Morocco: Protection and Prevention

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Morocco's pork production sector has never been one of country's industrial heavyweights. In a nation with a majority Muslim population and minority Jewish community, farmers catered mainly to European tourists, producing an estimated 270 tonnes of meat annually, generating around Dh12m (€1.1m), according to 2008 figures. In a normal year pigs would be a peripheral part of government planning, but since the emergence of A/H1N1 flu, better known as "swine flu", the government's health sector has received extra funding and ramped up its prevention programmes.

Unlike Egypt, where the government responded to the outbreak by calling for a slaughter of all of the country's 300,000 pigs, Morocco's response has been more measured. There have been no calls to eliminate the pig farms and their estimated 5000 pigs, most of which are in the vicinity of Agadir, Casablanca and the north-central city of Taza. The World Health Organisation (WHO) has said that since the virus is not transmitted by the animals, killing them will have no effect on its spread. Although no cases had been detected in the Kingdom as of early May, with 81 individuals infected in Spain, Morocco launched a prevention programme.

Swine flu may strain Morocco's already stretched health care resources, but the government has earmarked Dh850m (€76.2m) for the operation. The funds will be channelled to programmes that prevent the disease from entering the country and to individual protection plans. On the nationwide level, the government has established a number of tracking systems. The first follows airline passengers coming from countries where cases of the epidemic have been confirmed, so that daily checks of the situation can be made. Additionally, thermal scanners, which can detect elevated skin temperatures, a possible sign of infection, have been installed at entry points. Finally, laboratories throughout the country have been mobilised to step in if suspicious symptoms are detected. On the individual level, some of the government funding will go towards buying medications and masks, in case an outbreak occurs.

Along with these technical and medical responses, the Ministry of Public Health has launched a public information campaign on its website. Although many parts of the site remain under construction, there is a substantial amount of information about H1N1 on the homepage, including links to government statements and bulletins from the WHO. Swine flu can be treated fairly effectively if identified quickly, so making information available may both prevent panic and give people the tools they need to understand prevention and treatment.

Luckily for Morocco, many of the institutional systems set up in response to the avian flu in 2005 are still relevant and the government called for their reactivation. It is fortunate that emergency plans for addressing a major medical scare are in place because the Kingdom is in the middle of a massive overhaul of its health sector.

General health indicators in the country are good and government spending is rising, but there is a shortage of doctors and a lack of access to health care for poorer citizens. And although many statistics are encouraging, with expanded childhood vaccination programmes and life expectancy rising to 71 in recent years, modern lifestyles are starting to take their toll. Alarmingly, a third of the population over the age of 20 already has high blood pressure and nearly 7% of the same age group also suffers from diabetes. Still, the government is committed to improving these statistics through allotting 6% of GDP. The current five-year plan, Strategy 2008-12, aims to ameliorate these problems, in part through increasing links to the private sector. The public sector has a lack of doctors and overstretched facilities, but the new strategy will allow it to externalise some medical services for the first time, with the private sector able to bill the government for the expenditures, Dr Ennaceri Mimoun, the head of the Hospitals Division at the Ministry of Public Health, told OBG.

The ministry has drawn up an agreement with the national association of nephrologists (kidney specialists) under which its members can provide dialysis for patients on waiting lists in public hospitals, and Mimoun thinks that this framework can be extended to other services. In addition to easing overcrowding, the new arrangement will also add expertise to the public sector. Mimoun estimates that there is an overall deficit of about 9000 doctors and that this is compounded by the departure of highly experienced doctors, who "gravitate towards the comfort of working in the private sector". With the increased links between the two, however, doctors can treat poorer patients, while still maintaining their lifestyles.

Further funding from non-governmental organisations and foreign countries also plays an important role in improving the sector. Morocco's rural regions have thus far suffered from underdeveloped facilities, but a new initiative launched in the Fes-Boulemane region will help to treat children with cancer. The regional division of the Ministry of Public Health and the local branch of l'Avenir, an association of parents and friends of children with cancer, have embarked on a partnership to supply medicines and medical equipment and cover the costs of some laboratory tests and x-rays. The EU has also been involved with increasing equal access to health care and is planning to give €86m for development. According to the head of the EU Commission in Rabat, Ambassador Bruno Dethomas, these funds will help sectors of the population which may not be covered either by the obligatory health insurance scheme (Assurance Maladie Obligatoire) nor Regime d'Assistance Medicale (RAMED), which insures the poorest sectors of the population. RAMED is relatively new and only covers a small percentage of its target population, so although it aims to be available to all needy citizens by 2012, the EU funds will be helpful to cover immediate costs.

In addition to addressing the needs of its own population, the Kingdom has the challenge of providing international-calibre services for tourists. Currently, Moroccan law states that clinics must be owned and operated by Moroccan citizens, but with new international challenges, this protectionist measure seems increasingly limiting. As more visitors come under the Vision 2010 and Vision 2020 development plans, and global sicknesses like swine flu move quickly across national borders, the government may need to allow foreign participation in the health sector, opening the door for new partnerships and investments.

© Oxford Business Group 2009