This case study examines country-level primary health care (PHC) systems in Tunisia in the context of the COVID-19 pandemic between January 2020 and August 2022. The case study is part of a collection of case studies providing critical insights into key PHC strengths, challenges and lessons learned using the Astana PHC framework, which considers integrated health services, multisectoral policy and action, and people and communities. Led by in-country research teams, the case studies update and extend the Primary Health Care Systems (PRIMASYS) case studies commissioned by the Alliance in 2015.