Pharmacists are suspending the end-motivation system, and patients are already charging for medication

The Tunisian Syndicate of Private Pharmacy Owners has suspended working as a motivating party throughout Tunisia for the benefit of social insured persons belonging to the National Sickness Insurance Fund, starting from 1 November 2026. This decision came after the meeting of the National Enlarged Board of Trade on 27 October 2026, following a prior notification to the Fund's management and stakeholders on 19 October 2026, to confirm that work cannot continue in the event of non-compliance with financial obligations.

This procedure required patients and social workers to pay the full value of medicines in cash and directly within pharmacies, bringing back to the forefront renewed difficulties in citizens' access to treatment. Under this suspension, citizens are forced to bear the burden of direct payments, pending the submission of recovery files later to the Fund's offices which experience continuous delays in remittances, putting increasing pressure on health and subsistence services.

The current crisis is due to the accumulation of the National Health Insurance Fund's drugstore debt of nearly 200 million dinars. Payment delays were recorded at more than 180 days, compared to the contractual term of 14 days, within the legal framework of Law No. 71 of 2004 on the introduction of the sickness insurance system and the sectoral agreement concluded to ensure continuity of health coverage.

On the official level, the Minister of Social Affairs decided on 5 November 2026 to suspend the disbursement of private pharmacies' fees and order their resumption with the pharmacist's withdrawal from the decision to stop the system. The course of the crisis had seen in previous months the signing of memoranda of understanding and extension supplements sponsored by the Ministry of Social Affairs in January and July 2026 for the payment schedule, before disagreements renewed as a result of default and lack of liquidity.

The next steps are towards making administrative and technical contacts between the Tunisian Association of Private Pharmacy Owners and the Fund's management to explore mechanisms for handling patient files. These communications aim to set a date for a new round of negotiations seeking to settle arrears and end the suspension of work under the joint sectoral agreement.