The day after the suspension of third-party payment by pharmacists, the Head of State summoned the Minister of Social Affairs to discuss the National Health Insurance Fund (CNAM). Behind the institutional tone, a political signal addressed to an entire social system losing balance.
Monday October 27, 2025, Kaïs Saïed received the Minister of Social Affairs, Issam Chebbi, at the Carthage Palace. According to the presidency press release, the meeting focused on social funds, in particular on the National Health Insurance Fund (CNAM). The Head of State reiterated the need to restore the balance of these funds, by developing legislation adapted to their missions.
“The funds must regain their balance and achieve the objectives for which they were created,” underlines the text.
CNAM – pharmacists: The rupture
This message comes as the Union of Community Pharmacists of Tunisia (SPOT) announced, the same day, the suspension of third-party payment for ordinary illnesses.
Pharmacists denounce payment delays of several months and a CNAM incapable of respecting the terms of the agreement in force.
“We held out until the end, but the CNAM let the sick down,” declared Molka Moudir, president of the union.
This is not the first time that the CNAM has gone through such a zone of turbulence. Similar tensions had already erupted in 2019, 2021 and 2023, each time around the same difficulties: reimbursement delays, growing deficit and disagreements over conventions. These recurring episodes have gradually undermined the trust between the fund and its partners, fueling the idea of a system running out of steam.
A presidential warning
The explicit mention of the CNAM in the Carthage press release is not accidental. By calling to “restore the balance of social funds” and “enforce the law”, Kaïs Saïed is directly targeting the health insurance fund, but also the entire Tunisian social system.
The president intends to remind us that these institutions, often managed slowly and opaquely, must return to their primary mission: guaranteeing solidarity and social justice.
The warning therefore goes beyond the sole conflict between the CNAM and pharmacists. It is part of a broader political sequence, initiated several months ago: that of the reform of the financing of social funds.
The 2026 finance bill provides for new taxes and contributions intended to strengthen the CNAM, the CNSS and the CNRPS.
Already in May, the president spoke of the creation of a “new financing model” to ensure their sustainability.
In other words, the Palace of Carthage does not speak of an incident: it depicts the beginning of an announced recovery.
A drifting social model
The CNAM is no longer a simple paying agency.
It crystallizes the contradictions of a social model which promises coverage for all, but no longer manages to finance it.
Insufficient contributions, transfer delays, cross debts between institutions: the system is failing on all sides.
Each new crisis – pharmacists, hospitals, providers – reveals an additional aspect.
By placing the CNAM at the heart of his speech, Kaïs Saïed seeks to reestablish the authority of the State in a field undermined by mistrust.
But without structural reform and without new resources, presidential voluntarism risks hitting the budget wall.
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