New field study highlights major gaps in Morocco's universal health coverage scheme

A recent field study by the Arab Reform Initiative has shed light on several challenges facing the rollout of universal health coverage and its ability to meet the broad societal expectations tied to it.

Among the key issues are the inefficiencies of linking healthcare access to targeting systems, which end up excluding eligible groups who fall outside certain thresholds.

The 20-page study also highlighted unclear funding mechanisms for the project, the absence of healthcare services for some groups—like women in the informal sector, refugees, and migrants—and limited access for others, such as people with disabilities.

This study, conducted more than three years after the launch of Morocco’s social protection reforms and authored by sociologist Abdelhadi El-Halhouli, is based on field interviews.

It showcased “the emergence of a new policy intervention context for the state toward the issue of social security within the societal context by trying to institutionalize it–especially for the benefit of the uninsured-producing a dynamic of social action by the official actor or within uninsured groups of small traders, peasants, the indigent, and the poor.”

The study noted that “as a result, some of the targeted groups now find their way to health treatments or services and seek compensation for damage or treatment costs from the social reserve funds.”

It added that “this presents an important shift in the social security system in Morocco, as the idea of health security had been reserved for the elite from Morocco’s independence until the new system’s activation,” explaining that “the social and economic status of individuals now determines the possibility of compensation and full or partial coverage.”

The study also revealed several gaps that will stand in the way of the effectiveness of the right to treatment and UHC in Morocco.

According to the same source, this includes linking access to healthcare to the social targeting system, which is ineffective due to the fragility of the selection criteria, the unclear status of workers in the informal sector, widespread unemployment, and the significant number of marginalized individuals.

It explained that “Morocco’s social targeting system can help reduce inequality by providing greater support to disadvantaged households, but it can also produce other exclusions, such as removing eligible beneficiaries or producing new stigmatization of target groups through the publication of lists of beneficiaries.”

The study added that “excluding some groups from the right to insurance by being categorized as beyond the threshold, contradicts the perspective of health protection as a human right, rather than an unconditional guarantee for indigent or vulnerable groups.”

The results also revealed a lack of clarity on “how UHC is financed due to the state being the primary contributor for many of the targeted population; it is also difficult for other groups to sustain their contributions due to their precarious social and professional status, or because they refuse to subscribe to state social security, perhaps preferring to go with a private agency.”

The same source also noted that “healthcare services are absent for mothers working in the informal sector, despite being the largest demographic in Morocco,” noting that “there is also limited recognition of people with disabilities in healthcare, especially in the light of the heterogeneity of this social segment due to their varied physical characteristics and needs vis-a-vis the healthcare system.”

It also highlighted that “there is a complete exclusion of migrants and refugees, which also contradicts the human rights approach.”

The study concluded that “the digital divide prevents many of the targeted and disadvantaged from accessing healthcare,” explaining that “this gap increases for the elderly and those who are geographically isolated, the compulsory health coverage programs did not offer any alternatives or guarantees to help these groups benefit from support and health care, not to mention the administrative difficulties and specific procedures for registration and utilization.”