The Center for International Private Enterprise (CIPE) recently sat down with one of its team members working on the SAHA Project, an initiative that aims to reduce corruption in the healthcare sector in Tunisia. Dr. Fatma Habboubi discussed her professional background, the SAHA project, and the role of Tunisian women in the healthcare sector. In addition to her role as the SAHA Project Manager, Dr. Habboubi is a global health professional with public health and legal expertise. In this interview, Dr. Habboubi reflects on her own experiences and observations.
Note: This interview took place on February 28, 2023, and has been edited for length and clarity.
Could you tell us a bit about your background? When did your interest in healthcare begin?
I studied at the Faculty of Medicine of Tunis because I was curious about science and I got good grades in high school – in Tunisia, if you do well academically, medical school is often a natural progression. While in medical school, I became interested in the intersection of healthcare and civil society, particularly around public health, and looked for opportunities to explore that. I joined an organization called Associa-Med Tunisia, where I worked to educate future medical professionals and citizens about public health – many people think it’s just about going out and exercising, but it’s so much more than that. This opened the door to the world of public health for me, and I was eager to discover and to understand the system from different points of view. After graduating from medical school, I volunteered at the Tunisian Ministry of Health and worked with the World Health Organization on reforming primary care services, but I felt like there was a missing piece. We would have these ideas, but we kept running into obstacles in putting the ideas into practice. Going back to school to get my master’s in health law from the University of Carthage enabled me to understand the legal and regulatory aspects of the healthcare system and how critical that is for real change.
What brought you to the SAHA project?
I spent two years at the Ministry of Health working in the medical research department, where my responsibilities included working on a draft law on biomedical research and supporting the response to the COVID-19 pandemic. During this time, I saw a lot of projects with international donors, some of which were more successful than others. With the SAHA project, I saw an opportunity to apply my public health and legal background, as well as my experience at the Ministry of Health, to implement a project that will have an important impact on Tunisians.
What’s an aspect of the SAHA project that you’re enjoying right now?
With the SAHA project, I love the advocacy work that we’re doing. This includes activities like the “Lawathons” with medical and legal students, but especially the dedicated work being done within the project’s four reform groups, which are high-level bodies bringing together government officials, experts, and civil society to update Tunisia’s legal framework for the health sector. With these groups, it’s not just about drafting laws, but rather about building consensus among a group of diverse stakeholders. Everyone comes with their own point of view and experiences, but they are all committed to strengthening governance within the sector and improving the lives of Tunisians. The consensus building is challenging, but so important.
[Editor’s note: The “Lawathons” are student competitions to develop draft health sector laws and are one of the ways the SAHA project is engaging future medical and legal professionals in anti-corruption efforts in the healthcare sector.]
Let’s talk about women and healthcare in Tunisia. What is it like for Tunisian women in healthcare professions?
Tunisia is one of the rare countries in the region where we really do see significant numbers of women in leadership and management positions, including within the healthcare sector. In many places, women in the healthcare sector tend to be congregated in family planning and maternal health, but in Tunisia you can find them in every field and as the heads of medical departments.
However, women in Tunisia do face significant healthcare challenges, including unequal distribution of resources between urban and rural areas, cultural and societal norms that pose obstacles, and corruption that diverts resources away from essential healthcare services. Rural women face significant barriers to accessing healthcare services, such as a lack of facilities, healthcare providers, and transportation, which can have serious consequences for their health and well-being. Cultural and societal norms can lead to stigmatization and discrimination, especially in sexual and reproductive health, preventing women from seeking care. Marginalized groups, such as women living in poverty or with disabilities, may be particularly affected by these challenges. Another specific example is that maternity leave is only for two months, if that – when I was on leave, they called me after a month and a half asking where I was.
Trying to institutionalize a gender lens demands both money and political engagement. Addressing these challenges is critical to achieving gender equity in healthcare access in Tunisia. It requires effort to promote accessible, affordable, and high-quality healthcare services for all women, regardless of their location, income level, or background.
What are some ways that corruption impacts women?
Women are often disproportionately affected by corruption and poor governance. Corruption can exacerbate existing gender inequalities, making it harder for women to access basic services and undermining their economic opportunities. In the healthcare sector, corruption can be particularly harmful to women who need reproductive health services such as prenatal care, family planning, and maternal healthcare. There is also evidence that women are more likely than men to be asked to pay bribes when seeking public services. Collecting gender-disaggregated data is crucial to understanding the distinct experiences of men and women with corruption, and to tailoring effective policies and interventions in response.
Who is a Tunisian woman who inspires you?
Tawhida Ben Cheikh was the first Tunisian female doctor, and a pioneer in women’s reproductive health and family planning. While I was in medical school, our classrooms had her photo hanging on the wall – throughout my studies, I would look at it and feel inspired. Today, we’re not fighting the same fight as she was in the 20th century, but we still find our inspiration from her.