The government’s decision to harness private clinics to support the national effort to fight the epidemic continues to cast a shadow over the public debate, especially after the response of the Sanatorium Owners Syndicate, which confirmed that it, in turn, complained of a lack of oxygen.
Through this report, JDD Tunisie will attempt to reveal how the state controls private clinics and the violations that the Court of Accounts has identified.
What do we know about sanatoriums?
Private clinics occupy an important and growing position in the health system, embodied by the establishment of free initiative and the abandonment of the administrative licensing system assigned by the Ministry of Health in the various activities under its jurisdiction and its compensation with the specifications system, especially with regard to creating or expanding jurisdiction, introducing changes or transferring a private health institution This is pursuant to the decision of the Minister of Public Health dated May 28, 2001, revised and supplemented by the decision dated December 24, 2007.
Accordingly, this sector witnessed an acceleration in the pace of creation of private clinics, reaching 103 clinics with a total occupancy of 6,676 beds until the end of February 2020, which represents 24% of the national occupancy capacity, knowing that 48 clinics were created after the year 2001 according to the specifications system.
The process of supervision and control over private clinics was entrusted to several stakeholders. In addition to the Ministry of Health, a number of other technical structures contribute to this process, notably the National Center for Radiation Protection, the National Agency for Health and Environmental Control of Products, the National Agency for Waste Management, in addition to the National Fund for Disease Insurance, given the contractual relationship it has with clinics, as well as the Ministry of Commerce entrusted to it. The process of price control and investigation of anti-competitive practices in the field.
The accountant court is supervising
The Court of Accounts undertook the completion of an evaluation mission that covered mainly the period from 2014 to the end of April 2020. This mission concluded by identifying breaches related mainly to the limited oversight when establishing private clinics and when concentrating heavy and radioactive equipment therein, and weak control over health preservation and resistance to hospital rots, medicines and medical supplies In these clinics, the lack of tight control over the disposal of human resources, as well as shortcomings that marred the contractual relations with the National Fund for Disease Insurance and the transparency of transactions.
It also became clear that the adoption of the conditions book system related to private health institutions was not accompanied by the development of a clear strategy for its creation that takes into account national priorities and directions and outlines possible ways of partnership between the public and private sectors in the health field. This situation contributed to the concentration of 90% of private clinics on the coastal strip of the country.
The limited oversight when creating private clinics resulted in expansion and changes being carried out without respecting the terms of reference and the dispatch of clinics whose engineering designs do not match the examples approved by the Ministry, as well as the erection of a number of clinics within urbanly unprepared areas to focus health facilities.
In addition, 32 clinics, upon entering into operation, did not respond to the building safety conditions, and the non-conformity of the buildings of 35 clinics to the maximum capacity to accommodate them and licensed by the civil protection services, which is in violation of the provisions of Law No. 11 of 2009.
He also recorded weak oversight when informing of the beginning of the activity, which is often delayed, sometimes by a whole year, which led to the entry of some clinics into exploitation without responding to the required conditions.
