Human capital – the collective skills, knowledge and health of a population – is a critical driver of economic growth and social progress. Tunisia has made significant strides in enhancing human capital, with investments in education and healthcare serving as the cornerstones of national development. As the country aims to fulfil the 2030 Agenda for Sustainable Development, achieving key targets related to two particular sustainable development goals (SDGs) – SDG 3 (good health and wellbeing) and SDG 4 (quality education) – remains a high priority.

But a confluence of economic challenges, political instability and climate-related disruptions now threatens to undermine these achievements. Here, we examine the state of Tunisia’s education and healthcare systems, identifying structural weaknesses that could jeopardise human capital and, by extension, the country’s sustainable development goals.

Education: access gains undermined by quality concerns

Tunisia’s efforts to expand educational access have been notable, achieving high enrolment rates across primary, secondary and tertiary levels. Education spending accounted for 6.66% of GDP in 2023, aligning with international benchmarks set by the Education 2030 Framework for Action. Despite these achievements, the quality of education remains a significant concern, posing a serious risk to the development of a competitive and skilled workforce.

Curriculum deficiencies and skills mismatch

One of the most pressing issues facing Tunisia’s education system is the outdated curriculum, which emphasises rote memorisation at the expense of critical thinking, digital literacy and problem-solving skills. This approach leaves students ill-prepared for the demands of a modern, knowledge-driven economy.

The disconnect between educational outcomes and labour market needs is evident in the high rate of youth unemployment, which exceeds 30%. Employers across key sectors, such as information and communications technology (ICT) and renewable energy, consistently report a shortage of graduates with the practical skills necessary to thrive in these industries.

The failure to equip students with relevant skills not only contributes to high unemployment, but also limits Tunisia’s ability to leverage its young population for economic growth. While the country’s higher education institutions are achieving high enrolment rates, they often struggle to align their curricula with the evolving needs of the economy. This skills mismatch highlights the urgent need for comprehensive reforms in vocational and technical education to prepare students more effectively for employment.

Regional disparities in education access and quality

While Tunisia has made progress in increasing access to education, significant disparities persist between urban and rural areas. Urban schools benefit from better infrastructure, access to digital tools and higher-qualified teachers, whereas rural schools face severe challenges, including inadequate facilities, limited resources and a shortage of trained educators. These inequalities are manifest in lower student performance and higher dropout rates in rural areas, perpetuating socio-economic disparities and limiting opportunities for rural youth.

In the 2023 baccalaureate exams in Tunisia, there were significant disparities between coastal and inland regions. Coastal governorates recorded notably higher success rates compared with their inland counterparts. For example, the Sfax 1 region achieved a success rate of 56.05%, while Sfax 2 followed closely with 51.31%. The Sousse region also performed well, registering a success rate of 50.76%. In contrast, inland regions such as Kasserine had a success rate of 23.65%, Gafsa 25.23% and Jendouba 27.52%.

These figures highlight the educational disparities between coastal and inland areas in Tunisia, reflecting broader socio-economic inequalities that affect educational outcomes. For example, many rural schools lack access to essential digital technologies, a deficiency that has become increasingly problematic as the global economy moves towards digitalisation. Students without adequate digital skills face limited job prospects, exacerbating the cycle of poverty and exclusion in these communities.

In addition, the projected decline in government spending on education raises concerns about the sustainability of recent gains, particularly in maintaining and improving the quality of education in underserved regions. Disparities between private schools and public schools are also widening social inequalities.

Healthcare: resilient but inequitable

Tunisia’s healthcare system demonstrated resilience during the Covid-19 pandemic, rapidly integrating digital health solutions such as telemedicine to meet surging demand. But deep-rooted structural issues continue to hinder the system’s overall effectiveness.

The country’s dual-track healthcare system, comprising both public and private providers, has created significant disparities in access to quality care. Public healthcare facilities, which serve the majority of the population, are plagued by chronic underfunding, outdated infrastructure and frequent shortages of essential medicines. In contrast, private healthcare services offer higher-quality care but remain accessible mainly to affluent, urban residents.

Systemic inequities in healthcare access

The inequities in Tunisia’s healthcare system are most pronounced in rural areas, where infrastructure is limited and specialised services are scarce. Rural residents often face longer travel times to access healthcare facilities and receive less comprehensive care compared with their urban counterparts. The shortage of healthcare professionals in these areas exacerbates the problem, contributing to poorer health outcomes and widening the gap between urban and rural populations.

In Tunisia, there is a notable disparity in the distribution of physicians between coastal and inland regions. Coastal areas, such as the governorate of Tunis, have a significantly higher concentration of medical professionals compared with inland regions. For example, in 2018, Tunis had 3,639 doctors serving a population of approximately 1,071,375, resulting in a ratio of about 3.4 physicians per 1,000 inhabitants. In contrast, the inland governorate of Sidi Bouzid had only 241 doctors for a population of around 449,026, yielding a ratio of approximately 0.5 physicians per 1,000 inhabitants.

This uneven distribution underscores the challenges faced by inland regions in accessing adequate healthcare services, highlighting the need for targeted policies to address regional disparities.

Non-communicable diseases (NCDs), such as diabetes and cardiovascular illnesses, are on the rise in Tunisia, placing additional strain on an already overstretched public healthcare system. The emphasis on curative care rather than preventive measures continues to drive up healthcare costs and limits the system’s capacity to address emerging public health challenges effectively. Addressing these gaps is critical for achieving SDG 3 and ensuring equitable access to healthcare services for all Tunisians.

The interplay between education, health and human capital

The weaknesses in Tunisia’s education and healthcare systems pose a serious threat to the country’s human capital. Human capital is a foundational asset for any economy, driving productivity, innovation and long-term growth. In Tunisia, the skills gap in the labour market, coupled with inequitable access to quality healthcare, limits the potential of its workforce. This, in turn, affects broader socio-economic goals, including poverty reduction, gender equality and inclusive economic growth.

Education and health are mutually reinforcing components of human capital. Children who receive quality education are more likely to have better health outcomes, while healthier individuals are better equipped to learn and perform well academically. The interdependence of these two sectors means that deficiencies in one can have a negative impact on the other, creating a feedback loop that stifles human capital development. Without targeted policy interventions, Tunisia risks falling short of its development objectives, hindering progress towards the 2030 Agenda.

Conclusion

Tunisia has made considerable progress in education and healthcare, laying a strong foundation for human capital development. But persistent structural challenges threaten to erode these gains, putting the country’s long-term socio-economic progress at risk.

By prioritising curriculum modernisation, enhancing healthcare infrastructure and addressing regional disparities, Tunisia can protect and strengthen its human capital. With coordinated policy efforts and strategic investments, the country can harness its potential and make significant strides towards achieving its sustainable development goals, ensuring a brighter, more inclusive future for all.

The work has benefited from the comments of the Technical Experts Editorial Board (TEEB) of the Arab Development Portal (ADP) and from a financial grant provided by the AFESD and ADP partnership. The contents and recommendations do not necessarily reflect the views of the AFESD (on behalf of the Arab Coordination Group) nor the ERF.