Teaching research methodology to student midwives through a socio-constructivist educational model: The experience of the high school for science and health techniques of Tunis.

Since its independence in 1956, Tunisia's maternal health indicators have steadily improved as the result of the implementation of a national holistic strategy that emancipated women and developed midwifery education and maternal health services provision. The last review of the midwifery education programme, occurred in 2008, and was based on evidence based core competencies. This paper describes the implementation process of the socio-constructivist educational model used by to teach research methodology to student midwives, the changes observed among them, the challenges and the lessons learned.

Living with diabetes and hypertension in Tunisia: popular perspectives on biomedical treatment.

OBJECTIVES: The growing prevalence of non-communicable diseases across the Middle East and North Africa poses major challenges for underfunded health services. This article presents data on the perspectives of ordinary Tunisians who are coping with two of these diseases--diabetes and hypertension--and who are obtaining treatment through Tunisian public health clinics. Little has been written to date on patient experiences of biomedical treatment in Maghreb countries. METHODS: Based on qualitative methods and semi-structured interviews with 24 patients attending two clinics, one urban and one rural. RESULTS: We examine popular aetiological beliefs, ideas about biomedical treatment and its implications, and comparative views on the benefits and drawbacks of treatment in both public and private clinics. CONCLUSIONS: We highlight two main themes. One was nostalgia for a recent past when 'pure' and 'natural' food, 'proper' meals and less stressful lives meant less chronic illness, with demanding and costly treatment. The other concerned communication in the clinic, and the recurrent dismay patients felt at what they saw as the cursory attention and guidance they received from clinic staff in public facilities.

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

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.