9. Achouri H. and E. Farawan (2003), ‘Autonomous Structures- with Incomplete Autonomy: Unusual Hospital Reform in Tunisia’, in Preker A. S. and A. Harding (Eds.) Innovations in Health Service Delivery: The Corporatization of Public Hospitals, The World Bank, Washington DC, 485-510.

This chapter in the book traces Tunisia's experience with health care reform and concludes with the following lessons: Involve sector professionals and all sector constituencies in the reform design process; define and implement a communication strategy from the start of the reform process that targets all sector constituencies; define the political, strategic, and operational goals of reform and the criteria to be used in determining whether the goals were accomplished; assign specific management responsibilities for implementation in advance of initiating reform measures; include feedback loops in reform management to allow necessary adjustments and flexibility in view of implementation experience and changes in the external environment; MPH role and methods of interacting with and guiding the hospital must be consistent with the envisioned level of autonomy otherwise, they will undermine the reform; develop incentives and qualifications criteria to ensure recruitment of appropriate reform managers; Ensure stability in the units involved in reform by avoiding staff turnover; promote information exchange between and among providers and the Central MPH; conduct continual staff training and institutional development; and ensure that the focus of all action in health care institutions is on patients.