Interview with Allal Amraoui: Radioscopy of the new health system

– First, allow me to recall how we arrived at the need for in-depth reform of a system which no longer meets the requirements of the time. Indeed, Morocco has changed a lot demographically, we are moving from a young society to an increasingly old one, with behavioral and environmental changes that have led to a change in the way of life of the population in a general.

Paradoxically, Morocco experienced its greatest public health successes in post-independence with few resources. This was due to a judicious bet on prevention and the promotion of a healthy lifestyle, notably with the national program of immunization and family planning. Thanks to this, there has been an improvement in all the indicators, with a historic leap in life expectancy, which was concomitant with the eradication of several communicable diseases. The system then swung towards a more curative medicine dealing mainly with the repercussions of chronic diseases with a natural attraction towards advanced medicine which is very expensive.

The Ministry of Health was therefore transformed into a ministry of care, managing increasingly overcrowded hospitals until they suffocated with a deterioration of medical services, especially in the public sector. The reform was therefore inevitable, knowing that HM the King has not stopped calling since 2018, for an in-depth overhaul of the sector.

The pandemic has raised awareness of the urgency of immediate change and has positively accelerated the progress of the long-awaited reform project. Personally, I am delighted with the presentation of the draft framework law and I find that it is the beginning of a real revolution since it encompasses all the aspects necessary for the proper functioning of a health system.

– The reform provides for the creation of a High Authority for Health, a kind of regulatory body, is this necessary in your opinion and what are the conditions for its success?

– The High Authority has been long awaited, it was an old demand from specialists given the importance of its role in monitoring and supporting the system which, I remind you, is not the prerogative of the Ministry of Health only. It is for this reason that we need such a body so that all the stakeholders concerned can express themselves. Their voice is all the more important since they will have their say on the execution of the reform as provided for by the framework law, the generalization of medical coverage, the distribution of the healthcare offer according to the new health card, quality of services, etc.

The Ministry of Health cannot perform all of its functions alone. That is to say, to be judge and party at the same time. So we need a higher body that can assess and judge the action of the supervisory ministry and other ministries as well since, I remind you, all the ministerial departments are involved in one way or another in public health. I conclude by saying that the solution to the ills of the health system can only be budgetary. We may invest in infrastructure, and the increasingly exorbitant cost of curative care, it would be difficult to make the reform succeed without a real prevention policy in which all the actors concerned must participate.

– There will also be a National Medicines Agency, should it be autonomous and independent of the Ministry of Health?

– Yes, it was absolutely necessary for such an agency to see the light of day and for it to be endowed with its own financial means. Its role will be to implement the new drug policy, and especially to remedy problems relating to approval procedures and registration procedures. This agency must therefore ensure the quality of the supply of medicines and promote generic medicines. It is a sine qua non for guaranteeing our national sovereignty.

– Currently, there is a big disagreement between pharmacists and the ministry on the question of the right of substitution, should it be granted to them?

– Admittedly, this is a question that generates a lot of debate within the profession. As you know, the fact that the right of substitution is claimed is completely legitimate as long as it exists in several countries. This claim is achievable provided that there are the necessary conditions that the National Medicines Agency could ensure, through its next role in terms of bioequivalence.

– With the generalization of AMO, 22 million new beneficiaries will be entitled to medical coverage by 2023, this will lead to a sudden increase in demand for drugs, how to deal with this demand in the short term?

– The consumption of drugs will certainly increase following the generalization of medical coverage, which is why the production of generic drugs must be developed. This will result in reducing the cost and price of drugs. We cannot achieve this goal without redressing and re-boosting the national pharmaceutical industry, which has been a flagship of our industry. This is a sine qua non for guaranteeing our national sovereignty in this area. I am personally confident in our ability to meet the challenge provided that the new bodies provided for by the reform perform well.

– The government has promised a reform of the Public Health Service with an enhancement of doctors. Do you think fee-for-service might be enough to encourage doctors?

– First, the development of human resources cannot be done without legislating and designing a specific law for health officials. It must be recognized that the health personnel have been managed in a disastrous way, to say the least, in the absence of adequate regulatory texts. Therefore, I believe that the new Public Health Service will have the virtue of better managing human resources and making the public sector more attractive, and this, through better remuneration of doctors and nursing staff in return for better performance for satisfactory use of our public or private facilities. .

– The authorization of foreign doctors is still disputed, what do you think?

-It is quite natural that an open country like Morocco welcomes foreign skills like the majority of other countries. However, a law is not enough to attract foreign doctors, medical practice in Morocco and our system must be attractive.

– Should the mobility of doctors be regulated more strictly between the public and private sectors?

– Mobility between the two spheres is important provided that there is complementarity between the public and the private sector, on which the success of the generalization of AMO will depend. This is where solutions must be found. It is clear that the private sector employs half of the human resources at the national level, it has made enormous efforts in terms of heavy equipment, and treats the majority of citizens who had medical coverage before its future generalization.

Therefore, a point of balance must be found so that mobility is fruitful and beneficial and not an obstacle for the system. I would add that mobility remains necessary since the patient has the right to choose the doctor who will treat him. It is therefore vital that we show intelligence in establishing a public-private partnership in this direction.