Tunisia

Tunisia's health system is one of the most effective in the region, although there are still infrastructural problems. Over 80% of Tunisians are enrolled in either private or public medical insurance, which is a high rate for a middle income country.

Tunisia for many years granted a monopoly of drug imports to a public sector procurement body (the PCT), which in turn supplied hospitals and about 60 wholesalers. This monopsonistic purchasing power may have deterred the entry of certain innovative drugs to the Tunisian market.

Tunisia has pursued a deliberate ëimport substition' policy with regards to its domestic pharmaceutical industry, levying higher tariffs on imported finished pharmaceuticals than it does on imported active ingredients.

Nonetheless, imported active ingredients are still taxed at an average rate of 9%, which acts as a significant cost inflator for locally manufactured products. Imported products are taxed at a rate of 14.5%, amongst the highest in the region.