Morocco's Health Care System in Distress
By Aida Alami
CASABLANCA — As dawn broke on a late January day, workers on Rue Sebta in Casablanca were busy picking up garbage, painting shabby walls a fresh white and planting trees to spruce up the surroundings of Ibn Rochd public hospital.
It was a makeover fit for a king, Mohammed VI, whose visit, to inaugurate a new oncology wing, was later broadcast on national television. But it did not do much to mask the reality of health care in Morocco, where even Health Minister Houssaine Louardi has conceded that standards of care for the country’s 33 million people are far from adequate.
Public hospitals are decrepit and lack doctors, equipment and medicine, and fewer than 30 percent of Moroccans have health insurance coverage.
The Moroccan government spends more than $5 billion a year on health care. It allocated 3.2 percent of its budget to health care this year, according to the Finance Ministry’s 2013 budget documents.
World Bank data published last year showed that Moroccan public health spending accounted for 6.5 percent of all public spending, compared with 8.12 percent in Algeria and 6.2 percent in Tunisia. Those figures include recurrent and capital spending from central and local government budgets as well as other sources like international agencies.
Annual spending per person averages $147 in Morocco, compared with $186 in Algeria and $246 in Tunisia, according to the bank’s data.
Whether or not the level of spending is adequate, critics of the health system say that resources are not getting to where they are needed.
“In Casablanca, there are the least catastrophic public hospitals in the country. In rural areas, many don’t even have any kind of medical access nearby,” said Dr. Mohamed Naciri Bennani, secretary general of the Morocco union of private-sector doctors.
“There aren’t enough doctors or equipment and the state is not showing any will to improve the current conditions,” he added.
On the day that the king visited Ibn Rochd, a university hospital that is something of a showcase for Morocco’s public health system, a woman was screaming at hospital employees for attention at a nearby blood transfusion center. She said her mother was in a surgical unit at a hospital half an hour away and she urgently needed to buy blood so that the doctors could operate.
“The hospital doesn’t have any blood, and the center does not have enough available blood,” said the woman, who gave her name as Nora, 30. “We donated our blood and have been waiting for hours and we still don’t know when we will get what we need.
“My mother is going to die if we don’t get the blood back to the hospital fast enough.”
A few miles away, in the emergency room of Mohamed Baouafi Hospital, a patient who identified herself only as Hada, 69, said she had been hit by a car. She sat waiting on an old examination bed with no sheets, begging fruitlessly for an injection to kill the pain.
“Our stocks are very limited. We keep them for people in extreme pain,” the doctor in charge, a resident trainee, told her.
Baouafi Hospital has no intensive care unit and the operating theater has been closed for renovation since April 2011, according to a sign on the door, though no sign of renovation work could be seen. Hospital employees said patients requiring surgery were transferred to other hospitals in Casablanca.
Outside, people holding prescriptions begged passers-by to help them buy medicine. Inside, some patients offered bribes of the equivalent of a dollar or two to guards who could help them skirt hours in waiting lines.
Few medical tests were available at the hospital’s own laboratory.
“When a child comes in with meningitis, we must perform a lumbar puncture, but we can’t because we don’t have the equipment to do it,” said a doctor who asked not to be identified by name because complaining might cost him his job. “So we try to use our instincts to guess if they’re sick or not.”
A group of trainee doctors in the hallway were discussing a recent case of a baby with breathing problems. Lacking a respirator, all they had been able to do was rub his chest. The infant had died.
“Monitors don’t even work,” said one of the doctors. “Once, the machine in pediatrics indicated 265” as a pulse, “which doesn’t even exist — and the baby was already dead. We didn’t realize he was dead right away.”
Critics charge that the system is crippled by corruption, both large and small. The Central Commission for the Prevention of Corruption, a Moroccan governmental institution, published an investigation in 2011 on corruption in the health sector. Three people out of 10 said they had resorted to bribery to receive health care.
“There is a lot of small corruption in these hospitals because doctors and nurses are not paid well,” Dr. Naciri Bennani of the doctor’s union said.
The health minister, Mr. Louardi, could not be reached for comment despite several requests to senior advisers in his office. But he recently was quoted by the Moroccan daily newspaper L’Économiste as saying that emergency services in Morocco needed “real shock treatment.”
“Our emergency services are in a pitiful state,” he told the newspaper. “We must take drastic measures to improve this situation.”
According to Yves Souteyrand, the representative of the World Health Organization in Rabat, there have been many improvements in the public health system in Morocco over the past decade, including extending health insurance coverage to more people and a huge drop in infant mortality. But, he said, there is much still to be done, including increasing hiring at hospitals, expanding health services in rural areas and providing better quality of care.
The W.H.O.’s aim “is to help Morocco implement universal health coverage for everybody without catastrophic spending for the state,” he said. “Today, more than half of health expenditures comes from the pocket of users. There is awareness among the members of the government that there is a lot to be done, and they are working on it.”
According to Health Ministry figures from the three countries, Morocco has one doctor per 1,600 inhabitants, compared with one for 800 people in Tunisia and one for 600 in Algeria.
A lack of trained doctors was clearly an issue at the Baouafi Hospital. Medical residents and interns are frequently expected to pull extra hours at night because no other doctors are available.
“Sometimes I am left alone at night,” a trainee resident said. “I get really scared because I don’t have enough experience. I hope nobody will die under my watch.”
You can read the story on the New York Times' website.
CASABLANCA — As dawn broke on a late January day, workers on Rue Sebta in Casablanca were busy picking up garbage, painting shabby walls a fresh white and planting trees to spruce up the surroundings of Ibn Rochd public hospital.
It was a makeover fit for a king, Mohammed VI, whose visit, to inaugurate a new oncology wing, was later broadcast on national television. But it did not do much to mask the reality of health care in Morocco, where even Health Minister Houssaine Louardi has conceded that standards of care for the country’s 33 million people are far from adequate.
Public hospitals are decrepit and lack doctors, equipment and medicine, and fewer than 30 percent of Moroccans have health insurance coverage.
The Moroccan government spends more than $5 billion a year on health care. It allocated 3.2 percent of its budget to health care this year, according to the Finance Ministry’s 2013 budget documents.
World Bank data published last year showed that Moroccan public health spending accounted for 6.5 percent of all public spending, compared with 8.12 percent in Algeria and 6.2 percent in Tunisia. Those figures include recurrent and capital spending from central and local government budgets as well as other sources like international agencies.
Annual spending per person averages $147 in Morocco, compared with $186 in Algeria and $246 in Tunisia, according to the bank’s data.
Whether or not the level of spending is adequate, critics of the health system say that resources are not getting to where they are needed.
“In Casablanca, there are the least catastrophic public hospitals in the country. In rural areas, many don’t even have any kind of medical access nearby,” said Dr. Mohamed Naciri Bennani, secretary general of the Morocco union of private-sector doctors.
“There aren’t enough doctors or equipment and the state is not showing any will to improve the current conditions,” he added.
On the day that the king visited Ibn Rochd, a university hospital that is something of a showcase for Morocco’s public health system, a woman was screaming at hospital employees for attention at a nearby blood transfusion center. She said her mother was in a surgical unit at a hospital half an hour away and she urgently needed to buy blood so that the doctors could operate.
“The hospital doesn’t have any blood, and the center does not have enough available blood,” said the woman, who gave her name as Nora, 30. “We donated our blood and have been waiting for hours and we still don’t know when we will get what we need.
“My mother is going to die if we don’t get the blood back to the hospital fast enough.”
A few miles away, in the emergency room of Mohamed Baouafi Hospital, a patient who identified herself only as Hada, 69, said she had been hit by a car. She sat waiting on an old examination bed with no sheets, begging fruitlessly for an injection to kill the pain.
“Our stocks are very limited. We keep them for people in extreme pain,” the doctor in charge, a resident trainee, told her.
Baouafi Hospital has no intensive care unit and the operating theater has been closed for renovation since April 2011, according to a sign on the door, though no sign of renovation work could be seen. Hospital employees said patients requiring surgery were transferred to other hospitals in Casablanca.
Outside, people holding prescriptions begged passers-by to help them buy medicine. Inside, some patients offered bribes of the equivalent of a dollar or two to guards who could help them skirt hours in waiting lines.
Few medical tests were available at the hospital’s own laboratory.
“When a child comes in with meningitis, we must perform a lumbar puncture, but we can’t because we don’t have the equipment to do it,” said a doctor who asked not to be identified by name because complaining might cost him his job. “So we try to use our instincts to guess if they’re sick or not.”
A group of trainee doctors in the hallway were discussing a recent case of a baby with breathing problems. Lacking a respirator, all they had been able to do was rub his chest. The infant had died.
“Monitors don’t even work,” said one of the doctors. “Once, the machine in pediatrics indicated 265” as a pulse, “which doesn’t even exist — and the baby was already dead. We didn’t realize he was dead right away.”
Critics charge that the system is crippled by corruption, both large and small. The Central Commission for the Prevention of Corruption, a Moroccan governmental institution, published an investigation in 2011 on corruption in the health sector. Three people out of 10 said they had resorted to bribery to receive health care.
“There is a lot of small corruption in these hospitals because doctors and nurses are not paid well,” Dr. Naciri Bennani of the doctor’s union said.
The health minister, Mr. Louardi, could not be reached for comment despite several requests to senior advisers in his office. But he recently was quoted by the Moroccan daily newspaper L’Économiste as saying that emergency services in Morocco needed “real shock treatment.”
“Our emergency services are in a pitiful state,” he told the newspaper. “We must take drastic measures to improve this situation.”
According to Yves Souteyrand, the representative of the World Health Organization in Rabat, there have been many improvements in the public health system in Morocco over the past decade, including extending health insurance coverage to more people and a huge drop in infant mortality. But, he said, there is much still to be done, including increasing hiring at hospitals, expanding health services in rural areas and providing better quality of care.
The W.H.O.’s aim “is to help Morocco implement universal health coverage for everybody without catastrophic spending for the state,” he said. “Today, more than half of health expenditures comes from the pocket of users. There is awareness among the members of the government that there is a lot to be done, and they are working on it.”
According to Health Ministry figures from the three countries, Morocco has one doctor per 1,600 inhabitants, compared with one for 800 people in Tunisia and one for 600 in Algeria.
A lack of trained doctors was clearly an issue at the Baouafi Hospital. Medical residents and interns are frequently expected to pull extra hours at night because no other doctors are available.
“Sometimes I am left alone at night,” a trainee resident said. “I get really scared because I don’t have enough experience. I hope nobody will die under my watch.”
You can read the story on the New York Times' website.
