Supporting the reform of social protection in health in Morocco

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Recent political and social developments in Morocco reveal the importance of the social dimension in the Government’s policies. With the African Development Bank’s support, the Government of Morocco has been engaged in large-scale social projects since 2005, including the Initiative for Human Development and the Regime d’Assistance Medicale (RAMED), a health insurance scheme for the most vulnerable.

Access to health care is limited by the poor coverage of social protection mechanisms. Today 32% of the population is ensured with 22 percentage points being affiliated with compulsory health insurance or private insurance, and about 10 points covered by RAMED.

Health expenditures in Morocco represent a heavy burden for households and expose them to impoverishment. Households bear more than half of total health expenditure (53.6%). The contribution of health insurance is only 18.8% and that of the state is 25.2%. Almost 2% of Morocco’s population incurs catastrophic expenditure, and 1.4% is poorer because of these expenses, the majority living in rural areas.

Reforming social protection in health is the foundation of social welfare policy in Morocco and relies on social inclusion. But most Moroccans still have no social safety net. So far, not all public and private sector employees are covered by the compulsory insurance scheme. Only two million of the estimated 8.5 million beneficiaries are covered by RAMED. And there is no modality to cover independent workers (self-employed, the informal sector and so on), which poses a challenge in terms of social cohesion, income protection and financing of the system.

Since 2002, when the reform of social protection in health started, the Bank has helped through budget support operations to the health sector. The Medical Coverage Reform Support Programme (PARCOUM), an AfDB project of US $153 million, now in its third phase (2013–2014), contributes to establishing a social safety net for the population. PARCOUM provides financial and medical protection for Moroccans, especially the most vulnerable, through the extension of basic social health insurance and access to quality health services. It thus contributes to improved governance and social inclusion.

The Bank’s comparative advantage lies in its expertise in financing health care, social safety nets and health insurance, enabling it to maintain a sectorial policy dialogue with high-level Moroccan authorities.