Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries

Abstract

This paper presents evidence from research into health system challenges of cardiovascular disease (CVD) and diabetes in four Eastern Mediterranean countries: the occupied Palestinian territory, Syria, Tunisia and Turkey. We address two questions. How has the health system in each country been conceptualised and organised to manage the provision of care for those with CVD or diabetes? And what were key concerns about the institutional ability to address this challenge? Research took place from 2009 to 2010, shortly before the political upheavals in the region, and notably in Syria and Tunisia. Data collection involved a review of key documents, interviews with key informants and brief data collection in clinics. In analysing the data, we adopted the analytical schema proposed by Walt and Gilson, distinguishing content, actors, context and process. Key findings from each country highlighted concerns about fragmented provision and a lack of coordination. Specific concerns included: the lack of patient referral pathways, functioning health information systems and investment in staff. Regarding issues underlying these 'visible' problems in managing these diseases, we highlight implications of the wider systemic pressure for reform of health-sector finance in each country, based on neoliberal models.

Health system challenges of NCDs in Tunisia

“…Following Phillimore et al (2013), this article adapts a well-known framework for health policy analysis (Walt and Gilson 1994) to present its findings. Walt and Gilson model the interplay between four elements of the health policy process-content, actors, context and process.…”

“…Subsequent analysis was assisted using Atlas.ti, to identify key themes (see Phillimore et al 2013 for further details). Qualitative research is unusual in health research in Tunisia and the region.…”

“…This research formed part of the larger comparative study (MedCHAMPS) featured in this supplement, taking place also in Palestine, Syria and Turkey. This article builds on a comparative examination of healthcare systems in these four countries by Phillimore et al (2013), and provides a more detailed analysis of the Tunisian situation. Data collection took place in 2010, immediately prior to the revolution and political transformation which started in Tunisia at the beginning of 2011.…”

Context-led capacity building in time of crisis: fostering non-communicable diseases (NCD) research skills in the Mediterranean Middle East and North Africa

“…Some of this evidence stems from our own research in MedCHAMPS: in particular from comparative country-level analyses of epidemiological data, which depict more heterogeneous trends [6,27] than is apparent from recent Global Burden of Disease (GBD) studies of cardiovascular risk factor trends across the Middle East and North Africa (MENA) region [33]. Literature on the challenges for healthcare, health systems, and governance is also growing [34][35][36][37][38][39], and, as with the epidemiological picture, there are national particularities to take into account. However, a recurring theme concerns the gap between health needs and policy response [5], a situation exacerbated by the lack of national health research frameworks across the region, including in Turkey.…”

“…As noted, RESCAP-MED grew out of preceding EC-funded research, in MedCHAMPS, which likewise had a focus on NCDs. MedCHAMPS' analyses linked together epidemiological modelling of cardiovascular and diabetes trends, using mainly existing national data sources [6,27,41], with qualitative analyses of health policies and the structure of health service provision to manage these NCDs, based on primary data collection [37]. Along with European partners, four research teams from the Mediterranean region were involved: from Ramallah (Palestine), Aleppo (Syria), Tunis (Tunisia), and Izmir (Turkey).…”