The main aim of this European Commission-funded project to strengthen the management of the Tunisian health system is to implement a medical-financial information system in Tunisian hospitals. The project is being managed by FIIAPP. In other words, to improve the organisation of files and medical records to help reduce costs in the sector.

Carlos Armendariz is Chief Medical Director of the Castilla – La Mancha Health Service (SESCAM) and he worked as head of this European Union twinning project alongside Tunisian experts.

What progress have you seen in the six years since the project’s beginnings?

When we first started the project, the objective was to implement a medical-financial information system in sixteen hospitals. To do this, the first thing that needed to be done was to take a step that was unheard of here: consolidate the medical histories. The histories were scattered in different locations; if you went to seven different services over the course of a year, you would have a medical history in each of them. This is a totally antiquated way of working.

How are things different, now that patients have a single medical history?

Streamlining medical histories brings nothing but advantages. Each of the specialists a patient sees makes their notes, their diagnoses, treatments, and the next professional to see the patient knows what has happened before. The contextual information any doctor who sees a patient gets from this history is always crucial.

What else has been put into practice?

It was also important to make the professionals aware of how important it is that they complete a discharge report, which was not done in any of the hospitals. These discharge reports are not only beneficial, they are a patient’s right. This has been hard work because there was no custom or habit of completing them.

What is the next step?

The Tunisians who are involved in the project, alongside the Spanish experts, defined a Minimum Data Set (MDS) for Tunisia. This is a collection of data for every hospital process that allows the subsequent analysis of the hospital’s activity.  This means that you can know how many patients with pneumonia have been seen during a year, or which types of pneumonia have been seen, or how many appendicitis operations have been performed, etc.

How is it analysed?

By coding it. The coding allows more refined information to be obtained: it allows us to know the types of diseases, the procedures or techniques that a hospital has used. Births, surgeries, cardiac catheterisations, infection by this or that bug… Everything always has a code.

Has everything that was planned been achieved?

The project entailed a change in the way the Tunisian health system works that I think has been achieved, but it has been slightly hobbled. In the sense that, in a project of this magnitude, the change needs to be accompanied by mandatory rules. In Spain, how a file works is highly regulated, as is the length of time medical records must be kept, which documents they must contain, etc. And this has been done, but there is no national legislation requiring that these things be done.

Otherwise, I think that a great deal has been achieved. We have won over many followers in the hospitals, people who were initially very reticent who, when they saw the benefits and advantages of working in this way, became firm supporters. And as they are best able to recognise and acknowledge the advantages and disadvantages, they are the new system’s best advocates. Without these people the project would not have taken off.

What did you think of Tunisia personally?

Tunis reminded me a lot of Madrid at the end of the 1960s, when I was small. Working-class neighbourhoods like those on the outskirts of Tunis: houses with two or three storeys in run down neighbourhoods with unpaved streets. Otherwise, it is a Mediterranean country with a similar sensibility as ours in some things.

And with respect to health?

Very similar. There are old hospitals with old structures where it is not the same for patients as it is in our country, with rooms for one or two people. But when I was a medical student, in the Madrid Clinic there were rooms with eight patients. I think health care is like any other service, it adapts to the resources that society makes available to it.

The doctors generally have good training. They have a lack of resources and technology, probably, but I do not think that health care here is bad. It seems to me that it could improve, but the staff are knowledgeable and they know what they are doing. The results can certainly be as good as anywhere else.

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