The benches of public medical faculties in Morocco are empty. For almost two months, the majority of the approximately 24,000 students registered there have been boycotting classes, internships and even the first semester exams, the course of which last week was marked by a record rate of absenteeism – up to 100 % in certain establishments, according to the national commission of medical students.
The strikers are protesting in particular against the reduction in the duration of medical studies, which went from 7 to 6 years at the start of the school year. “A poorly prepared reform which poses more questions than it provides answers,” assures Imad Hamidine, president of the Tangier medical student office, who deplores the lack of visibility surrounding the fate reserved for the content of the seventh year of training, until then devoted to hospital internships for full-time interns.
Acted during the summer of 2023, the tightening of the curriculum is supposed to allow Morocco to train more practitioners. With 30,000 doctors for around 40 million inhabitants, the kingdom has a density of healthcare workers below the critical threshold of 2.5 per 1,000 established by the World Health Organization (WHO). In 2023, the Court of Auditors estimated that there was a shortage of 47,000 doctors in the kingdom and that the deficit would reach 53,000 by 2035.
The debate around these deficiencies is an old antiphon. Neither official reports, which regularly warn about the situation, nor government initiatives, such as that of former Prime Minister Driss Jettou, who in 2007 stated the ambition to train 3,300 doctors per year from 2020, have produced any convincing results. In 2021, 2022, and 2023, an average of only 2,100 students graduated each year. A number considered “very insufficient” by health professionals, who estimate that two to three more are needed.
Geographic imbalance
The concern is such that the Economic, Social and Environmental Council, in its last annual report sent at the end of 2023 to King Mohammed VI, made the lack of doctors a point of vigilance, in the same way as the weakness of investments and the loss of purchasing power.
Will the reform of medical studies succeed in raising the density of nursing staff to 4 per 1,000 in 2030, as announced by the Minister of Health? The practitioners interviewed are categorical: the objective is “unattainable”. And while everyone agrees on the need to improve medical coverage, their opinions differ on the measures to take. “It is good to want to increase the number of doctors, but it will not be enough to reduce inequalities of care in the country,” warns infectious disease specialist and health economist Jaafar Heikel, who insists on the inequitable distribution of doctors in Morocco: three quarters are concentrated in urban areas, when the rural environment is deserted.
This geographical imbalance is certainly not unique to the kingdom, but it is aggravated, according to Jaafar Heikel, by legislation which prohibits mobility in the country and which he considers “archaic”. “Today, a doctor in Rabat does not have the right to practice in Casablanca, even one day a week, unless he closes his practice,” he explains. It’s as if a doctor in Paris couldn’t practice in Lille, that doesn’t make sense. If we facilitated the mobility of doctors within Morocco, we could quickly fill deficits in certain specialties, depending on the needs in each territory and in coordination with the supervisory authorities. »
The desired increase in the number of doctors also risks posing a problem upstream: that of welcoming students. Long reserved for the country’s main cities, public faculties opened in 2023 in medium-sized towns, such as Errachidia, Beni Mellal and Guelmim, but the teacher supervision rate nationally is considered “too low”.
A “brain drain”
Part of the medical profession is also calling for an expansion of student internship areas, which are restricted to hospital centers. “Why not extend them to private establishments, which often have more resources? This would make it possible to better distribute the number of students and ensure higher quality internships,” notes Rachid Choukri, president of the Moroccan college of general medicine.
More broadly, the working conditions of public health doctors raise questions. Responsible for defining the reforms to be carried out to reduce inequalities in the country, the special commission on the development model had highlighted in 2021 the need for better promotion of health professions. The body affirmed that their remuneration “does not promote motivation within the public hospital”. “A young contractual resident in a university hospital receives around 800 euros per month. At the end of your career, after thirty or thirty-five years of practice, it’s around 2,500 euros. In France or Germany, he would receive three or four times more,” confides Loubna El Mansori, who practices in Tangier.
The bottom line is the phenomenon of medical graduates who go abroad every year. A “brain drain” according to sociologist Hicham Jamid, author of a thesis on highly qualified migrants. The foundation of liberal medical teachers estimates their number “between 600 and 700”, up to a third of the practitioners trained annually in Morocco, “while we need its resources”, warns Jaafar Heikel.
It is mainly Europe that attracts these graduates. In 2017, the National Council of the Order of Physicians in France indicated that nearly 1,200 Moroccan doctors qualified in Morocco were registered with the order – no more recent data is available. In a study published in 2021 by the European Journal of Public Health, a survey of Moroccan students in their final year of medicine revealed that 70% of them intended to leave the kingdom.
In this context, the recent remarks of French Prime Minister Gabriel Attal, who announced at the end of January to appoint an emissary “responsible for seeking doctors abroad” to respond to the lack of white coats in France, have not gone unnoticed. . Questioned on a Moroccan radio station, the former director of a university hospital hoped that the departure of Moroccan doctors would no longer be a hemorrhage for the country, but an opportunity to allow them to specialize before they return to Morocco “with real added value.”