Challenges

Continuing to improve quality in hospitals

As Morocco continues its progress within phases IV and V of the integrated mortality transition framework, improving the quality of health care services continues to be a priority for decision makers. One of six goals in Morocco’s 2017–2021 ENAP/ EPMM plan was to strengthen the availability of essential quality interventions for mothers and newborns across the continuum of care.¹

However, the latest national quality assessment survey conducted in 2018 revealed areas for improvement in Morocco’s hospital system, such as strengthening implementation of national policies and guidelines for quality maternal, newborn, and child health care.² The results of this survey revealed challenges in regional hospitals, with respect to the management of delivery and neonatal facilities, the skill level of health care providers, and the establishment of a standard care package across facilities. Regional hospitals are essential to expand emergency obstetric and neonatal care to communities, and will be a focus area for improvement in the coming years.

Reaching full coverage of health insurance programs

Morocco has made great efforts in sustainably expanding health coverage, but there is still work to be done on several fronts: reducing inequalities in insurance coverage, implementing health reforms, and sustainably financing the programs. Disparities in coverage and usage remain between wealth quintiles and residences, with the highest rates in urban areas and wealthier quintiles.³ Nearly a quarter of Régime d’Assistance Médicale aux Economiquement Démunis (RAMED) beneficiaries turned to private health care, increasing the risk of catastrophic health expenditure.⁴ AMO-Tadamon’s reimbursement of private services may help to reduce future financial burden on these beneficiaries. The announcement of AMO-Tadamon also comes along with substantial health care reform activities to improve the health system’s structure and governance, including the creation of new agencies, further reduction of drug pricing, and reducing staff shortages.^4,5 In June 2023, Morocco received US$450 million from the World Bank as a program-for-results loan to support the launch.^4,5 The government is in the process of progressively mobilizing additional funding through new mechanisms such as taxes on unhealthy products, airline tickets, private services, and other areas to bridge this financing gap.⁴ Health coverage for all is predicated on successfully implementing reforms and raising additional funds sustainably—which is a politically challenging and lengthy processes to navigate.

Managing the effects of climate change on health

Many of Morocco’s maternal and newborn health initiatives are intended to reach rural and remote communities. Many of these communities are located in desert regions, which are increasingly affected by a myriad of drivers stemming from climate change. Extreme weather scenarios may contribute to poorer maternal health status, reduce women’s access to health services, and increase dropout rates for girls’ education.⁶ Morocco is experiencing downward trending precipitation results in multiple consecutive years of drought, which can accelerate water scarcity, reduce food availability, and increase malnutrition.^7,8 Drought can also impact the economic livelihoods of households dependent on agriculture, as highly variable crop yields are closely linked to precipitation levels.⁹ Morocco has a history of innovative and progressive policymaking on climate change: to continue the trajectory of progress, the downstream health impacts on the most marginalized communities in Morocco will need to be addressed and integrated into climate-oriented policies.