Project to support the generalisation of mandatory health insurance in Morocco

During the Throne Speech in the summer of 2022, HM the King of Morocco initiated a large-scale reform which aims to universalise the four pillars of social protection, starting with the generalisation of mandatory health insurance by the end of 2022, combined with a reform and “upgrading” of the health system. The universalisation of family allowances, pensions and severance pay will also be phased in by the end of 2025. The mandatory health insurance system was initially restricted to private sector employees. The objective of this unprecedented reform is to include self-employed workers and their families, as well as the most vulnerable people who currently benefit from the medical assistance scheme (RAMED).

With this technical assistance project, which is financed with a €4 million grant, Expertise France is assisting the Moroccan authorities with the implementation of the first pillar of the reform. This involves tripling the current population covered by the health insurance system. Up until now, only public and private sector employees – i.e. 10.2 million people out of a population of 36 million – benefited from health insurance, along with the RAMED medical aid recipients.

In his speech of 30 July 2022, HM the King of Morocco announced that over 6 million self-employed workers and their entitled families would benefit. These beneficiaries must now become real members of the system who pay contributions to ensure its sustainability.

Operationalising the generalisation of mandatory health insurance

The project’s first area of operation aims to assist the Moroccan institutions responsible for managing the reform, both with organising its implementation and developing and setting up operational tools to ensure the sustainability of the system.

These tools will be necessary both for the management, to inform the decisions that need to be made for the public finance management policy and control of health expenditure, and technically to facilitate the interoperability and smooth flow of the benefits.

Strengthening healthcare provision

The project’s second area of operation aims to help strengthen healthcare provision in the context of this generalisation of mandatory health insurance.

Indeed, this reform will lead to an increase in healthcare demand and consumption, in particular by patients with chronic diseases which weigh heavily on health insurance expenditure. This influx of patients will require rehabilitating certain facilities, strengthening the organisation of the health system and accelerating modernisation processes.

Consequently, the project will in particular support coordinated healthcare pathways, as well as the dissemination and appropriation by health professionals of the new care protocols. The implementation of these tools is crucial to the project’s success.

In view of the completely new nature of these procedures, which will run into the cultures of both the health professionals and patients, the change requires strong support, both technical and operational and in terms of changing mentalities. This support will need to be given at all levels, including at the institutional level, and in particular for the two ministries in charge of the reform: the Delegate Ministry in charge of the Budget and the Ministry of Health which has also recently regained responsibility for social protection. Special support will also be provided to:

• The National Social Security Fund (CNSS), currently the fund for employees, which in future will have to manage coverage for the entire population (with the exception of civil servants covered by the Moroccan Health Insurance Fund)
• The National Health Insurance Agency (ANAM), whose regulatory role will be more crucial than ever in ensuring the sustainability of the system.

The project will also focus on taking gender issues into account in a crosscutting manner in the implementation of the activities. This will involve analysing the potential obstacles which women may face in access to health insurance, in particular by tackling the causes of losses of rights which may arise in the event of a change in marital status (divorce or widowhood), or an insufficient number of hours worked or periods of discontinuous work, and by exploring the possibilities of access through individual registration for coverage.