Spatial disparities impact citizens’ access to care

A report by the Ombudsman for Democracy and Human Rights (MDDH) revealed alarming figures regarding the weakness in terms of the provision of health services in Morocco and the access of citizens in various regions of the Kingdom to care. A report that highlights the strong spatial disparity experienced by the health sector in Morocco.

Health policy in Morocco under the 2012-2016 and 2017-2021 government mandates was the subject of an observation and evaluation report by the MDDH. To develop its copy, the MDDH based itself on several points. First, there is access to health services in Morocco, the coverage rate, the quality of services and other criteria based on the situation of health services, financing, drug policy and governance.

Thus, the report revealed that eight regions of the Kingdom have at least one hospital for each, while two regions have two hospitals each, two others have 3 hospitals each which reflects a spatial disparity between the regions in terms of the number of regional hospital units.

After 2011, the regions with more than one regional hospital, after the merger of the regions, are Tanger-Al Hoceima and Fez-Meknes, while regions like Rabat-Salé-Kénitra have only one regional hospital despite the integration of the two regions of Gharb, Chrarda-Bani Ahsan, and Rabat-Salé-Kenitra. The report also points out that the regional hospital of Kenitra is in the process of being completed.

Despite the spatial disparity of health structures resulting from the new administrative division, no work has been done to remedy this by aligning the health supply to the infrastructures with these administrative variables necessarily imposed by a change in the demographic structure of the regions.

Another point raised in the report concerns the distribution of doctors between the regions. The finding of spatial disparity and inequality is flagrant. Thus, we see in the report that this inequality between regions in terms of doctors is not related to the number of the population.

On the contrary, the difference remains even between regions with equal demography. Indeed, a third of the doctors are distributed in the regions of Casablanca-Settat and Rabat-Salé-Kenitra. By adding the regions of Marrakech-Safi and Fez-Meknes, four regions of the Kingdom have 7,601 doctors, or 67.86% of the total workforce.

As for the situation of paramedical supervision at the national level, the distribution shows an increase in paramedical staff working in the hospital network, up to twice the staff working in the network of primary health care establishments.

Medical and paramedical coverage in relation to the population also reveals a national average of 3.18 doctors per 10,000 inhabitants and 8.82 nurses per 10,000 inhabitants. At territorial level, a number of regions are below the national average, the report says. This means that a Moroccan citizen only benefits from 0.65 medical examinations per year compared to 0.83 paramedical examinations

Regarding the financing of the health system, reading the finance laws for the period 2017-2021 shows that the budget allocated to the health sector increased from 14,294,752,000 dirhams in 2017 to 19,774,145,000 dirhams in 2017, representing an average annual rate of increase of 7.66%, the MDDH indicated in its report.

Despite this increase in the budget, the MDDH estimates that the budget of the Ministry of Health does not exceed 5.89% of the general budget. If we do a calculation, we see that the share of each individual in total health expenditure is only 561 dirhams. Moreover, health expenditure represents only 6.5% of total public expenditure, while the WHO establishes a minimum rate of 10% raises the same source.

In this sense, the MDDH recommends in its report the adoption of a health map with regional health care plans that take into account the demographic data of each territorial perimeter as well as the adoption of urgent and necessary measures to fill the gap in human resources to try to get closer to the world average of 1.57 doctors and 3.82 nurses per 1000 people.

It is also recommended by the MDDH to rebalance the territorial distribution of health professionals through positive incentive mechanisms and service obligations in remote areas.

With regard to health financing, the Mediator recommends in his report to increase investments since it is a productive sector and not only with a social vocation.



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