Telemedicine and e-Health
Telemedicine and e-Health
Business Model Description
Provide remote diagnostic/telehealth services to increase access to healthcare services in remote areas
Expected Impact
Investments in telehealth will improve access to healthcare services for the population as a whole and reduce the pressure on healthcare facilities
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Tunisia: South-West
- Tunisia: Centre-West
Sector Classification
Health Care
Development need
Despite significant improvement, Tunisia is confronted with a limited healthcare system in terms of quality and efficiency. Access to healthcare services is a common problem, particularly in rural and inland regions. COVID-19 has exacerbated the issue and highlighted the underinvestment in basic and specialized services of sufficient quality (1).
Policy priority
The government pays particular importance to improving universal and equal access to healthcare, closing the gap between rural and coastal areas in terms of accessibility and quality of health services (2,3).
Gender inequalities and marginalization issues
Inadequate natality health services endanger the mother's and child's life. Between coastal, interior, and rural regions, there is a high degree of disparity in terms of care availability and quality.
Investment opportunities introduction
Health expenditure accounts for about 7% of GDP and is mostly driven by the private sector, which has expanded over the past two decades with the addition of private hospital beds and clinic projects underway. While Tunisia's health expenditure per capita is among the highest in the region, further efforts are now required to combat the COVID-19 epidemic (4).
Key bottlenecks introduction
Tunisia’s health system is faced with several challenges such as increased need for health financing, low rates of insurance penetration and unregulated private health sector. Consequences include higher health costs and inconsistent quality of healthcare services.
It is critical to emphasize the value of integrated care and the significance of public-private sector coordination and complementarity (5).
Health Care Providers
Development need
Out-of-pocket payments on health care represent 36.6% of total health expenditure (3). Geographic disparities in healthcare provider distribution and service accessibility in distant areas of the country obstruct the most vulnerable portion of the population from receiving quality care.
Policy priority
The government intends to deploy health care providers in underserved areas and increase their quality, as well as to improve primary care and expand access to specialized services. Tunisian Investment Authority highlights the need to promote new clusters specialised in e-health and telemedecine (12).
Gender inequalities and marginalization issues
insufficient natality health programs put at risk the lives of the mother and its child. High levels of inequality in care availability and quality between coastal and internal and rural areas.
Investment opportunities introduction
Numerous investments were announced in 2019 to upgrade and digitalize healthcare infrastructures, as well as to expand telemedicine.
Key bottlenecks introduction
Inland and rural communities may lack adequate transportation and telecommunications infrastructure, limiting access to remote diagnostics and e-health services.
Health Care Delivery
Pipeline Opportunity
Telemedicine and e-Health
Provide remote diagnostic/telehealth services to increase access to healthcare services in remote areas
Business Case
Market Size and Environment
< USD 50 million
15% - 20%
The National Strategic Plan for Digital Tunisia 2020 finances a set of strategic projects on the development of digital health with a provisional budget of 70 million TND (24 million USD) over 2017-2020 (7).
The global telemedicine market size was estimated at USD 41.4 billion in 2019 and is expected to witness a CAGR of 15.1% (11).
Indicative Return
20% - 25%
Experts active in digial health in the Maghreb region point to a return range between 20-25% (8).
Investment Timeframe
Short Term (0–5 years)
The 102% growth rate of Med.Tn, an online health platform over 4 years vouches for the ability to generate returns in the short run (9).
Ticket Size
USD 500,000 - USD 1 million
Market Risks & Scale Obstacles
Market - High Level of Competition
Impact Case
Sustainable Development Need
There is significant regional disparity in medical service provision in Tunisia as well as serious bottlenecks in data availability and shortage of public services in specialties such as ICU (3).
The COVID-19 pandemic has reinforced the significance of telemedicine given increased medical needs in Tunisia.
Gender & Marginalisation
There are rural-urban disparities in the access to health services and personnel in Tunisia.
Expected Development Outcome
Telemedicine would give access to health services to every citizen regardless of their area of residence.
Gender & Marginalisation
Increase access to essential medicines for female, inmigrants or rural ppopulation
Primary SDGs addressed
3.8.1 Coverage of essential health services
3.7.1 Proportion of women of reproductive age (aged 15–49 years) who have their need for family planning satisfied with modern methods
- 70%
- 62.7%
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Public sector
Indirectly impacted stakeholders
People
Corporates
Outcome Risks
The practice of telemedicine and teleconsultation brings in new risks of error in medical practice (4).
The use of connected devices can increase the risk of cyberattacks.
Impact Risks
Preferences of patients and doctors not being taken into account may result in low use and thus limit the delivery of impact.
The lack of direct physical contact with the patient may reduce the quality of care and thus limit the positive impact creation (3).
Availability of technological devices and internet connection are external factors that might risk the delivery of impact.
Impact Classification
What
Increased access to healthcare services regardless of location and reduced pressure on healthcare facilities.
Risk
While telemedicine and e-health model is proven, embracing user preferences, the quality of care, and the availability of tech tools and internet require consideration.
Impact Thesis
Investments in telehealth will improve access to healthcare services for the population as a whole and reduce the pressure on healthcare facilities
Enabling Environment
Policy Environment
Digital health is one of the strategic axes of the Tunisian Digital National Strategic Plan 2020 (7). Telemedicine is presented as a viable solution to the lack of medical specialists in the disadvantaged regions of Tunisia (13).
The IT center of the Ministry of Health (CIMS) details in its axis 1 the need to strengthen the digital infrastructure by acquiring and renewing IT equipment, with a view to supporting digital health uses such as telemedicine (14).
The 2016 Stategic Plan "Digital Tunisia" include an eHealth Strategy Plan, with hospital application as the main target and setting long term strategy for eHealth (10).
Financial Environment
Financial incentives: The National Strategic Plan Tunisia Digital 2020 whose estimated budget is about 70 million TND (USD 24 million) over the period 2017-2020, has already confirmed the ambition to fund a set of strategic projects for digital health (16).
Fiscal incentives: Started in 2019, the French Development Agency is providing a loan of 27.3 million EUR to the Tunisian Ministry of Health to modernize its health information system and develop digital technologies in health.
Regulatory Environment
Law No. 2018-43 of July 11, 2018 having amended Article 23 of Law No. 91-21 of March 13, 1991 on the practice and organization of the profession of doctor and dentist. This amendment had introduced telemedecine as a sixth type of authorized medical act for medical progressionnals (15).
Organic law 2004-63 of 27 July 2004 on the protection of personal data with the obligation to respect confidentiality and extends it to the processing of collected data and their sharing.
Marketplace Participants
Private Sector
Health Technology Service, Tobba, DoqToor, DabaDoc, Respir-Sud, Med.Tn
Government
Ministry of Health, CIMS, The National Observatory of New and Emerging diseases (ONMNE), Ministry of Communication Technologies and Digital Economy, Ministry of Social Affairs
Multilaterals
French Development Agency, GIZ
Public-Private Partnership
The Ministry of Women, Family and the Elderly/ the organization Médecins du Monde
Target Locations
Tunisia: South-West
Tunisia: Centre-West
References
- (1) Maxula Bourse. http://www.maxulabourse.com.tn/sites/default/files/note_valeur/FOCUS%20VALEUR%20ADWYA_0.pdf
- (2) The Republic of Tunisia, 2021. Voluntary National Review 2021. https://sustainabledevelopment.un.org/content/documents/279442021_VNR_Report_Tunisia.pdf
- (3) WHO, 2018. Tunisia: Health Systems Profile. https://rho.emro.who.int/sites/default/files/Profiles-briefs-files/TUN-Health-System-Profiles-2018.pdf
- (4) Tunisia Investment Authority. PHARMACEUTICAL SECTOR SECTOR PRESENTATION. https://tia.gov.tn/storage/app/media/ARGUMENTAIRES/TIA_TUNISIA_PHARMA/AG%20PHARMA%20ANG.pdf
- (5) Shops Plus and Health Finance&Governance, 2018. Trends in Health Financing and the Private Health Sector in the Middle East and North Africa. https://shopsplusproject.org/sites/default/files/resources/Trends%20in%20Health%20Financing%20and%20the%20Private%20Health%20Sector%20in%20the%20Middle%20East%20and%20North%20Africa.pdf
- (6) Respir-Sud. https://respir-sud.com/english/home.html
- (7) Maghreb Healthcare Forum. E-Health Tunisia. https://maghrebhealthcareforum.com/e-health/tunisia
- (8) Stakeholder Consultations held in 2021.
- (9) Challenges, 2021. Un taux de croissance de 120% et une 2e levée de fonds en vue, Emna Jallouli Med.Tn. https://www.webmanagercenter.com/2021/03/19/465164/la-tunisie-qui-gagne-startup-un-taux-de-croissance-de-120-et-une-2e-levee-de-fonds-emna-jallouli-med-tn/ "10) EC. INFORMATION PAPER on Main eHealth activities outside of the EU. https://ec.europa.eu/health/sites/default/files/ehealth/docs/ev_20180515_co25_en.pdf"
- (11) Grand View Research Telemedicine Industry Analysis, https://www.grandviewresearch.com/industry-analysis/telemedicine-industry
- (12) Tunisia Investment Authority, 2021. Pilotage des feuilles de route sectorielles, secteur Pharmaceutique.
- (13) Sante Tunisie, 2018. La télémedecine en tant que bonne pratique pour pallier au déficit de médecins spécialisttes dans les régions défavorisées en Tunisie. http://www.santetunisie.rns.tn/images/docs/anis/actualite/2018/avril/paz2/Article-4---La-tlmdecine-_valuation-PAZD-II.pdf
- (14) CIMS.rns.tn, Axes stratégiques 2018-2020.
- (15) La Tunisie médicale-2020, vol 98 (n°06), p°425
- (16) Sante Tunisie, Programme de développement de la "santé Numérique" en Tunisie. santetunisie.rns.tn