World standards pharma industry, public-private partnerships and the opening of capital for private clinics

Morocco is an island of security and stability of a continent in turmoil: the extension of the war in Mali, political problems in Egypt or the penetration of the Islamic State in the Maghreb. However Morocco positions itself as a model of political and social reform. We would like to know what the transition process was like in the country and the reforms from the time of the referendum until now. What has this meant for the development of the economy and health?

Morocco has completely changed over the last ten, twenty years, sincerely. And now since the new constitution of Morocco from July 1, 2011, Morocco is a constitutional monarchy, a democratic monarchy, a parliamentary monarchy, and a social monarchy. The key word is democracy; second keyword is human rights.

What does this change consist in? Firstly, as in all emerging countries Morocco cannot avoid it. There was much more inequality between sectors, in rural areas, in urban ones, and even within different rural areas, in terms of health indicators and others. If we take the case of health, I’ll give you one or two indicators of what has changed. In 1962 life expectancy of a Moroccan citizen on average was 47 years. In 2010 that life expectancy increased to 75 years.

The Government of Morocco has created a favorable environment to improve public health and ensure the future of its citizens. But there is still some way to go, particularly in areas where international partnerships and private partners stepping in could be decisive. Can you tell us about the sector strategy for the 2012-2016 period?

We have a vision for management, we have an emergency, and we have priorities. What is the vision for the management of this sector? The first element of the vision: for us it is essential and urgent to reposition institutionally the Ministry of Health in this sector. The second element of the vision is the private sector. It’s the public-private partnership. Something remarkable on which I place a great deal of importance: putting the means in common, working on a network; but especially the 131-13 law. This Act is the opening of the capital of private clinics for non-physician investors. Because until now our law requires that to open a clinic one should be a doctor. And this law will change everything, because what we say is that to operate, to practice the art of medicine, you have to be a doctor, but to invest and equip, I don’t see why. This allows us to open large doors to investment. The third element of the vision is regionalization which didn’t exist before. You know that in its constitution Morocco goes towards regionalization. We, at the Ministry of Health, we have anticipated this. This year we started at the Ministry of Health: the first experience, the unique experience of regionalization in competition.

The pharmaceutical industry in Morocco is an example of modernization and industrialization with 100% Moroccan laboratories like Laprophan and Sothema.

In Morocco we have 42 laboratories for the production of medicines, we have 40 wholesale distributors, and we have 12,000 retail pharmacists. The pharmaceutical industry turnover exceeds 10 billion dirhams annually. And about 8 to 10% is exported abroad. You know Moroccan medicine is classified as a quality European area. Morocco exports to Europe, France, Finland, Switzerland, it exports everywhere. This is an area where Morocco has succeeded greatly. The centre of our concerns in this national pharmaceutical policy is the citizen.  When we say citizen, it is the most impoverished, but also the producer. Because the idea is not to destroy people who are wealthy, who produce, who have laboratories, saying: do populism and give to the poor. It’s not that. What is being discussed is establishing a fair price for the poor, for the ordinary citizen, but also the right price for the one who invests billions, who produces, the right price for the one who distributes, and the right price for retail pharmacists.

So what is this policy roughly speaking? Firstly, it is to reduce the price of medicines. Morocco is one of the few, if not the only country in the world, which was successful in reducing the price of medicines last year: for 1600 medicines, a net decrease in the price between 20% and 80%. And we are currently reviewing the Pharmacists Act. We have also increased the budget for medicines. Until 2011, the Ministry of Health contributed a maximum of 675 million dirhams, for the entire public sector. Now with this government, this year we are at 2 billion 200 million dirhams, which is huge.

There's no national security without regional security. What will be the response of Morocco to the Ebola virus? A country that, thanks to companies like Royal Air Maroc is fully connected to Europe and sub-Saharan Africa, an asset but also a threat.

Ebola is a serious disease; unfortunately it evolves very quickly, and kills between 50-90% of those affected and unluckily for the world there is no treatment, antibiotics or vaccine, or anything. A second element of the disease: it is a misleading virus. That's not to say that we should not take action, adopt all measures. Why do I say a misleading virus? Take all measures, yes; misleading virus, yes; so zero risk does not exist.

So, in Morocco we have taken all kinds of measures. Moreover I would like to inform you, as you must surely know; if you do not know I can tell you as a doctor: when talking about Ebola, it’s the panic that’s worse.

What have we taken as measures? We have a national response plan against Ebola that is based on 4 points. As a first step, we have flights but we have infrared thermal cameras; so, before even a citizen of Guinea or of Liberia boards the plane he is examined. With RAM, Royal Air Maroc, pilots and staff, at the slightest doubt, refuse to let him get on the plane. So we keep him there. When he boards the plane, there are cameras, all our planes are equipped with them, aircraft which do Guinea, Sierra Leone and Liberia because these are the three countries mentioned.  So these are the means: with an isolation room at the airport also. And all these means do not exist at the airport only. They exist at Tanger Med for people who come by sea. They exist in a small town called Guerguerat which borders Mauritania, because we have about 600 people getting in.

The second step consists in measures for suspected cases. If we suspect someone, we have very quickly equipped 4 laboratories to very high levels: the Pasteur Institute of Casablanca, the Royal Gendarmerie in Rabat, the Military Hospital here, and Guelmim Military Hospital in the South.

The third measure is if we ever have a case confirmed in town. It must be taken care of. We took two reference services. The one in the interior of Morocco is Casablanca, with negative pressure rooms; and the other in Dakhla, the extreme south of Morocco, if ever there is a case at Guerguerat.

The final measure is communication, it is joint work, it is coordination, because there are several players: ourselves, the Ministry of Health, and there is also the Ministry of the Interior and there is the police as I mentioned that we locate these people and monitor them.

We wanted to talk about the relationship you have with Spain, because you talked about the opening up of private capital, you spoke of the importance of human capital, of training. What relations are there between Spain and Morocco in the health sector?

There are excellent relations. I'll tell you, between Morocco and Spain there is a joint committee which manages matters, and meets. Firstly, we have a relationship at the central level. There's the Spanish Agency of International Cooperation for Development; and then at the regional level. At the regional level we have "enfermeras para el mundo", we have "the Junta de Andalucía", we have the Public Health School of Andalusia, we have the Carlos III Foundation and we have the Foundation Clinic of Barcelona.

What would you like us to put in the report that will be published next year concerning your sector?

The public-private partnership and the opening up of capital for private clinics; it is a fundamental element of cooperation with Spain: public-private partnership, opening up of the capital of private clinics for non-physicians.