Al-Tayeb Hamidi, a physician researcher in health policies and systems, presented ten challenges to face the risks that may face health facilities, saying: “After the first phase of reviewing the health system and generalizing compulsory disease insurance, which was devoted to legislation, rationing and administrative oversight, which is proceeding smoothly to the extent of today, the risks will not be late to appear on the surface.”
The first challenge posed by Hamidi in a research paper is related to “reconciling Moroccans with their health system,” considering that “improving the quality of services and the relationship between citizens and the health system in a clear, tangible and rapid way” goes through “improving public sector governance, organizing the private sector, ensuring territorial justice, removing inequities in access to health services, and strengthening governance and transparency.”
The second challenge is “building trust,” says Hamidi, explaining that “health insurance depends on solidarity and balances that require the involvement and trust of the citizen/insured, the involvement of health professionals and their representatives, healthcare professionals and their representatives, communicating this desire for change, explaining the importance of the project and its expected individual and collective projections, and activating the unified social register.”
Acidic raised among the challenges “women and men with credibility.” “Making this will for change tangible on the ground through management institutions and assigning tasks and structures to personalities known for their expertise, technical competencies, integrity, and credibility for good management and trust-building.”
The researcher stressed the need to make the public sector attractive, and explained, “Health is a public service. Therefore, it is necessary to strengthen and improve the public sector, encourage the non-profit private sector, and stimulate and regulate the for-profit private sector.
My acid also spoke about the challenge of the “solidarity basket of treatments,” noting that “the compulsory disease insurance system cannot claim that it is able to provide all services and in all circumstances to all beneficiaries, but it must guarantee the right to basic health care of quality and fairness for all, and complementary services can be funded in other ways. Therefore, it is necessary to define a basket of solidarity remedies and ways to benefit from them in an equitable and sustainable manner. The public and private non-profit sectors should be willing to undertake this task, while encouraging the for-profit private sector to cooperate to reduce the burden and expenses left on families.”
The same doctor recommended the provision of “primary health care,” and explained that “successful health systems depend on prevention and health education, encouragement of a healthy lifestyle, outpatient care or primary care, promotion of medical consultation and course of treatments, day hospital, and hospitalization at home, rather than a system that focuses on the hospital.”
Hamidi also warned of the necessity of “expanding the benefit of the third party performer: redefining solidarity and ending inverted solidarity.” He said, “The clearing fund intended to support the poor serves the rich more than the poor. Many private sector employees who are insured by the National Social Security Fund contribute monthly without being able to actually benefit from health care due to low income (two-thirds of them earn less than the minimum wage), and the lack of a third-party system that performs non-hospital health services such as medical consultations, radiology, analyzes, and others. Hence, the lowest-income fund a system that they do not benefit from, but rather those with higher incomes benefit from it, which pushes the simple to abandon the request and access to health care, which undermines all efforts.
The most important challenge facing the health system is related to human resources. In this regard, Hamidi said, “The shortage of health professionals, including doctors, nurses, and others, is already evident, and is exacerbated by the migration of medical talent abroad, and due to the demographic and epidemiological shift towards aging and chronic diseases that require more care, and the generalization of disease insurance that puts more pressure on the system, and the role that health must play today as a pillar of development.”
The same researcher called for the necessity of training more professionals, improving wages, income and working conditions, continuous training and career development to control the flow of migration, and stimulating the return of Moroccan medical talent abroad, permanently or temporarily and partially, while contributing to strengthening the Moroccan health system from their current countries of residence through several channels and aspects.
At the end of his research paper, my acid mentioned two final challenges, the first related to “fairness” and the second to “digitization.” Concerning the first, he said that “contributing to the financing of the system as well as benefiting from its services must be subject to the rules of fairness in order to perpetuate the system.” A human rights-based approach that takes into account the needs of all (the various regions and the health map, villages, women, people with special needs, the elderly, the poor, mental illnesses, etc.)”, while he called in the last challenge to accelerate and generalize digitization and “overcome hesitation and resistance.”