From crisis to transformation: Tunisia and the World Bank's journey toward a stronger health system

When COVID-19 swept across Tunisia in 2020, it exposed the vulnerabilities of a health system that had long served its people with dedication but limited resources. The question was not whether Tunisia’s health system needed reform, but how fast we could act and how far we could go. It was in this context of urgency that our partnership with the World Bank Group was born. A collaboration that, over time, has moved beyond immediate crisis response and evolved into a lasting, shared commitment to building a health system that is more resilient, more equitable, and better prepared to meet the challenges of the 21st century. A Response Built on Trust In the immediate months of the pandemic, speed was everything. Working alongside the Tunisian government, the World Bank helped mobilize over USD 140 million in emergency financing across successive operations to strengthen the country’s pandemic response. From the very outset, this support enabled the procurement of personal protective equipment for health professionals, ensuring that those on the front line could work in safer conditions. The results were tangible. Medical oxygen was secured in 118 health centers. Intensive care capacity was strengthened in 45 hospitals, and 500 dialysis units were installed to protect patients whose treatment could not be interrupted. Tunisia also launched an ambitious vaccination campaign, administering six million doses to protect its population and ease the burden on an already pressured health system. Throughout this period, one element proved decisive: the trust that developed between our teams. Built through candid exchanges, transparent communication, and a shared sense of urgency, that trust allowed us to move faster, solve problems together, and maintain a common direction even in the most demanding moments. But even as we worked to contain the immediate crisis, we recognized something important: emergency response, however well-executed, is not in itself a lasting transformation. Tunisia needed to draw lessons from the pandemic and seize this opportunity not merely to get through the crisis, but to emerge from it with a stronger, more resilient health system, better prepared for the future. As the acute phase of COVID-19 began to recede, the partnership evolved. We designed a new health project of USD 125 million, combining World Bank financing with a contribution from the Pandemic Fund, a global partnership created in 2022 to help countries prevent, detect, and respond to health emergencies, and for which Tunisia was selected through a highly competitive process. Its contribution supports the modernization of more than 50 public health laboratories, the upgrading of the Public Health Emergency Operations Center, and the expansion of national disease surveillance. At the heart of this new project is primary care. Tunisia has more than 2,000 primary care centers spread across the country, yet for too long these facilities operated in isolation, with limited connectivity and uneven service quality. The project aims to change that reality: modernizing these centers, connecting them, and integrating them into a truly national network capable of delivering more coordinated, continuous, and data-driven care, wherever a patient may live. This matters enormously for equity. Health outcomes in Tunisia, as in many countries, have historically been shaped by geography. A child born in a coastal city has better access to specialists, diagnostics, and follow-up care than a child born in an interior governorate. Closing that gap is not only a technical challenge. It is also a fundamental matter of equity: ensuring that every Tunisian has access to quality health care, regardless of where they live. Innovating for the Future Perhaps the most notable aspect of our partnership is the pace at which Tunisia has embraced innovation, not as an afterthought, but as a genuine strategic driver of health system transformation. One of the key lessons drawn from the COVID-19 crisis is that the public sector must be the driving force of a resilient and high-performing health system. This conviction guided our decision to invest in advanced medical equipment and cutting-edge technologies, not as a luxury, but as a strategic imperative. Tunisia is deploying robotic surgery, neurosurgery navigation platforms, and next-generation diagnostics such as mass spectrometry and HPV testing. These technologies are being introduced within public hospitals, as part of their public service mission, so that medical excellence remains accessible to all Tunisians rather than reserved for those able to seek care elsewhere. These are not incremental upgrades; they represent a meaningful shift in the kind of care Tunisian hospitals can offer. Digital transformation represents another critical pillar. A national digital Human Resources for Health system is being rolled out to give planners and administrators an accurate, real-time picture of the health workforce. A Logistics Management Information System is improving procurement and supply chain efficiency, addressing one of the most critical lessons learned from the COVID-19 shortages. This drive for innovation is now taking institutional form. Under the World Bank’s Health Works Initiative, Tunisia has been selected to join the National Health Compact Initiative, a global platform supporting countries in their efforts to progress toward Universal Health Coverage. Tunisia’s Compact will place digital health at its core, building on national efforts in telemedicine, interoperability, health information systems, and AI-enabled services. Its validation is expected at the Regional Digital Health Conference in Tunis on October 1st, alongside AFD, GIZ, UNICEF, WHO, and other partners. And looking further ahead, Tunisia is steadily strengthening its pandemic preparedness infrastructure. The Public Health Emergency Operations Center is being modernized, and national disease surveillance systems are being expanded. The question is no longer whether another health emergency will occur, but whether, when the time comes, we will be ready to respond — more quickly, more effectively, and with a more resilient health system. What This Healthcare Journey Means to Us We both remember the early days of the COVID-19 crisis vividly. The pressure on hospitals, the race to secure supplies, the weight of decisions that had to be made in hours rather than weeks. What kept us going, and what still drives us today, was the extraordinary resilience of Tunisia’s health professionals and the shared conviction that this crisis had to become a turning point, not just a chapter to get through. Looking back, what we built together over the last six years was never simply a financing arrangement. It was a relationship grounded in candid conversations, mutual respect, and a genuine alignment of purpose. We navigated disagreements on approaches, worked through institutional bottlenecks, and celebrated hard-won milestones together. This, in our view, is what defines a genuine partnership: the ability to work together even when solutions are not obvious, to overcome challenges, and to remain focused on a shared goal. And it is that dynamic that made all the difference. The pandemic made the status quo untenable, but it also created something rare: the political will, the social urgency, and the professional energy to build something better. Together, we seized that opportunity to build things differently. And we continue to do so today. The work is far from finished. Health systems are never truly complete: they must adapt continuously to new needs, new technologies, and new threats. But something has fundamentally shifted in Tunisia: in the ambition of its plans, in the quality of its data systems, and in the connectivity of its services. That shift is irreversible. And it belongs, above all, to the Tunisian people and the dedicated professionals who serve them every day. Our partnership is also part of a broader ambition that extends beyond national borders. Alongside the United Nations Quadripartite, we are advancing the One Health approach, which recognizes the interdependence between human, animal, and ecosystem health. As Tunisia prepares to host a Regional One Health Center in Tunis, it is contributing to strengthening preparedness and health security capacities across the MENA region. This momentum will also resonate at the global level during the Universal Health Coverage Summit in Tokyo in December 2026, where countries will have the opportunity to share their national Compacts, their reform commitments, and their experiences in pursuit of more inclusive and equitable health coverage. We are proud to have contributed to this story. Together, with the goal of placing the health of every Tunisian woman and man at the heart of a more just and prosperous future.