27 MARTINDALE CENTER FOR THE STUDY OF PRIVATE ENTERPRISE Despite the failed attempt of the King to implement compulsory coverage for all Moroccans by 2022, there have been a few notable achievements (Hekking, 2020). Life expectancy rose from 76.77 years in 2020 to 77.43 years in 2023 and is projected by the UN to reach 82.36 years by 2050. The 2023 life expectancy was slightly lower than Tunisia’s (77.63 years) and Algeria’s (77.50 years) but is predicted to surpass that of Tunisia and Algeria by approximately a half year in 2050 (United Nations - World Population Prospects, 2024). Part of this extension is due to the decrease in the Moroccan infant mortality rate. The current rate is 16.117 deaths per 1000 live births, a 16.68% decline from 2019. The infant mortality rate is expected to decrease by a further 10 deaths per 1000 live births by 2050. These positive trends are in part due to the rise in health-care spending per capita from 2017 to 2020, demonstrating the ongoing commitment of the country to advance its health outcomes and current system (World Bank, 2024). One contribution to these positive outcomes has been the movement, however slow, toward more affordable and quality care. As part of the UN sustainable development agenda, policymakers created a minimum number of required health workers, set at 4.45 per 1000 individuals. Although at the end of 2021, Morocco had only 1.64 health workers per 1000 individuals, that was a 0.13 increase per 1000 compared to 2011 (Rahhou, 2023). Having enough doctors is a necessity for UHC. Because only “39% of people with a higher income are more satisfied with the country’s health care system, compared to 12% of Moroccans who fall into lower income brackets,” Pfizer in 2023 signed two agreements with the Ministry of Health and Social Protection to support the implementation of UHC as a response to the heightened partnership during the COVID-19 pandemic. The agreement sought “to contribute to the overall success of UHC projects through the improvement of management and healthcare.” The agreement is aimed at strengthening Morocco’s health ecosystem while expanding access to innovative medicines (Kasraoui, 2023, May 25). Together, these agreements, modest as they may seem, suggest Morocco is on the right path. Nonetheless, significant challenges face the nation if it is going to meet the goals laid out in the 2025 health plan irrespective of the precise date of achievement. Barriers to UHC The goal of the 2025 health plan is to provide a full range of services at minimal cost. However, several challenges, including shortage of human resources, unequal distribution of quality health facilities between urban and rural areas, and problems with the costs associated with upgraded health services, must be addressed before achieving UHC (Doukkali, n.d.). Despite the implementation of some reforms and subsequent increases in life expectancy, there remains a significant gap between the desired outcome and the current reality. The primary factor contributing to this disparity is the financial constraint faced by Morocco, hampering the country’s ability to compensate workers in the new universal system adequately. Consequently, the shortage of health professionals is exacerbated, particularly in rural regions. Furthermore, the current inadequacy of equipment in rural clinics inhibits their ability to provide comprehensive care. These challenges, especially staffing shortages, hinder hospitals and clinics from functioning at full capacity, emphasizing the need for Morocco to offer everything that UHC can offer. Only then can health status and life expectancy progress at a greater rate. Staffing shortages Adequate numbers of professionally trained healthcare workers and equitable distribution of those staff members between urban and rural areas are the paramount issues demanding immediate attention, as Morocco has not met the minimum requirement for health workers per 1000 individuals recommended by the UN. Staffing shortages hinder the ability to deliver high-quality care, resulting in prolonged wait times. The shortage of health professionals leads to other problems within hospitals, including lack of physical accessibility, long waiting times, rushed consultation time, and prolonged administrative procedures. If at least one of these hospital logistics is not functioning correctly, quality of care and patient satisfaction are impacted negatively (Frichi et al., 2020). Moreover, rural areas suffer from an insufficient number of doctors, forcing citizens to endure hours of travel to access the nearest health-care facility, and there is no guarantee that these facilities possess the necessary equipment to effectively treat their medical conditions. Consequently, individuals residing in these remote regions are deprived of regular medical consultations, leading to a decline in their overall well-being. To tackle this issue, Morocco has initiated a program to augment the number of health professionals to 90,000 by 2025, up from 68,000 in 2022. The objective is to have 24 professionals for every 10,000 citizens by 2025, and 45 for every 10,000 citizens by 2030 (Latrech, 2022). This initiative does seem promising, but its feasibility is questionable due to the substantial financial resources needed to employ such a large number of health professionals.
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