Health systems in the Maghreb

Health is increasingly at the heart of concerns for people living in the southern Mediterranean. 

Countries in the Maghreb are faced with long and complex transitions (demographic, epidemiological, organizational and democratic) with limited financial resources, and a rising demand from inhabitants for high-quality, inexpensive health care. Given the extent of the challenges and the complementary features between Maghreb countries, they need to embark on significant structural reform. The keys to tackling these common challenges include promoting good practices and reinforcing South-South and South-North cooperation on health matters. 

IPEMED’s debate and analysis was undertaken in collaboration with a group of health experts from the Maghreb, and provides several valuable pointers.
Health systems in southern Mediterranean countries are undergoing an endemic crisis. All health sector workers, users and investors agree that current health policies are incapable of satisfying the needs of the populations concerned. Southern Mediterranean countries therefore face major common challenges over the next twenty years: to develop health policies adapted to the basic needs of their inhabitants that are realistic in economic terms and supported by the majority of the population.

In 2011, IPEMED therefore launched a wide debate on reforming current health policies with the aim of defining funding priorities and the diseases to be treated. The first step was to produce an overview of public health systems in Maghreb countries with the publication of a report including concrete and realistic recommendations on health programmes focused on inhabitants’ needs in 2020-2030.

Several issues were examined:
-    The main limits of current health systems in terms of funding capacities, human resources and equipment, and efficiency and transparency of the pharmaceutical market,
-    How to tackle the priority issue of NCD (Non Communicable Diseases) such as diabetes, heart disease, respiratory disease and cancer;
-    How to organize a Euro-Mediterranean health and medicine market;
-    Priority health objectives;
-    Requirements and potential reforms to respond to these priority objectives.

The aim is not to take the place of public authorities in defining a new health policy for each country, but to produce a report in which countries keen on reform can find ideas and support.

At each stage of the thought process, the target was to highlight the potential for cooperation and convergence, even integration, between these three countries and with European Union states, and to identify avenues for action and concrete recommendations that fit in with Ipemed’s general project, so that debate can lead to concrete action.
When it comes to health issues, Mediterranean countries face common risks and challenges that call for a general approach.

The report, “Health systems in Algeria, Morocco and Tunisia: national challenges and joint issues” has two main objectives. The first is to establish the current state of health systems in these countries, with an emphasis on the potential and common challenges. The second is to present recommendations for public health policies that could be the object of cooperation and exchanges between Maghreb countries, as well as countries in the North Mediterranean. The idea is obviously not to take the place of public authorities in defining a new health policy for each country, but rather to produce a report that will give those countries embarking on reforms a source of reflection and clear guidelines to support their efforts.

Axes for development

First of all, put health back at the heart of politics and recognize that it is a fundamental citizen’s right.

Make healthcare policy an example of democracy by promoting information, consultations and joint decision procedures.

Encourage more strategic ministerial and governmental coordination, so that health ministries can extend their current role of managing healthcare towards conducting an inter-sector, cross-cutting approach to health issues and set up alliances with other ministries on common objectives.

Create efficient, appropriate management tools to centrally regulate decentralized health policy, with regions identifying health needs on their territory and making decisions.

Develop a health system that is aimed more at users (patients and inhabitants), moving from an equipment- and hospital-centred approach to one based on services, and reinforce the role of general practitioners.

6 – Promote a more socially responsible health system allowing for quality care and equal access to treatment for all at a lower cost.

Define an efficient strategy for allocating resources to clearly identified priorities, spread out over national health programmes.

8 – Rethink and reorganize education and information for all stakeholders (elected representatives, inhabitants and healthcare practitioners) in line with new priorities.

9 – Concerning medicines, aiming between a monopoly and an open market, establish increased market regulation to encourage greater convergence, even integration, in the Maghreb.

10  The Maghreb, a region with excellent burgeoning health systems, would gain from developing greater South-South and North-South collaboration, perhaps even alliances.
The working group led by Prof. Farid Chaoui and Prof. Michel Legros, comprised the following top experts:

   - Mohamed Adbelmoumene, former Vice-president of WHO, former Minister of health and former Minister of social services and employment in Algeria.
   - Noureddine Achour, professor of preventive and social medicine at Tunis Faculty of Medicine and general director of the observatory of new and emerging diseases,
   - Noureddine Fikri Benbrahim, professor of social medicine, public health and hygiene at the Faculty of Rabat and Vice-president of Mohammed V Souissi University in Rabat,
   - Jean-Paul Grangaud, professor of paediatrics and former director of the prevention department at the Algerian ministry of health,
   - Habib Rejeb, WHO/ EMRO consultant on community health training and trainer training (Tunisia).



Associate Expert

Professeur de l’Ecole des Hautes Etudes en Santé Publique