rank among the costliest both to thehealth system and to the economy—second only to tumours.There are current