Corruption and precariousness: the diagnosis of healthcare in Morocco
- Alarming diagnosis
- Factors and impact of corruption
- An inadequate protection system
- Vulnerability and illiteracy
After revealing the extent of corruption in the Moroccan healthcare sector in its latest National Survey (2022), the National Authority for Integrity, Prevention and Fight against Corruption (INPPLC) has launched a large-scale study to identify shortcomings, measure risks and propose concrete actions to restore patient confidence in the national healthcare system.
The company in charge of the study, Forvis Mazars, addresses the phenomenon in three areas of the sector: care services and citizen-hospital relations (patient journey); the value chain of health products and medicines; and the private sector, including the regulation of private clinics and doctors' surgeries.
For its part, the Economic, Social and Environmental Council (CESE) presented an alarming report on the dramatic situation of older people in Morocco, urging a paradigm shift to combat the precariousness of the protection system and proposing measures to address this problem and develop a ‘silver economy’ capable of turning this demographic risk into an economic opportunity.
Alarming diagnosis
The study seeks to better understand corruption in the health sector and its impact on the quality, transparency and equity of access to care and services, providing a detailed analysis of its manifestations, risks, frequency and intensity, as well as the causes and consequences of this phenomenon.
The results of this study will make it possible to establish monitoring and evaluation mechanisms in the new health system, which is characterised by new governance bodies that enjoy a certain degree of autonomy.
The National Authority for Probity, Prevention and Fight against Corruption (INPPLC) conducted a national survey on corruption, based on a sample of 5,000 citizens residing in Morocco between October and December 2022, and 1,000 Moroccans residing abroad (MRE), who were in the country during the months of July and August 2022.
The survey revealed that 56% of Moroccan residents (and 53% of MREs) consider the quality of health services and care to be one of their top three concerns, while 20% consider it to be the main concern for Moroccans.
68% of respondents (76% for MREs and 75% for businesses) consider the health sector to be the most affected by corruption and believe that corruption is widespread and pervasive.
Factors and impact of corruption
According to the same survey, 17% of Moroccans have paid or been asked to pay a bribe to benefit from public health services.
Bribery is the most common form of corruption in Morocco.
The study showed that the incidence rate of bribery in the public health sector is 10%, ranking fifth after the auxiliary forces (31%), the Gendarmerie (23%), the Police (15%) and transport (13%).
Corruption has other faces that are present in other areas such as public procurement and contracts, licensing, approvals, delegations and authorisations, and even in the distribution of social assistance to the population.
With the public health sector being the most affected by corruption, the most frequent response to requests for payment is acceptance, with a rate of 57% compared to 25% who refused and only 3% who refused and filed a complaint.
Corruption can occur at various levels, starting with bribery and extending to large-scale corruption affecting markets, strategic and policy decisions, and authorisations.
Among the factors that may explain the extent of corruption in the health sector are the following:
- The regulatory and legislative framework
- The multiplicity of actors without any guarantee of consistency and clear coordination of their roles and responsibilities
- The accountability system
- The limited supply of services
An inadequate protection system
On 1 October, the Economic, Social and Environmental Council (CESE) presented an alarming report on the vulnerable situation of the 5 million citizens over the age of 60 (13.8% of the population) in the face of an insufficient protection system.
Faced with the reality of this category of citizens living in endemic poverty, social isolation and a lack of adequate structures, the CESE is calling for an urgent reformulation of public policies to develop a ‘silver economy’ capable of turning this demographic risk into an economic opportunity.
In its document entitled ‘Socio-economic integration of older people in Morocco: better adaptation to rapid demographic ageing’, the EESC stated that, in just one decade, the proportion of Moroccans over the age of 60 has risen from 9.4% in 2014 to 13.8% in 2024, according to the latest results of the General Population and Housing Census.
Most worryingly, this category could represent 23% of the population in 2050, or around 10 million people. This is an acceleration of demographic ageing, coupled with a decline in fertility from 7.2 children per woman in 1960 to 1.97 in 2024.
In this context, the elderly represent a major challenge for Morocco, as 52.4% of them have no fixed income to guarantee them decent living conditions. Among those who do have an income, only 49.2% receive a retirement pension; the rest survive thanks to family support (25.6%), their assets (11.8%) or help from relatives (4.6%).
Vulnerability and illiteracy
In this regard, CESE data reveal an accumulation of vulnerabilities: 71.6% illiteracy among those over 60; 64.4% with at least one chronic disease; 11% victims of violence, of which nearly 44% occur within the family home.
Faced with this situation, Morocco has only 72 social protection institutions throughout the national territory and two hospital structures located in the Rabat-Salé-Kenitra region, highlighting the urgent need to take measures to improve an extremely vulnerable situation.
In this regard, the Council calls for accelerating the implementation of the National Action Plan to Promote Active Ageing 2023-2030 through three basic axes: immediate support measures, strengthening institutional governance and structured development of an economy dedicated to older people.
According to HCP projections, there will be 5.4 million older women by 2050, requiring immediate action to prevent millions of senior citizens from living in poverty and isolation. The Council advocates for the implementation of innovative training programmes that combine literacy and digital skills, as well as a substantial increase in direct social assistance.
It should be noted that nine out of ten older women are illiterate, which reinforces their dependence within the family and limits their autonomy, as they are unable to read, manage their administrative documents or follow developments regarding the evolution of their rights.
Illiteracy is yet another challenge that limits older citizens' access to information and decent jobs, exacerbates poverty, hinders this group's participation in the country's development and deprives them of freedom, opportunities and their contribution to decision-making.