MRIC Global Essay Contest 2nd Prize Winning Essay: Gaps and disparities in healthcare between past c
Author: Karim Moutchou
Introduction
The majority of current healthcare systems were implemented during the 20th century, at the same time that colonizing countries were in charge of colonies in Africa, Asia, and South America. This situation made healthcare systems in the colonies not only defective but also dependent on and in service of the colonizers. In this article, we compare Morocco’s healthcare situation with the situation in France.
Historical context
Since 800 AD, Morocco’s successive empires took great interest in science. The country was one of the main scientific poles of the Arabic enlightenment period. For decades Morocco rose as one of the leaders in various scientific fields, and the first medical university in history was created in Fez, the historical capital of the country. The Moroccan government and historians believe that it was where the first medical degree was delivered (1).
Moroccan society has seen a great decline since the 18th century. The pre-colonial period was characterized by famines and infectious epidemics. The health crises and financial difficulties weakened Morocco enough to accept colonization.
In 1912, France signed the protectorate agreement with King Moulay Abd El Hafid, which gave it access to the central part of Morocco. Soon after that, the country was also under Spanish colonization in the north and the south. However, because the major part of the population and the institutions were located in the center,Moroccan systems, including healthcare, were almost exclusively attached to France.
France built institutions and hospitals that were essentially meant to serve the European citizens and preserve enough Moroccan “human capital” to assure the continuity of their work. General Lyautey, the official representative of the French government in Morocco during that period, said that “a doctor is like a soldier”.
It took 3 years after independence in 1956 for morocco to organize its first national health conference. While France achieved universal healthcare coverage shortly after World War 2, it was only in 2004 that Morocco created obligatory medical insurance that covers governmental and private sector workers and their families.
The Current Situation
The Moroccan system still follows the French system in many ways (e.g., the hierarchy of referrals from local health centers all the way up to the university hospitals and obligatory coverage for active employees and their families that reimburses 70% to 100% of medical expenses).
Moreover, the official language of medicine in Morocco is French, which creates a scientific dependence on the French guidelines and studies that might not reflect the situation for a northern African country. It also makes the communication between physicians and patients, who mostly speak Arabic, very complicated.
Understandably, comparing two healthcare systems can be difficult because numerous parameters and variables can be used. However, we can compare the most important healthcare indicators.
Starting with the human and institutional capital, France has 37 public medical schools for its 67 million habitants, whereas Morocco offers only 7 schools for its 33 million citizens. This in part explains why it has only 0.71 doctors per 1000 residents, compared to France’s 3.3 per 1000. Morocco also has 1.3 hospital beds per 1000 people; the ratio is 6.1 per 1000 French citizens (2, 3). In addition, medicine in Morocco still depends on the expertise of the French, and most schools still hire French professors to teach. Conversely, 7000 doctors born in Morocco are practicing in France instead of their motherland (4).
Life expectancy for both sexes at birth in Morocco is 76 years, compared 82 years in France (2, 3). Neonatal mortality is almost 15 per 1000 live births in Morocco; in France, the rate has dropped to 2.4 per 1000 live births.
Financially speaking, studies in 2014 showed that France spends around 11.5% of its gross domestic product (GDP) on healthcare, which is around $4959 USD per capita. Morocco spends only 5.9% of GDP, $190 USD per capita, on healthcare (5). While Moroccan insurance covers around 60% of the population, French insurance coverage is almost 100%.
Conclusion:
Decades after colonization, the disparity between colonizers and the colonized is clear and evident. Most past colonies are still recovering from the colonial period’s effects, on all levels, including medicine. Colonial powers placed the healthcare systems in the colonies in service of their interests. By almost all healthcare factors, the 20th century superpowers are still in advanced positions by comparison to poor countries.
Morocco is a clear example. While the country historically may have benefited from basic healthcare institutions and guidelines implemented by France, the consequences of colonization made the system’s growth very slow. Seventy-two years after independence, the French healthcare system is one of the best in the world; meanwhile, Morocco is still struggling to find its medical system’s identity and strength.