For the Morocco health system COVID-19 is a severe challenge. Swift financial action from the EU bank helps fight the crisis—and train medical staff to improve life across the country

Beds are filling up with COVID-19 patients at the Centre Hospitalier Universitaire (CHU) Ibn Rochd in Casablanca. Professor Kamal Marhoum El Filali, head of the hospital’s infectious disease service, says the hospital “is managing” the influx. But if admissions keep rising, he says, the hospital could quickly run out of intensive care and resuscitation beds.

 “We’re in greater and greater difficulty,” Dr. Marhoum says. 

Morocco acted decisively to contain the pandemic in the spring, putting the entire country in lockdown and cutting off tourism and other travel. But like many nations, Morocco is now facing a second, tidal wave of infections. The country was recording around 5 000 cases a day in mid-November, with around 80 deaths. Over 320 000 people in the country of 37 million have contracted the virus, and around 5 000 have died. The health system is creaking under the weight.

CHU only takes patients with severe cases of COVID-19 – those requiring intensive care or resuscitation – and its own employees who’ve been infected with the virus. One of the biggest problems the hospital has right now, Dr. Marhoum says, is managing the increasing number of hospital workers who have fallen ill or been exposed to the virus and need to self-isolate for up to 14 days. “We’re already short-staffed,” he says. “It’s an enormous organisational problem.”

Staring down a pandemic

When Morocco locked down in the spring, the country had only recorded 77 coronavirus cases. The Moroccan government, however, had watched the virus decimate parts of Spain, and officials knew that the country’s health system lacked the resources to fend off a similar onslaught. “If we had reached the same level as Europe, we would have been overwhelmed,” Dr. Marhoum says.

The drastic measures enabled Morocco to keep the number of deaths low. The fatality rate—the number of deaths to total infections—in the first wave was one of the lowest in the world. As in other parts of Africa, the low death rate is attributed to Morocco’s young population.

Lockdowns also bought the government precious time to set up testing facilities and websites and hotlines to communicate with the public. The government worked with global bodies like the World Health Organization to hone its pandemic response and raised urgently needed funds from international lenders, including the European Investment Bank, which is providing a €200 million loan for medical supplies, training and other measures to reinforce the health system. These efforts spared the country’s fragile health system and its 9 200 public-sector doctors from severe stress.

Tapping international support

Morocco is now one of the African countries most touched by the coronavirus. Anna Barone, head of the EIB Representation in Morocco, says the pandemic exposed huge gaps in the country’s health care system: inadequate hospital infrastructure, a lack of trained medical personnel and large disparities in health care coverage. At the beginning of the crisis, Morocco had one of the lowest numbers of hospital beds per population in the region with just 1.1 hospital beds for 1 000 people. Total public spending on health care is also low for the region, at about $160 per person each year, she says.

While the lack of infrastructure remains a daunting challenge, in the short term Morocco has managed to respond effectively to the crisis, successfully tapping the international community for money and expertise. The country has doubled the number of hospital beds, to about 3 000. Testing centres were set up and new ones are opening every day. Loans from the EIB and other lenders have helped pay for much-needed medical supplies, equipment and treatments.

Putting together the legions of qualified medical staff needed to fight the pandemic has been a bigger challenge, however. Qualified medical professions are particularly sparse in rural areas, which may have limited infrastructure and daunting geographical barriers, like mountains or the desert. “They can have all the money in the world, but if they don’t have the staff to distribute the masks and do the lab tests, it will be complicated,” says Dana Burduja, a senior EIB health economist, who is working on the Morocco project.

Morocco has about one-third the number of doctors per 1 000 inhabitants as neighbouring Tunisia (0.54 per 1 000). Part of the EIB loan will be used for “soft” investments, such as educating clinicians and doctors and providing training for medical and administrative staff at hospitals.

Bumpy road to universal care

Morocco embarked on a plan to introduce universal health care in 2002. While the road has been long and arduous, it has yielded results. Life expectancy in Morocco is high, and key indicators have steadily improved. Infant mortality, for example, was cut in half from 42 death per 1 000 live births in 2000 to 20 in 2017.

The most recent drive to expand health coverage takes the form of a five-year strategy, from 2017 to 2021, that calls for improving hospital resources, expanding medical coverage to the self-employed or those in liberal professions, increasing the number of health-sector employees and standardising the education received by medical students in Morocco.

The government has put hard cash behind its plans. Government spending on health rose 10% in nominal terms in 2019, while overall investment in health care, in the public and private sector, increased 40%, according to Oxford Business Group.

The reality, however, is that health care, particularly primary care, remains elusive for many Moroccans. While United Nations Sustainability Development Goal 3 calls for universal access to at least basic health care, many Moroccans don’t have access, either because they live in rural areas or because they aren’t covered by the public insurance system, RAMED.

“Basically, even if on paper the poor and vulnerable have the right to have access free of charge,” Barone says, “those services face a lot of shortages in terms of structure, staff and quality.”  

Now or never

Barone says that the groundswell of international support Morocco received during the pandemic could provide the momentum needed to tackle the remaining pieces to improve access to health care. “We need to take advantage of the urgency of the crisis to implement reforms that typically take much longer,” she says.

The European Investment Bank has a role to play there, too. Barone says that the Bank can help increase cooperation between the different agencies involved in Moroccan health care, providing expertise and technical support. The EU bank can also help renovate and build more hospitals, particularly in rural areas.

The European Union and Morocco are working on a new cooperation agenda for 2021-2027, which could also provide new momentum for reforms. “It could be a huge opportunity to set priorities to relaunch the economy and support society, making improved health care a central pillar of the country’s recovery,” Barone says.