Health care in the north African region

General history of health insurance in the north African region


The Algerian social security system and its principal component, health insurance, are derived from the French system. The peasantry, who accounted for 90% of the population, were completely excluded. After independence, the health insurance scheme was continued in its original form, until a few years later, when it was considerably developed. Originally restricted to limited sections of the population, the system underwent major transformations as a result of socialist policy and as part of socioeconomic development plans.

In addition to the unification of systems, the major thrust of the 1983 legislation was to move towards the greatest possible extension of social protection. More than 25 million Algerians (more than 85% of the total population) benefit from all the advantages provided with respect to all the risks covered. This move is based on the principle of the Welfare State, which gives great social protection to almost the whole population. Social security, (and therefore health insurance) thus shifted from the economic and "occupational, sectoral" field to the social field (all sections of the population). One of the many results of this change (shift) looked at strictly from the health point of view was to give easier access to preventive and curative health services to great sections of the population.


Health financing is taking place in a comparatively unfavorable macroeconomic context. During the 1990s, average per capita economic growth was zero. Per capita GDP did not rise during the decade and was stable at less than US$1300. The economic situation made it impossible to reduce unemployment (22% in urban areas in 1999) or reduce the poverty rate, which actually rose from 13% in 1990191 to 19% in 1998/99. At the same time, health-related needs and costs, and people's demands and expectations have all been increasing steadily, in particular because of the demographic and epidemiological transitions the country is going through. It is therefore of prime importance constantly to rethink health financing in order to adapt it to people's needs, the society's economic capacities and the economic situation. For many years, much thought has been given in Morocco to how to reform health financing, but implementation is very slow in coming and this is undoubtedly causing the country further expense.


Individual and collective preventive and public health care, as well as the costs of certain illnesses that are the subject of research protocols, are funded by the state and provided free of charge to the whole population of Tunisia. Coverage for curative care is provided by public health insurance schemes managed by two social security funds for the benefit of those affiliated to them (employees and employers) and by the state for the benefit of the poor, for whom care is entirely free of charge, and those on low incomes, who pay reduced, highly subsidized, charges in public health facilities. These public schemes cover almost the whole population: 8% receive health care entirely free of charge, 25% pay reduced charges and 66% are covered by social security health insurance. There are also private schemes in the form of group insurance and occupational mutual funds, but they are Iimited to a few companies and occupational groups. Furthermore, some occupational and/or social categories, the majority of whom pay social security contributions, receive free treatment in public health facilities and in health care facilities specific to them where these exist: the army, internal security forces, customs officials, health personnel, etc.

Healthcare eldorado in Africa

“According to a 2015 McKinsey report, Tunisia, Morocco, Algeria and Egypt represented 70 percent of the pharmaceuticals market in Africa. The Economist Intelligence Unit in 2011 said Tunisia was leading health innovation in the Maghreb, thanks to good indicators such as qualified specialists, strong public and private hospitals, and a high level of services and developed healthcare infrastructure. At the time, 90 percent of Tunisians had access to health insurance.”

Financing health insurance in North Africa


  • Compulsory public system

  • Unified system (benefits and funding)

  • State: taxation

  • Health insurance: social security deductions (contributions): 34.596, 16.75% (CNAF), 7.5% (CASNOS)

  • Households: income


  • Optional cover provided by several schemes managed by various institutions: only 16% of the population

  • Malfunctioning of the system for identifying the poor

  • Inefficiency and inequity


  • Multiple social security health insurance schemes

  • Rate of contribution varies from 1 to 6.5%, according to scheme

  • The schemes cover 82% of the population

  • The state provides free health care for the economically disadvantaged

  • Health insurance funds reserve 25% of spending to cover health risks


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