MOROCCO- As the global momentum toward achieving Universal Health Coverage (UHC) grows, African and other developing nations are increasingly at the forefront of this movement.
Despite historically lagging behind in healthcare services compared to the developed world, many nations in these regions are now making significant progress towards providing affordable high- quality healthcare for all in line with World Health Organization standards. One such Country is Morocco.
Officially known as the Kingdom of Morocco, the African-Arabian country is found in the Maghreb region of North Africa, right in the heart of the larger Sahara Desert.
Spreading over a surface area of 446.55 square kilometers, the Kingdom boasts of a general population of 38.2 million people as at March 30th 2024, indicating a growth of 1.02%, an increase from 2023. The North African Country is headquartered at the city of Rabat.
With a rich history spanning about over 300,000 years back, the Kingdom came into existence in 788 after the establishment of the Idrisdid dynasty by Idris. The Alawy dynasty, which rules the country to this day, seized power in 1631, and over the next two centuries expanded diplomatic and commercial relations with the Western World.
Morocco’s strategic location near the mouth of the Mediterranean drew renewed European interest; in 1912, France and Spain divided the country into respective protectorates, reserving an International Zone Tangier. Following intermittent riots and revolts against colonial rule, in 1956, Morocco regained its independence and reunified.
Healthcare overview
Generally, the Moroccan healthcare system is in two tiers-the public and the private sectors. The public healthcare system is known as National Health Insurance Fund (CNAM) and is funded by public coffers.
This provides access to basic medical care, including preventive care, hospitalization and emergency services. The public sector runs 2,689 primary health care facilities and 144 hospitals at different levels, with a total bed capacity of 22,146.
Although the Country has both public and private health facilities, private hospitals are preferred owing to long ques and lower quality medical care experienced at the public healthcare facilities. The private sector healthcare market on the other hand is growing rapidly with more than 356 private clinics and 7,518 physicians.
The private health sector holds a bed capacity of over 27,000. This includes ultra-modern facilities such as Clinique Internationale in Marrakech, Clinic Averroes founded in 1975 by Dr. Ahmed Laaabi also in Marrakech and Anfa Fertility Centre in Casabalanca.
Strides made in the Moroccan Healthcare System
Despite the challenges facing the Moroccan healthcare system, there have been several notable achievements in recent years that offer hope for improvement. One significant achievement is the implementation of universal health coverage through the Ramed program in 2011. This program aims to provide health coverage to vulnerable populations, including those who are poor or have chronic diseases.
The Ramed was replaced in 2023 by the generalization of social coverage for the benefit of all Moroccans, which was launched on July 29, 2020, by King Mohammed VI. This project requires a rigorous reform of social systems and programs following the crisis linked to the COVID pandemic, which has highlighted several shortcomings, particularly the weakness of social protection networks.
Over the years, there have been significant improvements in key health indicators. Life expectancy at birth has seen a remarkable rise, increasing from 47 years in 1967 to 74.8 years in 2013. Infant mortality rates have seen a substantial decline, with numbers falling from 113.6 per thousand live births in 1967 to 28.8 in 2013. Similarly, maternal mortality has witnessed a significant decrease, dropping from 359 per hundred thousand live births in 1981 to 112 in 2013.
The healthcare system has also made great strides in vaccination coverage, with a commendable 94.5% coverage rate and equitable distribution across different regions. This has resulted in the elimination of targeted diseases like poliomyelitis and diphtheria, as well as a notable decrease in the incidence of diseases such as measles.
The expansion of health coverage has been a priority, evident through a substantial increase in the number of basic healthcare establishments and hospitals throughout the country. Moreover, there has been a notable rise in the number of doctors, with a ratio of 1 doctor per 1775 inhabitants in 2009, which improved to 1.5 doctors per 1000 inhabitants in 2014.
Another significant achievement is the development of the pharmaceutical industry in Morocco. The industry has been successful in meeting 70% of the national demand for drugs, ensuring a more self-sufficient and accessible healthcare system for the population.
According to the Country’s Minister of Health and Social Protection Dr. Khalid Ait Taleb, Morocco plans to promote local production through collaboration between the Ministries of Commerce and Industry and that of Health and Social Protection-
“In collaboration with the Ministry of Industry and Commerce, we are actively working on promoting the ‘Made in Morocco’ brand and local production. This is because Morocco has significant potential; we can easily become an African hub, and not only that but also a part of the European hub. Other countries are now looking to reshore their production, which will considerably impact their healthcare costs. Hence, Morocco can benefit from this situation and become a key player in both African and European pharmaceutical distribution” Said Dr. Taleb.
These accomplishments in Moroccan healthcare reflect the country’s commitment to improving the well-being of its citizens and provide a solid foundation for the continued growth and advancement of the healthcare sector.
The Moroccan authorities have also invested in expanding healthcare infrastructure, including building new hospitals and clinics and upgrading existing facilities. Additionally, several e-health services, such as telemedicine and electronic health records, have been developed to improve healthcare access and efficiency. For instance, the Government has begun construction of Ibn Sina University Hospital in Rabat. This will be largest Public Hospital in Morocco with a bed capacity of over 1000 beds, at a cost of Dh. 1.55 billion.
Challenges abound
Meanwhile, in spite of the significant progress made in recent years, the Moroccan healthcare system still grapples with several challenges that limit its ability to deliver high-quality healthcare to all citizens.
One significant challenge is the unequal distribution of healthcare resources, with urban areas having better healthcare access and resources as compared to rural areas. This disparity is particularly pronounced in the areas of healthcare infrastructure, medical equipment, and specialist care.
One other significant challenge choking Morocco just like any other developing nation is inadequate funding for healthcare, which limits the ability to provide essential medicines and technologies, improve healthcare infrastructure, and increase healthcare access.
Additionally, there is a shortage of healthcare workers, particularly doctors and nurses, especially in rural areas. This shortage results in longer wait times for patients and limited access to specialist care.
Furthermore, non-communicable diseases (NCDs) are increasingly prevalent in Morocco, posing a significant health burden. NCDs account for over 80% of deaths in Morocco, and the healthcare system is not adequately equipped to manage these diseases. The prevalence of risk factors for NCDs, such as tobacco use, unhealthy diets, and physical inactivity, is also high in Morocco.
Moreover, insufficient health insurance coverage: 38% of the population does not have medical coverage, and those who do have coverage may still face high out-of-pocket expenses for healthcare services.
The Moroccan healthcare system struggles with the management of health data and information, which limits its ability to make informed decisions, monitor healthcare quality, and plan healthcare strategies.
Finally, it is evident that the main source of these difficulties is generally the lack of optimal, rational, and effective governance; good governance has become an essential factor in efforts to strengthen health systems and its impact on health is now more decisive. The overall governance of the system does not empower the actors, neither does it encourage quality.
Financing Healthcare
The Moroccan Ministry of Health’s budget is expected to see a 9.1% increase in 2024, reaching around MAD 30.7 billion (USD 3.48 billion), according to the new 2024 budget. The budgetary increase is primarily focused on enhancing the healthcare infrastructure across the country, as detailed in the official report released by the Ministry of Economy and Finance.
In recent years, the Ministry of Health and Social Protection, along with University Hospital Centers (CHU), have received substantial financial support. Notably, the 2024 budget is poised to introduce 5,500 new budgetary positions, contributing to a cumulative total of nearly 42,700 positions created between 2017 and 2024, with 35,500 allocated to the Department of Health.
In 2024, the country is slated to implement vital initiatives integral to the ongoing transformation of the national healthcare system. These initiatives encompass projects initiated by King Mohammed VI. Key initiatives for 2024 include addressing investment expenses related to the construction and equipping of new CHUs, along with comprehensive enhancements to Primary Healthcare Facilities (ESSP) throughout the country.
Additionally, these projects entail the deployment of an integrated information system, as well as the continued modernization of hospital infrastructure and equipment, aligning with the nationwide implementation of Mandatory Health Insurance (AMO).
The Ministry of Health is also set to initiate new hospital infrastructure projects and bring existing hospital construction projects to completion. The measures aim to improve healthcare and provide citizens with quality medical services. The budget increase for 2024 is expected to have a positive impact on healthcare accessibility and quality throughout Morocco.
Into the future
While the recent achievements in the Moroccan healthcare system are promising, several perspectives can guide future efforts to improve the country’s healthcare system.
The health map project which is currently being carried out aims to organize the care pathway territorially, to lighten the load on health structures, reduce waiting times and properly distribute care between regions.
In this scheme, the university hospital center plays a crucial role as a leading specialty, research, and training institution and as a structure to which the other hospitals in the region are linked within the framework of the Regional Health Groups.
The Public-Private Partnership is another means that aims to improve health services for the population, which will also make it possible to pool the resources of the public and private sectors and allow, for example, the health professionals of the latter to offer health care at the level of public health structures by taking advantage of their technology platform.
Addressing the unequal distribution of healthcare resources between urban and rural areas is essential. To achieve this, there must be a concerted effort to invest in rural healthcare infrastructure, medical equipment, and specialist care, as well as increase the number of healthcare workers in these areas.
Notably, adequate funding for healthcare is necessary to provide essential medicines, medical equipment, and technologies, and improve healthcare infrastructure. Increased funding will also facilitate the recruitment and retention of healthcare workers, particularly in rural areas.
Managing and preventing NCDs should be a priority. This requires a comprehensive approach that includes promoting healthy behaviors, improving healthcare access and quality, and addressing social determinants of health that contribute to the development of NCDs.
There are several propositions to enhance the Moroccan health system and pave the way for further improvements. First, the digitization of the health system can bring significant benefits. By embracing digital technologies, such as electronic health records and telemedicine, healthcare delivery can be streamlined, ensuring efficient management of patient data and enabling remote consultations. Additionally, reorganizing the care pathway from the community level to the regional level can improve access and coordination of healthcare services, allowing for better integration and collaboration among healthcare providers.
To strengthen the public healthcare sector, efforts should be made to make public hospitals more attractive. This can be well achieved by empowering them to generate their resources, promoting financial sustainability, and implementing measures that enhance the quality and efficiency of services. Encouraging public-private cooperation can also play a vital role in leveraging the strengths of both sectors, fostering innovation, and expanding access to healthcare for all.
Another perspective of great importance is the implementation of an integrated and intersectoral policy focused on prevention and health education. By addressing health promotion and prevention strategies, such as disease prevention campaigns and education programs, the burden of illness can be reduced, and individuals can be empowered to make informed choices about their health. This requires collaboration across different sectors, including education, public health, and community organizations, to create a comprehensive and effective approach to improving population health.
By embracing these propositions and perspectives, Morocco can lay the foundation for a more efficient, inclusive, and patient-centered health system that prioritizes prevention, embraces innovation, and ensures equitable access to quality healthcare services for all its citizens.
Challenges such as resource disparities, inadequate funding and rampant non-communicable diseases not withstanding achievements like Universal Health Coverage and improvements in Health Indicators show progress.
To enhance the system, addressing resource disparities, increasing funding and workforce, managing non-communicable diseases, embracing technologies and focusing on prevention are quite key. These steps would pave way for an efficient, inclusive and patient-centered healthcare system in the Northern Africa Country.
This feature appeared in the APRIL-JUNE 2024 edition of Healthcare Middle East & Africa magazine. You can access the full digital magazine HERE.
