Project description

Title: Support for decentralisation of the health service in the field of reproductive health
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Morocco
Lead executing agency: Ministère de la Santé
Overall term: 1996 to 2010

Context

Access to basic health services for Morocco’s rural population is inadequate. 43 % live more than six kilometres from a health centre. 60 % of women across the country encounter considerable problems accessing medical care, not least because a visit to the doctor is not always a matter of course due to their role in the family and with regard to their husbands.

In the Taza, Al Hoceima and Taounate provinces (TAT region), the situation regarding medical and preventative care is especially poor. In this conservative, rural environment young people receive no support on issues concerning sexual health and precautions. Due to the dispersed nature of settlements, state health institutions are difficult to reach. Working methods are insufficiently organised and of inadequate quality as a consequence of understaffing. Faced with these challenges, the Ministry for Health has drawn up an action plan for 2008-2012, which envisages among other things improved access for women to basic health services in order to reduce maternal and infant mortality.

Objective

The health system meets the population’s reproductive health needs.

Approach

The health project contributes to the decentralisation of the health service and is aligned with the national strategies of the Moroccan Ministry for Health for 2003-2007 and 2008-2012. It supports the qualitative improvement of health services by means of quality management at national, regional and local level. The target-oriented cooperation between the relevant ministries on youth health and HIV/AIDS prevention as well as the consolidation of a community-based approach for inaccessible areas receive support.

The project draws up studies on improvements to the health service and guidelines for youth health. Focusing on specific target groups, coaching sessions, workshops and seminars take place each month for women, men, young people and medical professionals from the Ministry for Health.

The partner ministry receives support, especially towards the end of the project, in anchoring successful approaches institutionally so that it can continue these in the future. Responsibilities and the distribution of work among departments and levels of management are agreed upon in seminars and strategy workshops.

Results achieved so far

The community-based approach has given women in the TAT region better access to contraception and to information about family planning. Women and men are better informed about health problems in connection with sexuality, pregnancy and childcare and increasingly take advantage of the services that health institutions have to offer.

A further ten provinces have adapted community-based concepts to their local conditions. Furthermore the approach has been adopted in a Ministry of Health handbook. This means it can also be implemented in other regions, for instance within the framework of the Moroccan National Initiative for Human Development (Initiative Nationale pour le Développement Humain).

The national competition for quality improvement (Systemic Quality Improvement) successfully contributed towards the promotion of quality management in health institutions. The first two rounds of the competition in 2007 and 2008 set a dynamic process in motion, the implementation of which is noticeable on all levels. All the hospitals and health centres that participated in the competition have developed improvement measures for their services. More than half of these have already been implemented.

The partner ministry has recognised the national competition for quality improvement as a successful instrument and in 2009 it was also introduced for centres for the diagnosis of tuberculosis and respiratory diseases.