Cancer Control and Prevention in Tunisia: The Malignancies of Poor Governance

Abstract

Globally, cancer rates have steadily increased in the last three decades, making the disease the second leading cause of death from non-communicable illness. In Tunisia, cancer represents 95.39 deaths per 100,000 every year, of which breast and lung cancers dominate for women and men respectively. Along with cervical cancer, breast and lung cancer represent two of three of the most “preventable” cancers. With lifestyle changes and early detection, diagnoses of these diseases can occur at curable stages and drastically improve prognoses. Unfortunately, prevention-based cancer care has not fully succeeded in Tunisia, resulting in high rates of mortality and morbidity. This thesis explores the reasons behind Tunisia’s failing cancer control and prevention system as viewed through the lens of healthcare professionals in the field of oncology. Particularly, it seeks to understand the barriers faced in improving this system in the context of a highly volatile political backdrop. Tunisia is currently undergoing a historic political and social transition following the 2011 Jasmine Revolution, a protest which led to the eviction of the authoritarian regime and paved the way for a new era of democratic political governance. While deemed a successful revolution, the subsequent years of turmoil and instability have affected all aspects of public service delivery, especially in the healthcare sector. Research findings highlight the gaps and shortcomings of Tunisia’s cancer control and prevention system as stemming from infrastructural deficiencies and a paucity of human resources, a lack of adequate prevention education and early screening practices amongst the people, and stalled collaboration and communication between governmental authorities and the medical community. Overworked healthcare practitioners and overwhelmed politicians are no longer capable of servicing the needs of the Tunisian people, particularly Tunisian cancer patients. This thesis offers a number of proposals aimed at addressing the different lacunae brought up throughout the research analysis. These include, in the short-term, engaging with NGOs to improve access to cancer treatment through housing and transportation programs, increasing screening and education programs via mobile clinics, and improving medical training programmes to incorporate cancer care into all aspects of medical care. Once political and economic stability sets in, the government and Ministry of Public Health can move towards more long-term structural changes such as increasing the capacity and number of cancer treatment centres, increasing the number of trained medical professionals, and implementing new programmes geared towards retaining healthcare staff in the country.