established around the Faculties of Medicine constitute the tertiary level of highly specialized care and the ultimate referral for the other levels. In addition, these structures have the mission of training the senior health officers and of participating in the various programmes of research and other preventive activities. 333. With regard to the private health care sector, it is developed for ambulatory activities, but its contribution to hospital services still remains low (about 20 %). 334. In order to successfully implement decentralization policy in health matters, a regional public health head office had been established in each of the 24 administrative regions of the country. The organization of these regional head offices gives a position of privilege to primary health care. This administrative devolution aims at promoting the managerial process at the regional level. 335. Since 1994, a national programme for the development of health districts had been developed. This programme was aimed at decentralizing the management of health problems with the objective of improving the efficiency of the health services and the quality of the health care provided for the population. The district health services had been regulated by a Decree n° 2000-2825 of 27th November 2000. This programme seeks to achieve three major objectives, namely: • The upgrading of the local teams through specific training on the management of the district and quality tools, the accompaniment of the teams in their initiatives to improve the quality and organization of the synthesis meetings to discuss the initial experiences and to exchange ideas; • The preparation of the authentification through the designing of operational indicators of the health districts and of a manual of procedures for the authentification of the districts. Furthermore, the quality indicators which are relative to mother and infant health have already been finalized; • The concretization of the district through the application of the provisions of the Decree organizing the district. It is in this manner that 55 districts had been created by two Decrees of the Minister of Public Health dated 19th February 2003 and 29th September 2004 respectively and 19 Doctors had been appointed to the post of chief medical officer of the district; 336. Within the context of the 9th development plan (1997-2001), a sectoral investment project was launched in 1998. This project, of a 5-year duration is made up of three components: the upgrading of the regional hospitals, the development and re-organization of medical emergencies and the putting in place of a national health information system. 337. In the establishment of its strategies of choice in the area of health, Tunisia took inspiration from the WHO recommendations. It is for this reason that it adopted the objective of « Health for All » by the year 2000, and subscribed to the Alma Ata Declaration on the 12th September 1978. 72