Doctors protest on 7 January. Photo posted on Twitter by @aydagrissa.
 
For the past week, thousands of young Tunisian doctors have been protesting against a bill that would force those who have finished studying their specialisation to work for three years in regional hospitals. Only then would they be able to choose where they work. While the government argues the move is necessary, doctors say the legislation is misguided.
 
Since January 2, senior public service doctors have had to take over the provision of basic medical care. The striking doctors studying for a specialisation will only do medical rounds and emergency care. On January 7, several thousand of them marched through Tunis, supported by university doctors furious after a security officer assaulted one of them during a demonstration.
 
The “38/2013” bill is currently before the National Constituent Assembly. It affects doctors who have finished their residency and have begun four years of specialist training. If the law is approved, the doctors will have to spend a mandatory three years in a regional hospital. The health ministry sees the move as a way to bridge the disparity between the public health services in large cities and rural regions, where there is a lack of personnel.
 
According to the World Health Organisation (WHO), there are 12 doctors and 21 hospital beds per 10,000 inhabitants in Tunisia, compared to 35 doctors and 71 hospital beds for the same number of people in France.

“Why send a radiologist to a hospital without a scanner?”

Salma Moalla is in her third year of study, specialising in radiology.
 
The problem with public health in Tunisia isn’t simply a problem with medical personnel, as is the case in Europe. It’s, more than anything, a problem with infrastructure and resources. Public hospitals in Tunisia, including those in large cities, lack resources and hygiene, and it’s even worse in the regions. Why send an anaesthetist to a hospital without a ventilator? Or a radiologist to a hospital without a scanner? These specialists will find themselves referring patients to the nearest university hospitals, but will have no right to practise there. The authorities want to put the cart before the horse.
 
Moreover, the specialists who want to work in the private sector will also be affected by this law, as not all specialists are required in the regions. A geneticist, an anatomist, and specialists linked to research laboratory work will have no place in a regional hospital, where they will have to do the work of a nurse or a general practitioner. Also, the idea of mandatory work is contrary to international conventions on workers’ rights.
 
Photo taken at Béjà Hospital (in Tunisia’s northwest).
 
Beds at the Gabès hospital (in the country’s southeast).
 
Besides, this policy doesn’t create more jobs in the regions or encourage the doctors already there to stay, since there will always be new specialists coming in to “fill in the gaps”.
 
Every year, there are 600 doctors who finish their specialist studies and who, with this law, will continue to earn a state salary for three years. That expenditure will be enormous! Instead of this, the state could hire only half of these doctors and spend the rest of the money on equipment for regional hospitals, thus encouraging them to stay.
 
It’s hard to impose a policy when the ministry submitted this law without consulting health professionals.
 
A guard “bed” at a children’s hospital in Tunis.
When contacted by FRANCE 24, Khaled Azzabi, a health ministry official, conceded that the obligatory aspect of the law is debatable: “We will consider this law as an emergency recruitment measure in order to deal with the disastrous situation in the regions while we look for a long-term solution. It’s easy for specialists to stay in the large cities while complaining about a lack of resources. Assuming that’s the case, they will go there and find a solution. The ministry has made concessions by proposing to reduce the mandatory work period to one year, and promised specialist salaries with possible bonuses in the regions. We hope to reach an agreement with representatives from the profession.”
 
Video of the doctors’ protest on January 7.
 
Article written by FRANCE 24 journalist Sarra Grira (@SarraGrira).