Médias24: With the health framework bill, the government is preparing to launch a major reform of the sector. Will this time be the right one?
Jaafar shrewd : First of all I want to clarify one point, it is not the reform of the health system we are talking about today, but the revision. This is the term used by her Majesty in many of her speeches.
We have actually had several governments that have had reform plans over the past 20 years, but the results have not followed up. Morocco is ranked 119th in terms of health equity and 124thAnd world rank in human development.
This means that the way we thought about our health policy, the way we implemented it was not the right one. The generalization of RAMED was a great idea for example, but the way and the way didn’t follow.
The current government wants to do well, it has the right ideas, it wants to generalize health coverage, but it is the how and the implementation that will make the difference. We want to have more doctors, it’s a good idea, but how to do more and better and give more resources to the people who are already there, that’s what will count …
What is at stake is not ideas, but their implementation.
– On this aspect, the “how” is clear, however according to the intentions of the government: it is a question of multiplying training courses by opening new medical faculties throughout the country …
– We want to increase accessibility to medical schools. It was already a Jettou project that wanted to train 3,000 doctors a year. At the time, Morocco was training 1,800 doctors. Jettou wanted to train another 1,000 each year. If we had applied this project, we would have had 15,000 more doctors today. You realize the waste… That’s why I tell you that what is at stake are not ideas, but their realization.
We have problems with management, organization of our health system, governance, equity, inequality and performance.
I can give you many examples of brilliant ideas that didn’t work. And if it didn’t work, it’s because we didn’t provide the means to achieve the goals. When I say it means, I’m not just talking about money. I insist on this, the problem of our health system is not just a financing problem, which is certainly an important factor, but it is a single variable in the equation. We have problems with management, organization of our health system, governance, equity, inequality and performance. This is reality. Today we must succeed in this project. We have no choice. Socially, we have no room for error this time around.
– When you have read the framework bill, do you feel reassured about the future?
– The framework law, as the name suggests, is a legal text that lists the fundamental principles. Everyone applauds the great principles. When you tell me you want to improve access to health services for citizens, I will applaud. But the challenge is not there, it is the how and the implementation.
-How can we ensure the correct implementation of these fundamental principles?
– First of all, it is the men and women you will choose to carry out this project that are the guarantee of its success. But there is also something else. I’ll give you an example. We have decided in the framework bill to create the Higher Health Authority. Is magnificent. This is a request we have had for years. But the problem is not to create this authority, it is the prerogatives that you will give it.
If it is an authority that has only an advisory role, it is not worth it, because today we have quite a few bodies that have an advisory role and do their job well: the National Council of the Order of Doctors, the EESC, the CSMD which has made excellent recommendations in the field of health. The challenge therefore is not to create another advisory body, but to give it public power.
Do you know how many ESEC health recommendations there have been? Several. But have they been followed or enforced by the government? Not really. And the government is in the law, it has no obligation to enforce these recommendations.
“For me this is not a health project. It is a social and social project ”.
As I told you, this project cannot be missing. For me, this is not a health project. It is a social and social project. We cannot afford to fail. And to do that, the government must provide the means, agree to involve as many people as possible, professionals, citizens, trade unions, political parties … There must be a national consultation, States General of Health.
The framework law is good, but within this law there will be many decrees, orders, texts… These texts must be successful and above all they must be applied well. That is the question. Because everyone agrees on the principles. When we established the Ramed, everyone agreed on the principle of giving access to health services to vulnerable citizens, it is a noble cause. But we’ve seen the results …
– Today we are facing an emergency, we will extend health coverage to 22 million people in one year. These people need quality care today, not tomorrow, otherwise we will have created a great social disappointment. How to deal with the emergency while waiting for these cardinal principles contained in the framework law to become reality?
– There you put your finger on the great challenge of the health system. Today we have 22 million new people who need to have access to public and private health services. I emphasize the word private, because we forget to say it. These people who are covered by the AMO now have access to both public and private. This is the difference with the Ramed. The Ramediste had access only to the public. Today everyone switches to the AMO and the law gives you access to health services from Tangier to Lagouira, in the public and private sectors. However, if you haven’t worked on all the other texts, this will be a problem.
Example of a former Ramedist who passed to the AMO. He will go to a private clinic, present his card to be treated. We will tell him that the national reference rates have not changed since 2006, and that he will have to pay … he will go to the public hospital. A hospital he already knows. With his AMO card, he will ask for quality care, that doctors and nurses are present, efficient, that they have the means… Which is not the case.
You cannot spend the night from a hospital where the citizen was not satisfied with the services to a hospital where everything is fine because the card has simply been changed.
For the citizen to be satisfied, he must find happy and motivated doctors, nurses and administrators. Because we have given them the means to work, we have appreciated them, we have given them a clean working environment, extra beds, medicines, medical imaging, biology…. Today we are creating a need that we do not yet have the capacity to satisfy.
– Supply doesn’t follow demand, right?
– It is not only the quantitative offer, but also the qualitative one. If you do not review the national reference rate which is obsolete, if it does not re-evaluate the human capital of citizens, in particular doctors, nurses and administrators, if you do not review the regional distribution rule between nurses and doctors, if not review the performance of hospitals public, if you don’t look at the public-private partnership, you go too fast and you end up with millions of people who you say they have access to health services, public and private, wherever they want, but will eventually go away with a big disappointment … This is completely normal when too many expectations are created among citizens.
We could have declared the goal and given ourselves two or three years to prepare, in concert with the professionals, to bring the public system up to standard, to ask for an effort from the private sector, to coordinate public and private action in regions where there is no are quite public offerings. When we have all this prepared, we will be able to succeed more easily.
There are simple things that can be solved quickly. When it is said, for example, that there is a shortage of doctors, when there is no mobility of doctors between regions, it is contradictory. I’ll give you an example. I am an infectious disease specialist, I practice in Casablanca, if I need it in Rabat or Laâyoune, I cannot go there. I cannot practice in Rabat or Laayoune. I am a Moroccan doctor, professor of medicine, enrolled in the order of doctors, and I am ready to go to help once or twice a week in another city, but I cannot. It is an aberration. While we are told that doctors are missing …
This problem can be solved immediately, obviously waiting for new doctors to be trained.
I hope there is a national consultation on the general state of health so that we can support government action and ensure the correct implementation of this project.
– If we understand correctly, do you think we are not well prepared for the generalization of the AMO in the current state?
– Look, I don’t know. Maybe the government is working hard to prepare the ground, I don’t know. However, I hope that there will be a national consultation on the general state of health so that we can support government action and ensure the correct implementation of this project. Everyone supports this framework bill and government action, but on condition that what is planned can be implemented and completed.
And you need to start with simple things that can be improved quickly. We want to increase the number of medical students, for example, but we are told that there are not enough teachers. What’s up. There are between 800 and 900 medical teachers in the private sector, why don’t we call them to teach? They were teachers when they were in the public sector, but as soon as they became private they are no longer teachers! This is another aberration that can be easily resolved.
Ditto for internships for doctors and nurses. We are told that there are not enough public hospitals to accommodate interns. Because we don’t use private clinics. It’s simple, you just need to accredit the clinics that want to hire interns and authorize them to hire doctors and nurses. It’s common sense …
How is it possible that we have managed to do brilliant things in other sectors, and that we have not been able to change things in these social sectors?
– You are therefore asking for a change of mentality in the management of the health system …
– A change of paradigm and way of thinking is needed. I believe that Morocco has all the necessary skills to be able to help carry out this real project, which is a first-rate social and social project. This is a project for the next 25 years. This is why we must be successful.
I am proud when I see projects like the TGV, highways, bridges, ports, Moroccan men and women shining in the best universities in the world in Morocco. But when it comes to the social sectors, health, education or youth employment, there is a problem. This keeps us at the bottom of the world rankings in terms of human development. I don’t blame anyone, but we have to ask ourselves questions. How is it possible that we have managed to do brilliant things in other sectors, and that we have not been able to change things in these social sectors? For me, men and women make a difference.
I’m not against the government. I’m just trying to be objective. I want this project to be successful, but if the government doesn’t consult widely; if it does not change its way of thinking and its paradigm; if the way of managing and governing health does not change; I fear that the achievement of the objectives is not happening as quickly as we would like.
