Facilities planning: Efforts are under way to extend services to rural areas

Health care infrastructure has seen significant developments, with the number of facilities rising from one for every 17,000 people in 1980 to one for every 12,000 in 2014. The system has 144 public hospitals, with 22,000 beds, and 373 private clinics, accounting for around 10,300 beds. However, despite improvements in health insurance coverage, notably since the advent of the Medical Assistance Regime (Régime d’ Assistance Médicale, RAMED), provision of health care services remains unequal between urban and rural areas, with 20% of Moroccans living more than 10 km away from the nearest primary care centre. RAMED has taken 7m people under its umbrella so far, but expanding infrastructure and services is key to improving coverage, and efforts are under way in a bid to reach the underserved population and improve coverage.

HOSPITAL PLANNING: Plans for two new university hospitals (centre hospitalier universitaire, CHU) in Tangiers and Agadir are currently under study, and once operational would bring the total number of CHUs to seven. “University hospitals contribute towards improving the quality of offerings and the availability of competent and skilled labour,” Mohammed Hamouiyi, former head of the emergency department at the Ministry of Health, told OBG. “The arrival of the new CHUs would help enhance health offerings, improve quality of treatments and address the disparity in public hospital distribution across the country,” he added.

Another component of the government’s plan to extend health services in remote areas involves developing hospital and pre-hospital emergency care. Plans to established 11 emergency medical services (service d’aide médicale urgente, SAMU) were first announced in 2000 to serve the 16 regions of the country. SAMUs were to be integrated within the CHUs or regional hospitals. As of today, seven are already operational, while the remaining four are expected to be set up in Tangiers, Laayoune, Safi and Setat. A number of deficiencies related to the expansion of services, combined with a rise in the number of patients seeking emergency care (estimated at 10% a year), has prompted the authorities to adopt a new strategy to modernise and reorganise the sector by training medical and paramedical staff, as well as upgrading services.

BOLSTERING EMERGENCY SERVICES: One of the main pillars of the new strategy involves expanding pre-hospital emergency care in underserved and rural areas. Figures from the Ministry of Equipment, Transport and Logistics in 2009 revealed that 80% of deaths from road accidents occurred at the scene or en route to hospital. As a result, since 2012, community emergency medical facilities (urgences médicales de proximité, UMP) are being set up within communal health care centres in underserved areas. The plan is to open 80 UMPs to handle the rising yearly number of Moroccans treated in emergency centres, estimated today at 4m and projected to rise to 6m by 2016. By late 2012, 20 units devoted to rural obstetrics had already opened.

Another service developed in the past two years consists of acquiring and equipping a helicopter to reinforce emergency services in Marrakech and its surroundings. The service, known as HéliSMUR, is a first for Morocco and will serve areas within 300 km. It is expected to contribute to reducing mortality rates associated with road accidents and maternity emergencies. Plans are under way to extend these services and ensure national coverage, with Laâyoune, Fez and Oujda next in line. “Once operational, these will enable most remote areas to be covered,” Hamouiyi said. Extending emergency services will help address the shortages encountered in a number of public health care centres in terms of service provision as well as allow for the development of family medicine, a specialty which remains largely unpractised in Morocco. “Directly resorting to specialists is very common in Morocco, and the development of family medicine as a go-between the patient and the specialist would contribute towards reviving the specialty, on the one hand, and better orientation of patients, on the other,” Yves Souteyrand, WHO representative in Morocco, told OBG.