By Hamza Mounhi
By Hamza Mounhi
Morocco World News
Ahmedabad, India, March 2, 2013
The social ladder has not been working in Morocco for many decades. Except of a happy few, poor people are doomed to remain poor. It is not only the case of Morocco, it is happening everywhere. This is what economists call the “poverty trap”. The way out from this trap, according to the same economists, is that individuals must be given sufficient aid so that they can acquire the critical mass of capital necessary to lift themselves out of poverty.
In Morocco, aid to poor is very scarce and given the increasing prices and expenditures, it is almost impossible for poor people to save. Those who are in extreme poverty can barely cover their daily expenses and are sometimes obliged to borrow (in emergency cases) and hence will never be able to have decent savings. Those happy few poor who can save will easily spend all their money if faced to unexpected emergencies (disease, death etc.).
Poor people all over the world are in desperate need of aid and external interventions like RAMED. Beyond its ethical meanings, the objective of RAMED is to help poor people offset the effect of financially-intensive (sometimes unexpected) health expenditures and, therefore, enable them to save enough to be lifted out of the “poverty trap”.
This week we are celebrating one year of its large-scale implementation. National media are proud and happy to praise the benefits of this program. The sky is always blue they said. This time, it is almost true except of a few other alarming indicators.
Well, good things first.
Personally, I see two major takeouts. In 2008, RAMED was deployed on a small scale in the region of Tadla Azilal. Local targeted solutions have two advantages. First, they are cheaper than large scale schemes and second, we can anticipate all future mistakes and readapt the concept and mechanisms for an efficient future larger expansion. It is easier also to involve all parties concerned and understand deeply the needs and constraints of each stakeholder. I believe that all-like public policy schemes should go through a small scale pilot phase.
RAMED has the objective to deliver free healthcare services to 8 million of people. Now we reached 5.26m beneficiaries i.e. 16% of the total population. These figures mean that we almost know all those in need of a real assistance from the state. As I pointed out in my article on reforming the compensation fund, all future poverty alleviation schemes will be efficiently directed to the real beneficiaries.
That was the blue sky part. Now, let’s add some clouds.
On a total expenditure of MAD 2.06m, the state is paying 75% from its budget. In terms of percentage of GDP (0.3%), the figure is not that high. This is numbers’ magic; with this so small proportion of our GDP we enabled 16% of the population to have access to a large span of healthcare services. Well, it is not completely true as RAMED will only help cover parts of the operating costs of hospitals as well as pay for certain medicines. Is this really the solution needed?
In fact, while enabling an access to a larger proportion of population to those vital services; RAMED is creating, in terms of pure economics, an additional demand for healthcare. The schemes will be obsolete if the equilibrium demand/offer is not reached. The equilibrium will be reached through building additional infrastructure and training the manpower to meet the international standards or at least requirements of the population.
Morocco has a very low rate of beds per 1 000 people (1.2 versus the world average of 3.6 beds per 1000 people). Your RAMED card is useless if the bed you desperately need is not available. We also only have 0.6 physicians per 1 000 people while the global average is 1.7. Again, your RAMED card is useless if there is no doctor to treat you. Adding to that the “unfair” distribution of medical public facilities between cities: Rabat and Casablanca have the highest rate of bed and physician per 1 000 people and some medical services are available only in those two cities. Well, RAMED is not of a high interest if a poor has to bare the travel and stay expenses to get cured.
The natural decision would have been to increase the expenditure in terms of infrastructure along with the implementation of RAMED. Healthcare expenditure in the annual budget remained stable during the last three years as percentage of GDP (5.2%-with a shy economic growth). I am afraid that the state is creating a positive demand which will exceed by far the offer available. I refuse to think however that it is just a game of numbers and media publications.
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