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Tunisia

Tunisia, officially the Republic of Tunisia, is a country in the Maghreb region of North Africa, covering 163,610 square kilometres. Its northernmost point, Cape Angela, is also the northernmost point on the African continent. The country has a population of 11.3 million people (in 2016), capital and largest city is Tunis. Spoken languages are Arabic (official) and French, English and other languages in tourist regions.

Tunisia’s accessible Mediterranean Sea coastline and strategic location have attracted conquerors and visitors throughout the ages, and its ready access to the Sahara has brought its people into contact with the inhabitants of the African interior.

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History

According to Greek legend, Dido, a princess of Tyre, was the first outsider to settle among the native tribes of what is now Tunisia when she founded the city of Carthage in the 9th century BCE.

Although the story is certainly apocryphal, Carthage nonetheless grew into one of the great cities and preeminent powers of antiquity, and its colonies and entrepôts were scattered throughout the western Mediterranean region. Carthage fought a series of wars with its rival, Rome. Rome prevailed in the mid-2nd century BCE, razed Carthage, and ruled the region for the following 500 years.

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In the 7th century Arabconquerors converted the native Berber (Amazigh) population of North Africa to Islam. The area was ruled by a succession of Islamic dynasties and empires until coming under French colonial rule in the late 19th century. After achieving independence in 1956, Tunisia pursued a progressive social agenda and sought to modernize its economy under two long-serving presidents, Habib Bourguiba and Zine al-Abidine Ben Ali. However, Tunisia remained an authoritarianstate with an all-powerful ruling party and no significant institutions of representative government. (For a discussion of political changes in Tunisia in 2011.

Tunisia’s revolution 2011

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Poverty and the lack of decent work opportunities in the country’s underprivileged regions were among the chief triggers of Tunisia’s revolution in 2011. 250 kilometers south of the capital of Tunis, the town of Sidi Bouzid came to symbolize the uprising that led to the collapse of Tunisia’s dictatorship.

It was there that Mohamed Bouazizi, a young street vendor driven to despair by the impossibility of earning a living and harassment by municipal officials, set himself on fire in front of the governor’s offices. It was the catalyst for the revolution that toppled the government.

Some key dates in Tunisia’s history:

Circa 1100 BC – Phoenicians settle the north African coast. The city of Carthage, near the site of present-day Tunis, becomes a naval power.

146 BC – Carthage falls to the Romans.

600s – Arabs conquer the territory of present-day Tunisia.

909 – Berbers wrest the region from the Arabs.

1600s – Tunisia becomes part of the Turkish Ottoman empire, but has a high degree of autonomy.

1881 – French troops occupy Tunis. France controls economic and foreign affairs; Tunisia is a French protectorate from 1883.

1956 – Tunisia becomes independent with Habib Bourguiba as prime minister, monarchy is abolished and Tunisia becomes a republic the following year.

1987 – ‘Palace coup’: Prime Minister Zine El Abidine Ben Ali has President Bourguiba declared mentally unfit to rule and takes power himself.

2011 – Mass protests drive President Ben Ali into exile, inspiring other popular uprisings collectively known as the “Arab Spring”.

Economy

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Real GDP growth slowed to 1.5% in 2019 following two years of rebounds. Growth in the agriculture and fishing sectors slumped to 1.7% in 2019 from 9.8% in 2018. Growth was spurred primarily by tourism and financial services and, on the demand side, by private consumption.

The fiscal deficit improved slightly to 3.9% in 2019, from 4.6% in 2018. The current account deficit was 10% of GDP in 2019 and is projected to stay fairly high at 9.9% in 2020 and 8.4% in 2021. Despite the central bank policy of raising interest rates since 2017, inflation remained at 7.1% in 2019 and is projected to moderate to 6.7% in 2020 and 6.1% in 2021.

Unemployment was 15.3% during the first quarter of 2019 but has dropped slightly as the decline in unemployment among graduates continued. Unemployment among people ages 15 to 24 is 34.3%. The poverty rate, which dropped from 20.5% in 2010 to 15.2% in 2016, increased by 30% from 2014 to 2018 due to increased living costs, according to the Center for Economic and Social Research. The Nord-Ouest region has been particularly affected with a poverty rate of 28.4% against 5.3% for the Greater Tunis region.

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Continuing inequalities are destabilizing the social climate and impeding investment and growth. Reducing them implies accelerating the structural reforms initiated since 2011 and introducing specific measures aimed at more inclusive growth. Public spending needs prioritizing and better targeting to spearhead the economy.
Tunisia has many strengths, including proximity to Europe, qualified labor, diverse industries (aeronautics, chemicals, textiles), high agricultural and fishery potential, and sizable deposits of phosphates, oil, and gas. The tourism industry (beach, business, mountain, oasis, eco-tourism, and seawater therapy) was until 2011 a significant source of growth and employment. In the medium term, it will benefit from the steady 5% growth in the global demand for tourism services.

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The wide social and regional disparities brought to light in January 2011 have not narrowed. In 2019, unemployment remained high among college graduates, with large differences between coastal and interior regions. Women are more than twice as likely to be unemployed than men.

Public spending has increased significantly since 2011, prioritizing current expenditures over capital expenditures. This increase has been financed primarily by external borrowing. Public debt, the majority external (70%), increased by 95% between 2010 and 2019, placing Tunisia at risk of serious shocks and reducing liquidity available to the private sector.

Tourism

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Tunisia’s landscape is mountainous in north west, where is the eastern extension of the Atlas Mountains, within the mountain range is Jebel ech Chambi at 1,544 m, the highest point in the country. Further to the east along Tunisia’s eastern Mediterranean coast is a broad coastal plain, known as the Tunisian Sahel, the area is famous for its Olive cultivation. To the south lies a hot and dry central plain, the semiarid area merges into the Sahara.

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Tunisia has enough history and diverse natural beauty to pack a country many times its size. With a balmy, sand-fringed Mediterranean coast, scented with jasmine and sea breezes, and where the fish on your plate is always fresh, Tunisia is prime territory for a straightforward sun-sand-and-sea holiday.

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But beyond the beaches, it’s a thrilling, underrated destination where distinct cultures and incredible extremes of landscape forested coastlines, Saharan sand seas in the south can be explored in just a few days.

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Terrorist attacks in 2015 that targeted foreign visitors caused damage to the important tourism industry, something that Tunisia has struggled to overcome, but the removal of travel advisories for the country by Western governments has given the industry a chance to start to rebuild.

Health

Tunisia’s health care system has been the focus of continued public investment that has seen an extensive network of public hospitals and health centres established nationwide. In recent years, however, the country’s private health care sector has taken the lead in investment, with the construction of new clinics intended to make the country into a regional medical centre.

In total, Tunisia hosts around  a network of 81 clinics and 2091 basic health centres; secondary, with 109 district hospitals; and tertiary, with 33 regional hospitals and 24 modern CHUs, according to MoS figures. In general, emergency services in hospitals and clinics are available 24/7, providing quality health care to patients.

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The Ministry of Health (Ministére de la Santé, MoS) oversees Tunisia’s public health care system, supported by several public institutions. The National Laboratory for Drug Control is charged with overseeing quality control of medications. The National Centre of Pharmacovigilance is responsible for legal follow-up when a medication is found to have any adverse effects. The Central Pharmacy of Tunisia has held a monopoly on drug imports since 1961, and the Directorate of Pharmacy and Medicines authorises the release of medications on the market and implements national policies related to medication and pharmacies. In 2016 the MoS was allocated a budget of TD1.8bn (€825.5m), representing a 9% increase on the TD1.6bn (€733.8m) granted in 2015.

State-owned health facilities and hospitals provide free services to all Tunisian citizens and residents.
The costs incurred within the public health centres are reimbursed if the insured attends one of three levels of infrastructure within the public system:
– health centres providing primary care,
– district and regional hospitals,
– university hospitals.
The insured may also be treated privately if the services are approved and if they are treating:
– severe and/or chronic conditions requiring full health insurance cover. This is known as APCI (Affections Prises en Charge Intégralement or Fully covered conditions).
– some cases of hospitaliation and surgery.
The terms and levels of cover are determined by:
– type of care: public or private,
– payment terms: per treatment or procedure or a lump sum
– type of cover: cash advance or third party payment,
– the level of cover desired: amount reimbursed, payment caps, reference price of drugs etc.
There is an agreement between France and Tunisia enabling seconded French nationals to keep their entitlement to French Social Security benefits for three years, as long as they are employed by a French company. Only expatriates are required to join the Tunisian Social Security system.
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Health insurance 
Health insurance is managed by the “Caisse Nationale d’Assurance Maladie”. The welfare scheme in Tunisia is compulsory for the entire population. It differs according to socio-professional category.
The insured’s spouse and minor children are entitled to Social Security benefits and therefore to health insurance.
To receive benefits from Social Security, you must either:
– have worked at least 50 days during the last two quarters,
– have worked at least 80 days during the last four quarters.

Private healthcare system

The private healthcare system in Tunisia has significantly expanded in terms of infrastructure as well as capacity and healthcare personnel. The private sector offers, for example, high-quality cosmetic surgery, spas and thalassotherapy to attract foreigners. Similarly, dentists and opticians are found almost exclusively in the private sector. Some services in the private sector are covered by health insurance.

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