Tunisia eliminates trachoma as a public health problem
Tunisia has been validated by the World Health Organization (WHO) as having eliminated trachoma, the world’s leading infectious cause of blindness, as a public health problem. It is the 31st country globally and the 9th in the WHO Eastern Mediterranean Region to reach this milestone.
Trachoma has been known to be a public health problem in Tunisia since the early to mid-20th century, particularly in rural areas with poor hygiene and limited access to healthcare. Surveys conducted between 1923 and 1938 indicated that at least half the population was affected, with significant regional variation: around 20–30% in the north, 60–70% along the coast and central regions, and 90–100% in the south and oasis areas.
In 1931, a survey in southern Tunisia found that 71% of the population had active trachoma and 3.9% were blind. Severe disease was common, with trichiasis-entropion in 25% of cases and visual impairment in 14%.
Since its establishment in 1947, Tunisia’s Ministry of Health has prioritized trachoma, implementing a strategy focused on screening and treatment, individual prevention, health education, and fly control to prevent transmission. A nationwide network of 12 ophthalmology sectors, each staffed by at least one specialist, led coordinated efforts across the country.
In the 1960s, large-scale screening and treatment campaigns were reinforced by legislation mandating preventive measures, including routine treatment in schools. These efforts were supported by the training of healthcare workers, paramedical staff, and teachers, alongside the expansion of ophthalmic services. Repeated mass antibiotic treatment significantly reduced transmission, with benefits extending beyond treated individuals.
From the 1980s, the introduction of primary healthcare facilities and the integration of preventive and curative services shifted trachoma interventions from mass campaigns to routine care. Expanded access through health centers, combined with nationwide school health programs, strengthened early detection and treatment of eye conditions. High enrollment rates among children aged 6–11 years further increased the reach of these services.
Today, trachoma, including trachomatous trichiasis, the blinding stage of disease, is managed through a combination of facility-based care and outreach. Patients are identified through routine screening, self-referral, or community campaigns and referred for surgery. Eye care is decentralised, with more than 600 ophthalmologists delivering medical and surgical services across the country, supported by ongoing training and quality assurance systems. Most procedures are performed on an outpatient basis, with mobile surgical units extending coverage to underserved areas.
School health programmes, jointly led by the Ministry of Health and Ministry of Education, remain central to prevention efforts. Health education, including hand and face washing, is integrated into school activities, supported by universal access to safe drinking water and routine hygiene practices.
Alongside health interventions, Tunisia has made broader gains in access to basic services and education. Nearly all households have access to safe drinking water (98%), with 87% connected to the water network and 62% to the sanitation system, while primary school enrollment has reached 98%, supporting strong coverage of school health services.
A mandatory disease reporting system further underpins surveillance, covering 34 communicable diseases, including trachoma. School-based screening and field surveillance systems enable early detection and timely response, supported by a centralized information system.
Tunisia’s achievement reflects decades of sustained investment in primary healthcare, strong surveillance systems, and the integration of eye health into community and school-based services. It demonstrates how coordinated, long-term efforts can eliminate a disease that once affected large parts of the population. ICTC congratulates the Government of Tunisia and all stakeholders involved.— Michaela Kelly, Chair, International Coalition for Trachoma Control
Trachoma is targeted for global elimination as a public health problem under Sustainable Development Goal target 3.3 and the neglected tropical diseases road map 2021–2030. As of November 2025, 97.1 million people still require interventions for trachoma globally—a 94% reduction from the 1.5 billion people at risk in 2002.
To achieve global elimination by 2030, ICTC estimates that approximately USD $300 million is required to fill funding gaps for surgery, antibiotic mass drug administration, surveys and high priority research.
Other countries validated by WHO as having eliminated trachoma as a public health problem include Algeria, Australia, Benin, Burundi, Cambodia, China, Egypt, Fiji, The Gambia, Ghana, India, the Islamic Republic of Iran, Iraq, the Lao People’s Democratic Republic, Libya, Malawi, Mali, Mauritania, Mexico, Morocco, Myanmar, Nepal, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Senegal, Togo, Vanuatu, and Viet Nam.
Trachoma elimination in Tunisia was supported by Tropical Data.
Photo credit: World Health Organization