The Tunisian societal dialogue for health reform (a qualitative study)

Abstract Background Tunisia is currently through its second phase of the Societal Dialogue for Health System Reform to develop a National Health Policy 2030. By contributing to the documentation of this process this work will allow the different partners to have an overview of its place in health planning as well as the success factors and the challenges of the model in relation to international norms and experiences. Methods This work was based on a qualitative analysis of semi-structured interviews with citizen juries and experts that took place from May 2018 to September 2018. The qualitative analysis was done according to a cross-matrix between the themes of the interview of the two groups of interviewees. The analysis of the data was mixed: a coding of the data collected was done beforehand. However this frame has been adjusted according to the transcriptions. Results The qualitative analysis of the data highlighted four axes: the context of initiation of the societal dialogue and the passage from the claim to the political instrumentalization, the citizen participation and the role of the various actors, the mixed perception of the societal dialogue and the crisis of trust, the methodology of the social dialogue process, especially the 'Citizen Jury' method. The main factors of success of the societal dialogue are the commitment of the actors, the political will, the inclusivity and the multidisciplinarity of the process and finally the communication around the process. The main challenges are the non-ownership of the process by the policies and the different stakeholders as well as the doubt about the achievement of these results. Conclusions It is important to introduce regular citizen and societal consultation so that it can credibly feed into policy review processes and inform policy makers on a regular basis. It would be important to think of a model for the sustainability of this approach. This involves finding the necessary financial and operational means. Key messages The promotion of citizen's participation in health is crucial in the new Tunisian democratic experience. A legal framework is needed to ensure the sustainability of the new approach of citizen's participation in health.