Policy Analysis of Informal Healthcare Provision in Urban Tunisia: A Gendered Perspective from 2000 to the Present

A substantial proportion of healthcare in urban Tunisia is delivered through informal channels, including unlicensed practitioners, home remedies, and the unregulated sale of pharmaceuticals. This sector operates outside formal oversight, with particular implications for women's access to gynaecological and obstetric services. This policy analysis aims to critically examine the gendered dimensions of informal healthcare provision in urban Tunisia. It seeks to identify the drivers of its use, its function within the broader health system, and the consequent implications for women's health policy. The study employed a qualitative desk-based review of academic literature, grey literature, and relevant policy documents. A thematic analysis was conducted to identify persistent patterns and policy gaps, with a specific focus on gender disparities. Informal care remains a primary, though often unacknowledged, resource for many urban women, particularly for gynaecological and reproductive health concerns. A key finding was the use of informal channels to circumvent social stigma associated with certain conditions. The sector is characterised by a consistent lack of targeted policy recognition or engagement. Informal healthcare is an entrenched and gendered component of urban Tunisia's health landscape. Prevailing policy frameworks fail to address its existence, thereby perpetuating risks related to patient safety, care quality, and equitable access for women. Policymakers should formally recognise the informal sector's role. Recommendations include developing targeted regulations for common informal practices, integrating an understanding of informal care into public health campaigns, and creating pathways to formalise safe, community-based practitioners. Informal healthcare, policy analysis, gender, urban health, Tunisia, women's health This analysis provides a systematic, gendered examination of informal healthcare policy in urban Tunisia, offering evidence to inform more inclusive health system governance.