Rabat, Morocco – Moroccan medical students have defeated a government plan that would have required them to spend two years in a civil service programme after graduation, but concerns persist about the state of the country’s healthcare system.
After months of protests, striking students signed an agreement this month with the health and higher education ministries that abandoned the mandatory civil service programme, which would have required them to work for two years in an area designated by the state – most likely an under-serviced region. The government promised to work out a new programme that integrated students’ feedback.
But the proposed programme has drawn attention to Morocco’s troubled healthcare system. In September, hundreds of students from across the country, clad in white lab coats, clustered on the boulevard in front of parliament in the capital Rabat. Protesters belted out slogans such as “no to obligation, no to slavery”.
Soukaina Sakab, 23, a sixth-year general medicine student at the Faculte de Medecine et de Pharmacie de Rabat, said she thought the civil service programme should be voluntary instead: “We can accept that. People are going to be very willing to do this type of work. Personally, I am willing to go tomorrow.”
“It was a favourable deal for the state but not for doctors,” added Anas Oulmidi, 27, a member of the National Coalition Movement of Medical Interns and Residents and an ophthalmologist based in Marrakesh. “We are asking the state to reconsider the place it gives to the dignity of doctors.”
The programme aimed to remedy the lack of access to healthcare in Morocco’s rural regions. Nearly half of the country’s doctors are concentrated in Rabat and Casablanca, although these regions are home to just one-third of Morocco’s population.
The government’s annual healthcare spending averages just $64 per person in Morocco, compared with $183 in Tunisia and $233 in Algeria, according to the World Health Organization (WHO). The North African kingdom has just 1.5 doctors per 1,000 inhabitants, while the WHO advises a minimum of 2.5.
The protesting medical students argued that not enough of the funds spent on healthcare go towards improving infrastructure and providing patients with basic resources.
Oulmidi said medical students have been silent for too long, leading to low wages and a lack of equipment and medicine in teaching hospitals. Medical school is free in Morocco, but Oulmidi said students pay the country back by working and paying taxes.
Doctors who work for the state in Morocco make between 3,000 and 10,000 dirhams ($300 to $1,000) per month, while the country’s minimum wage is 2,500 dirhams.
“It was a populist project based on the lie that doctors refuse to go to remote regions,” Oulmidi said about the proposed civil service bill. “The problem is that the government is not recruiting enough doctors to answer the country’s needs.”
Some Moroccans in rural areas were not pleased with the plan either. In a village near the town of Ouazzane in northern Morocco, Asmae Fahmi, 21, said she was not keen on having student doctors sent to fill the void.
“We need more hospitals. We need specialists, not just general medicine students. We need medical materials,” she said. “Ouazzane doesn’t have any of that. No specialists, no good doctors and no hospitals.”
Minister of Higher Education Lahcen Daoudi declined Al Jazeera’s request for comment. Minister of Health Houssaine Louardi could not be reached for comment, despite several requests.
In a televised speech in parliament following the agreement with the students, Louardi stood by the necessity of sending doctors to remote areas of the country, despite the new agreement scrapping the compulsory programme.
“The compulsory service will give students two years to consider options,” he said. “It will allow to not have 45 percent of doctors concentrated in one area. It will also allow to reopen all the medical dispensaries that are closed.”
Louardi maintained that doctors are reasonably paid, and that the two years of mandatory service were intended to provide them with training. “Those [doctors] who are sent there will get adequate wages,” he said. “We will take our time to negotiate. Nothing will be decided until we all agree. We welcome any realistic demands.”
While Morocco has made improvements in the last decade, with better health coverage and a huge drop in infant mortality, access to healthcare remains one of the country’s main challenges, according to the WHO.
Mohammad Hassar, a WHO consultant and former president of the Pasteur Institute in Morocco, said the biggest issue facing Morocco’s health sector is finding doctors to provide care in rural regions.
“The [minister of health] wanted to implement [the new bill] without any conversation,” he said. “There is no easy solution.”
Hassar believes a shorter period of mandatory service would be preferable, noting working conditions in rural medical centres must first be improved. “These people will be in the countryside without tools or medicine, and after two years they will forget what they have learned if they don’t practise in good conditions.”
Sakab, the medical student, said conditions in Morocco’s hospitals were unacceptable.
“In our hospitals, every day people come – we know they have a heart attack because they are dying, but we can’t give an EKG because it doesn’t work,” she said. “The CT scan doesn’t work much more… It will be out for months at a time, and then work for a week. It’s all very old equipment from the ’70s.”
Moroccan doctors say it is a challenge just to meet the basic needs of their patients.
“Yes, hospitals are free, but there is nothing. Patients even have to buy their own surgical sutures,” Oulmidi said. “When I am on duty, I don’t even feel fatigue, but just a very heavy emotional charge to not be able to provide the adequate care.”
Although the students have returned to class, medical interns and residents remain on strike to protest against what they describe as low wages and decrepit conditions in Morocco’s hospitals.