Abderrahim El Ouali
CASABLANCA, Aug 12 2007 (IPS) – Despite an annual health budget of half a billion euros, large numbers of people in this nation of 30 million still have no access to essential medical care.
Reform of the public health system began in 1995, with changes introduced that were intended to be in line with international standards. But some of the changes were, quite literally, in name only.
The hospitals division came to be known as the hospitals directorate, and the medicines division came since then to be called the medical directorate. But there is still a shortage of both hospitals and medicine.
According to the ministry of health Morocco has 42 general hospitals and 11 specialised ones. The country has a population of 32 million, which means there is on average one general hospital for 760,000 persons. And there is just one specialised hospital on average for three million people.
Now it is no more conceivable that the hospitable infrastructure should remain so retarded, Abdellah Daghi, member of the watchdog Democratic Federation for Health (DFH) told IPS. Public health has an annual income of more than 500 million euros from just the Obligatory Health Insurance (OHI).
Improving human resources would encourage health personnel to get more involved in the reform process, experts say.
For years now we have been drawing attention to the bad conditions in which public healthcare personnel work, Abdellatif Saddar, general secretary of another independent group, the Democratic Watchdog for Health (DWH) told IPS.
A serious effort is needed on the part of the ministry of health towards the personnel by way of salaries and continuous training. We need to develop an acceptable level of performance quality.
The OHI in force since January this year covers six million people, half of which are wage earners in the private sector. The number includes 700,000 civil servants besides other groups across the country.
The system provides medical cover for 40 heavy serious conditions such as cancer, AIDS and diabetes.
In all 8.5 million people are meant to be covered by another healthcare system RAMED (Régime d Aide Médicale aux Economiquement Démunis). The system was conceived to provide health cover for the poor, but it has not been applied yet. By law, RAMED is to be financed mainly by the government and municipalities. It will cover persons who do not benefit from any obligatory healthcare system and who do not have sufficient (financial) resources to cover medical expenses.
RAMED evokes a big problem concerning the participation of municipalities and other elected boards in it, Daghi said. This might lead to electoral populism, and there are no guarantees that all poor people would effectively benefit from it.
But whatever the cover, hospital services are themselves inadequate.
The ophthalmology service in Mohamed V hospital in Casablanca works without the necessary means to measure ocular tension, and this can be very dangerous for patients who receive surgery, Daghi said.
Medical personnel who complain usually get nowhere. We sent letters to the minister of health and regional director in Casablanca but we had no answers, Daghi said.
A letter sent by the FDH to the ministry of health on May 3 this year says two apparatuses to measure ocular tension had disappeared from the Mohamed V hospital in Casablanca.
The same day an inspection committee was sent by the ministry to the hospital, Daghi said. But nobody knows the results of the inspection. The only answer we had is that one of our members was threatened in a phone call.
Abdellatif Saddar said he has been victim of unfair dismissal from his job after the DWH exposed misappropriation of public health funds in Casablanca s hospitals. A report by the DWH of which IPS has a copy says that public health funds have been misappropriated in some of Casablanca s hospitals.
I have appealed to justice and we will carry on fighting all kinds of scams that hinder progress and improvement of public health services, especially corruption and misappropriation of public health funds and equipment, Saddar added.
Several phone calls from IPS to the health regional director in Casablanca and the ministry of health in Rabat remained unanswered. An interview request with managers at the Mohamed V in Casablanca was also refused.
