Implementation of new modes and mechanisms of governance under Tunisia health reforms

Abstract

The objective of this paper is to understand the implementation of new modes and mechanisms of
governance under Tunisia health reforms. Data were collected from a survey among a national sample of
board members (N = 30). The analysis integrates findings from both the qualitative and quantitative data
related to modes and mechanisms of governance. The results indicate a transition of the functions given to
the hospital board from a model with professional and autonomous boards towards two different functions.
They are a mixture between the tasks of a formal decision body and the behaviour of a body to secure the
interests of different stakeholders. The findings suggest also that the board of directors in hospitals must
act in a context of uncertainty and ambiguity. Political (contractual incentives and control systems) and
cultural requirements and trusting relationships are beneficial to improve the current practices.