Généralisation de la protection sociale au Maroc : les autres causes de la convergence.

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The generalization of social protection in Morocco remains among the most emblematic structuring projects on which all the forces of the nation are committed body and soul to succeed, because it constitutes the major inflection point towards the concretization of the rule of law, democracy, and solidarity that have always united Moroccans.

As a result, and as part of the articles dedicated to social protection in Morocco,The present sheet will be devoted to the analysis of the other reforms undertaken by the kingdom in order to achieve the social transition.

In the wake of this, and after a focus on governance and financing (previous article), this time, a light will be brought on the other necessary components to the desired reform, in this case: the reform of the health, the social targeting and the tax reform..., and on which the public authorities consensed intense efforts in order to establish the building site of the social protection on the way of the possibility and the sustainability.

I-Reform of the health sector.

Health sector reform aims to address major strategic challenges that prevent public health policies from fully playing their role as a catalyst for protection and that limit the scope of their overall performance. These challenges are mainly related to the supply of health infrastructure, the human resources issue, and the digitalization-governance nexus of the national health map.

In terms of supply sanitary :The success of the social protection project remains dependent on the effectiveness of the health sector, in which the public authorities are making considerable efforts to enhance the potential of the health system and bring it up to speed with the demands and social challenges of the moment.

On the budgetary side, the budget allocated to this department has increased significantly, rising to 28.12 billion dirhams against 23.54 billion dirhams in 2022, an increase of 19.5%. To meet the need for human resources, including medical and paramedical staff, this ministry, as well as the University Hospitals (UH), has received additional budgetary positions.

Thus, in the draft finance law of 2023, 5,500 budgetary positions will be granted to the Ministry of Health, bringing the total of creations over the period 2017-2023 to 36,117 budgetary positions, including 30,000 positions for the Department of Health. The program to increase the density of health personnel by 2030 (doctors, pharmacists, dentists, nurses and health technicians) will have an overall cost of about 2.45 billion dirhams.

In this respect, and in view of these budgetary efforts, the public authorities are betting on three major pillars of health reform, namely: the health offer, human resources and digital governance.

The upgrading of the structures of the hospital offer, the organization and the improvement of the channel and services of care, wants to be a priority axis of the government, what allows to propose a content of quality, in terms, of speed of answer of the services of receptions and medical in the treatment of the files of the patients, as well as, the raising of the performance of the material and equipment of the hospitals.

The supervisory ministry in the person of the Ministry of Health also aims to update the system of evaluation and accreditation of health institutions, the appropriate reorganization of hospital services located on the Moroccan coast, as well as, the identification of a circuit of care that traces the modalities of transfers by the various primary health institutions and general practitioners or family .

These devices will also ensure a better quality of care, enhance and modernize the health infrastructure of the kingdom and align with the requirements of international standards in this area.

In human resources :The problem of human resources remains among the major challenges of the health sector and for which the government claims special attention. In this regard, and on the basis of statistics, the last outing of the head of government, in response to the interventions of parliamentary groups, Aziz Akhannouch did not qualify the serious problem of human resources in the health system. Morocco is struggling to fill the gap in the ranks of doctors (-32,000), often recognized in the Western world.

This chronic shortage of medical personnel is mainly due to the immigration of skills to the West, attracted by higher salaries. As such, the head of government said that: "It is unacceptable that countries take from us cadres that we have trained just because they are able to offer them higher salaries.

In terms of figures, the Executive, according to him, has put 3 billion dirhams to increase the health staff to 24 per 10,000 inhabitants by 2025, then to 45 by 2030, in order to comply with WHO standards, which are 23 health professionals per 10,000 inhabitants. The goal is to reach 68,000 by 2022 and over 90,000 by 2025.

It is in this state of mind, that the strategy of the reform of the health sector, which aspires to an implementation of a special status incentive to the medical profession, in order to promote recruitment and fill the skills gap in this strategic sector, using, in addition to traditional recruitment, incentives to encourage foreign and Moroccan doctors practicing outside the Kingdom, to settle in Morocco temporarily or permanently. (law n° 33-21, modifying and completing the law n° 131-13 relating to the practice of medicine).

Recalling that the objective in this regard is to increase the ratio of medical professionals per 1,000 inhabitants to 2.5 by 2025, in order to reach 4.5 by 2030, thus meeting the proposal of the New Development Model, which itself is in line with the recommendation of the World Health Organization (WHO).

In terms of digital governanceale : Health governance via digital platforms is one of the State's priority actions in this critical sector in order to allow public decision-makers to have reliable data in real time on public health, to make the necessary diagnosis of the national health map in terms of strategic analysis by capitalizing on the strengths and pointing out the weaknesses, deficiencies, gaps and delays to be made up.

In addition, this digital project aims to provide health actors with the best tools in the field of hospital management and territorial planning, with the aim of enlightening decision-makers, ensuring a better implementation of regional programs and allowing, in the long run, to judge the relevance, coherence and performance of the choices made.

On this aspect, the effort of the public authorities aspires on the level of the mechanisms of intervention of the actors, in addition to the installation of an integrated Information System which would allow a precise follow-up of each patient, an identification and evaluation of the dies of care, through the creation of three new organizations, which are the High Authority of health, the Agency of the drugs and sanitary products and the Agency of the blood and its derivatives.

As far as hospital management is concerned, this governance mechanism aims to supervise the steering of health programs through the control of missions and functions at the central level of the supervisory ministry, as well as the use of digital platforms and new technologies in health management, and to pave the way for fruitful cooperation between all stakeholders operating in the health sector through public-private partnerships

In parallel to the two above-mentioned components, the executive aims at the completion of the governance by a good territorial planning of the sanitary offer via the creation of sanitary commissions which are activated at the national level. They have assigned as a role to ensure at the level of regional perimeters, the coherence and harmony of the national program in terms of preparation and implementation of investment projects and ensure the proper conduct of these plans which falls within their areas of competence.

II-Targeting policy: operationalization of the Unified Social Register (USR) ;

The law on the targeting of beneficiaries of social support programs aims to create, in addition to the single social register (SSR), a National Population Register (NPR) and a National Agency of Registers (NAR).

They are thus the most suitable social instruments for the sound management of public funds, whose purpose is to fight poverty and vulnerability. Such mechanisms allow to strengthen the harmony between social support programs, through a global vision, to implement them in a fair and sincere way and to guarantee the coordination and convergence of these programs.

This device displays the objectives of good governance that gains in efficiency and equity in the completion of security and social assistance programs for the benefit of poor populations.

Of course, the achievement of these objectives obviously depends on the completion of several actions, including: the establishment and development of a statistical database of social data that must be exhaustive, updated, harmonious and reliable, including the main variables relevant to the selection of target populations.

Thus, other actions must be taken, such as maintaining a degree of transparency and efficiency in the governance of the system, using scientific statistical methods for the selection of beneficiary populations, and guaranteeing a high degree of coordination and convergence of programs through steering and monitoring-evaluation mechanisms for these social programs.

III-Tax reform: introduction of the Single Professional Contribution (CPU).

The single professional contribution is a tax mechanism that aims to establish a contributory mechanism of social solidarity. It has been introduced in application from January 1, 2021, on the abrogation of the regime of professional income of lump-sum earners.

Nevertheless, the objective sought behind this device is to allow this category of natural persons with modest income to benefit from a basic medical cover, to simplify the tax system applicable in this matter, to harmonize the mode of taxation of the incomes of the tradesmen, the self-employed, the natural persons exercising liberal professions and those which operate in the informal sector... To create the conditions for the development of a climate of confidence and voluntary adhesion of the concerned populations, to generalize the compulsory health insurance against the social risks and to achieve justice and fiscal equity.

Ultimately, the outcome of this social protection strategy being deployed by the government remains dependent on the completion of other strategic projects, in this case governance, the sustainability of funding channels, health reform, the success of the policy of social targeting and not least the social acceptance of tax reform.

In addition, the success of these accompanying measures requires, from the outset, the availability of a good central statistical information system that covers all the sectors involved in the social protection project.

Indeed, it is this global coherence between all the systems that will ensure the keystone of the success of the transition, in order to establish a good policy, in terms of harmonized management and interoperability in the deployment of good practices in the governance of public social security policies.