Morocco

In Morocco, the health care system has witnessed some positive alternations, which require subsequent contributions. After the declaration of independence, the country did not have a sufficient number of health care providers and had poor health care services, with an insignificant number of facilities and outdated health equipment. Since then, the situation has remarkably improved as the number of health professionals and facilities increased (Semlali, 2010). Nevertheless, there are certain disparities between the occupational demands and available qualifications of the specialists, inconsistencies in health care quality, and the lack of health care providers, which negatively affects the creation of sustainable high level medical practice.

More specifically, there is a considerable discrepancy between the number of providers and the level needed to address health care needs of Morocco’s residents. Hospital facilities remain rather limited compared to the size of Morocco’s population. It is worth admitting that the density of rural areas is extremely low and inconsistent, with many health organizations closing because of the lack of personnel, supplies, and equipment (Semlali, 2010). Unfortunately, the given issues are often not known to patients, who usually unfairly blame health professionals for not delivering adequate and timely care.

During the last decades, the population has increased from ten million to more than thirty million currently living in Morocco (World Population Review, 2017). The following tendency has placed a large strain on the population who is in a desperate need of housing opportunities. With many people living beyond the poverty line and migrating to the cities, the urban areas have grown illegally with the lack of proper sanitation, clean water, and electricity. As a result, many citizens are at the increased risk of developing such illnesses as typhoid, gastrointestinal infections, and malaria. Notably, tuberculosis is considered a widespread disease in the country (Semlali, 2010). High poverty rates are also one of the major concerns in all African countries, where the large number of children under five is underweight (Holtz, 2017). Therefore, introducing positive changes in medical practice into the country will be a potentially fertile process, which requires the significant material, human, and financial resources. Given the fact that some practice improvements are already tangible, it is interesting to discuss the current health care system, health priorities, and nursing implications to become capable of addressing the existing needs of the population.

Location and Geography

Morocco or the “Kingdom of Morocco” is situated in the northwest of African continent. The country is surrounded by the Atlantic Ocean on the west and the Straits of Gibraltar and Mediterranean Sea on the north. Additionally, the territory shares a border with Algeria to the east and Mauritania to the south respectively. Additionally, Morocco is famous for the highest mountains in the northern part of the continent and the largest plains. Morocco is considered a sovereign Muslim State, with Arabic as an official language (Semlali, 2010). The languages spoken in this country include dialect Arabic, Spanish, French, and Berber.

In the north, the climate is predominately mild, Mediterranean, in the west, it is more of an Atlantic nature, whereas in the south, it is temperate Saharan due to the influence of the sea. It is worth mentioning that the country has nearly 500 kilometers of Mediterranean coast and approximately 3,000 km of the Atlantic Ocean coast, which places Morocco in an advantageous position, compared to other African countries where Saharan climate is dominant (Semlali, 2010). Even though the climate is rather wet near the coast areas, it is relatively dry across the interior section of the country. Generally speaking, the weather conditions are associated with seasonal drought and unpredictable floods, which significantly affects health development strategies and initiatives.

Population

The population in Morocco is estimated at 35,751,964 people, the majority of which resides in urban areas (World Population Review, 2017). The disparities between cities and rural or remote areas exist at economic and social levels of development. Therefore, the country urgently requires effective solutions that would address the issues of investment, infrastructure, and social programs for remote areas. Morocco has a relatively high life expectancy, which reaches 76 years with the level of fertility equating 2,17 children per a female (World Population Review).

In fact, the alteration in the age profile of the population is apparently one of the most considerable ramifications of the demographic transformation. The working part is the main group of the population reaching nearly 66% (Country Meters, 2017). Nevertheless, children and elderly constitute more than a half of the productive part, which presupposes that the labor force is obliged to maintain a family as well as cover the costs connected with the dependent population. Therefore, in Morocco the pressure on the working population remains rather high. Additionally, 6,1% of the country’s population is people over the age of 60, and the governmental system lacks appropriate infrastructure for this age segment, including the institutions related to the health care of the elderly (Country Meters, 2017). Furthermore, females have played a considerable role in the development of the country’s human potential (Semlali, 2010). In the past, women were often not involved in the human resource initiatives and processes, but after a continued social combat to attain recognition, they have managed to achieve significant progress. 

Government

Morocco is one of the former French colonies that has become independent in 1956 (Semlali, 2010). The country is considered a constitutional monarchy with the king as the Chief of State, the Commander of the Faithful, and Supreme Leader of the Army. The Prime Minister also possesses substantial power: he is the chief of the Council of Ministers, assists the king in choosing the governmental officials and formally proclaims the legislative texts (Semlali, 2010). Nonetheless, the ultimate authority belongs to the king of Morocco.

The system of governance manifests itself through the balance between political dynamism and institutional stability, safety and freedom, as well as power-sharing and well-being of the State institutions. It is worth noting that Morocco has established its institutions based on the multiparty political system (Semlali, 2010). Nowadays, nearly thirty parties freely function in the country. The legislative members are chosen each five years to form two Chambers: the Chamber of Councillors and the Chamber of Deputies.

Economy

Considerable economic changes are taking place in the Kingdom of Morocco. Despite a number of recent advancements, there are still many challenges that the government of the country attempts to tackle. The macro-economic environment of the country remains at a standstill, providing a limited number of opportunities for progress and development (Semlali, 2010). The country confronts most of the problems typical to all poorly developed nations, namely decreasing constraints on foreign trade and private activity, attaining economic stability, and reducing government spending.

The agricultural sector is predominately stagnant due to numerous challenges. Specifically, tenancy problems, lack of water, obsolete cultural practices, unfavorable weather conditions, and small farms affect the sustainable economic development. The textile industry, however, has substantially contributed to the economic growth in terms of export. Nonetheless, the increase of Asian exports plays a negative role in the maintenance of the Morocco export market. As a consequence, the national debt has increased, thereby resulting in the macroeconomic changes with the growing level of inflation and considerable budgetary deficit (Semlali, 2010). However, the favorable location, namely close proximity to the European content, provides benefits in the form of economic advances, as many European organizations opted to reside in Morocco for economic reasons. Today, the long-term challenges involve enhancing education initiatives, promoting freer trade with the United States and European Union, as well as attracting foreign investments to improve the citizens’ wellbeing and job opportunities for youth.

State of Health

According to WHO statistics, in Morocco the main cause of mortality is stroke. Health experts report that the disease claims 26.3 thousand lives of inhabitants (12,8%) annually (World Health Organization, 2015). Diabetes melitus (11.9%), Ischaemic heart disease (11.7%), and lower respiratory infections (5.5%) present other most common causes of death in the country (World Health Organization, 2015). Importantly, Morocco has successfully eliminated a number of childhood illnesses, including tetanus, polio, malaria, and diphtheria. HIV/AIDS remains prevalent among people between the ages of 15 and 50, and a number of inhabitants diagnosed with the infection continue to increase (Semlali, 2010). The predominant cause of prevalence is the low level of schooling and health knowledge to assist in prevention of the transmission.

Obesity has become another important health issue in Morocco. In fact, overweight stems from a greater availability and access to fast food and unhealthy lifestyle choices, especially in urban areas. A female who has poor education and lives in a city is at a higher risk of being obese. Adolescent girls are more likely to become overweight. Furthermore, the population tends to be ignorant of the medical conditions associated with obesity. From a cultural perspective, female overweight is highly valuable, as it is regarded as a symbol of beauty, wellbeing, and fertility as well as the indicator of social status. People often perceive a thin figure i as a sign of poverty and illness. Importantly, informed opinion of the general public plays a significant role in the health of the population (World Health Organization, 2006). Thus, it is essential to promote public awareness of health hazards related to obesity and overweight.

Maternal and child mortality is another significant health problem in Morocco. Health experts estimate the maternal mortality rate at 227 deaths per 100,000 births (Semlali, 2010). To reduce the incidence of fatal outcomes, the government along with health care providers has made the attempts have made to eliminate the barriers keeping females from accessing emergency health care services. Moreover, it is increasingly important to improve governance and quality of care across the whole country. 

During the last decades, nutrition status of Moroccans has considerably changed with rapid alterations due to demographic peculiarities of the region, increasing urbanization, economic progress, and social development. The country’s population is prone to excessive dietary intake and overweight (Semlali, 2010). The abovementioned improvements have contributed to the lifestyle changes and healthier nutrition patterns of inhabitants living within Moroccan borders, demonstrating a fresh view on food culture and everyday routine.

Culture/Traditional Medicine

Even though traditional medicine approaches have lost their official status, they continue to be popular among the large clientele in Morocco. The proponents of traditional medicine involve all strata of the society which are strongly committed to established and scientifically proved treatment methods in health affairs. The users of the traditional sector include those who suffer from serious conditions, mild diseases, and those who are discontented with services of the modern sector. The education of Moroccans based on a traditional framework powerfully promotes critical or even skeptical view of modern medicine, and, hence, the citizens prefer treatment under the supervision of a herbalist or traditional medicine practitioner, who specialize in the peculiarities of their way of living, better comprehend their psychology, and treat them with dignity and respect (Dieste, 2013). Moreover, many people in Morocco cannot simply afford the services of a modern medicine practitioner. 

One of the important benefits of traditional approach to treatment is the fact that it is deeply rooted in the Moroccan culture. Furthermore, the relationship between a patient and a provider is close and simple. The remoteness of villages and other rural areas from hospitals prompts people to resort to traditional treatment methods, which they can receive locally. The urban-focused nature of contemporary medicine is one of the primary factors that repel Moroccans from using it on a regular basis. Many doctors often provide health care services at patients’ homes. Nevertheless, there is always an option to turn to fuquha, who can provide medical assistance to the patients whenever they may need it (Dieste, 2013). People tend to believe in their recovery with the help of a traditional medicine practitioner, hoping to relive their emotional distress.

Many usually define health as a state of emotional, physical, and social wealth (World Health Organization, 2006). Traditional medicine adopts a similar approach viewing patient’s health as a perfect balance between social, physical, mental, social, and moral states and addressing all the consequences of the illness. Therefore, practitioners often engage families and communities into the treatment process to achieve holistic recovery. Ancient forms of traditional medicine generally involve religious and magic practices along with rituals (Dieste, 2013). Traditional providers often explain the etiology of the disease from a supernatural perspective, referring to an evil eye, evil spirits, possession, etc.

Health Care System and Delivery

In Morocco, health care system particularly focuses on the public sector, which is associated with free services and top-down management. In fact, the State is regarded as a center of the system fulfilling the functions of provider, administrator, and financial resource. The Ministry of Health is accountable for the work of the National Institutes and Laboratories, the Basic Care Health Network, as well as Hospital network. The local authorities deliver their own Municipality services (Semlali, 2010). The last decades have seen the rapid and independent development of the public sector. The Basic Health Care network deals with the issues related to ambulatory health care and prevention strategies, whereas the National Institutes and Laboratories are accountable for promoting research and expertise in ambulatory and hospital settings.

The shortage of health care providers annually mounts as a result of the personnel retirement and turnover. The statistics suggest that 18,269 doctors are currently working in the country, of which 45% operating in the private sector. During the last decade, the number of providers grew by 4,7%. It is necessary to admit that more than 50% of the doctors work in the big cities, such as Rabat (Semlali, 2010). The ratio of the population to medical and paramedical staff varies from one to another. Only one Moroccan district has reached the standard set by the WHO of 2.3 specialists for 1,000 citizens (Semlali, 2010). To better understand the shortage of health care providers, it is important to compare the ratio in Morocco with the one in the developed country. Thus, the medical density in Morocco reaches 5 physicians for 10,000 citizens, while in France there are 34 doctors for 10,000 residents (Semlali, 2010). Similarly, paramedical density equates 95 and 8 professionals for 10,000 citizens in Japan and Morocco respectively (Semlali, 2010). In such a way, the main strategic approach of the Ministry of Health in relation to a human resource shortage involves appropriate training and education to address the urgent needs of Moroccan specialists and residents.

Quality assurance and accrediting organizations powerfully promote the positive change of mindset, thereby assisting in attaining the goal of proper care, which is the ultimate indicator of the country’s high living standards. Unfortunately, Morocco’s health care system lacks the accrediting organizations and quality culture. The recent implementation of the former focuses on ensuring patients’ safety and the high quality of care, which is no longer associated with financial gains of professional bodies (Semlali, 2010). Education of medical specialists, however, suffers from insufficient quantity and quality related to particular issues inherent in educational approaches, training initiatives, and the location of internships. Additionally, there is a lack of evidence of the requirements for medical personnel, which presents a serious barrier to designing a comprehensive action plan and demands further efforts to address the urgent needs of citizens. Finally, the health care structure obviously lacks a legal and regulatory framework, which would guide the nursing practice and determine responsibilities for various medical professionals (Semlali, 2010). Similar to the National Order of Physicians, it is essential to create a national order of nurses to regulate the nursing work as well as ensure patient’s well-being and implementation of professional ethics.

The Moroccan Association of Nursing Sciences and Health Techniques is responsible for supporting the nursing profession in Morocco as well as advocate nurses at all levels. The following association aims to impact social, health, and education policies, offering a variety of career opportunities and education programs (Semlali, 2010). Furthermore, the nursing association promotes the image of nursing in the country, thereby cultivating trust in the medical profession. The organization actively supports the international exchange offering ongoing opportunities to enrich nurses’ professional experience.

Health Priorities

Based on the above country’s profile, it is appropriate to make a general comment on health priorities in Morocco. First, it is essential to raise public awareness of ramifications of infectious diseases and non-communicable diseases, especially HIV/AIDS and obesity. Promotion of healthy lifestyle becomes another important health objective that can be attainable through education efforts. Meanwhile, it is important to better comprehend cultural factors, such as commitment to traditional medicine, that alters Moroccans’ behavior (Holtz, 2017). Given the fact that many inhabitants live beyond the poverty line, another health priority is to study how socio-economic status affects risk factors.

Additionally, the Health Ministry should focus on the recruitment of the new providers who would work in remote and less covered areas. Notably, it is pivotal to provide incentive measures for providers to encourage them to deliver medical services in disadvantaged rural zones. Furthermore, attracting the medical staff requires comprehending their motivation, as well as introducing various social benefits, and career plans (Holtz, 2017). Adequate working conditions can be an increasingly important leverage in retaining human resources and facilitating stability for the industry and health care providers in particular. Additionally, a legal framework as well accrediting organizations would augment the development of a positive practice milieu, thereby enhancing health, protection, and wellbeing of providers and ensuring the delivery of high quality care.