Telemedicine: accessible healthcare for rural communities in Morocco (2018-ongoing)

Telemedicine is the delivery of medical consultations through a digital platform. The use of telecommunications software allows medical experts from across Morocco to guide local medical practitioners, such as nurses, technicians and non-specialized doctors, in diagnosing and treating patients, to improve the quality of service provided to rural communities. Telemedicine capitalizes on advancements in digitalization and access to the Internet to expand health services to 1.3 million people living in underserved rural communities.

In 2018, Morocco had 6.2 doctors per 10,000 people,¹ which is almost one-third of the minimum rate recommended by the World Health Organization (WHO) of 17.5 doctors per 10,000 people.² Regional disparities in the number of doctors per patient are prominent: more than 50 percent of doctors in Morocco work in the Casablanca-Rabat axis. Morocco’s mountainous geography exacerbates inequalities in the access to healthcare for rural populations. For example, over 40 percent of Moroccans have to travel more than ten kilometers to access health services, often in areas with limited access to public transport.³ Meanwhile, rural public health facilities are more likely to have inadequate equipment and staffing shortages than those located in urban areas.⁴

To increase access to affordable and high-quality health care, particularly for underserved rural populations, the government introduced telemedicine, which uses an integrated electronic platform to expand health services to remote populations. Telemedicine allows specialized doctors from any geographic location to examine and diagnose patients through video conferencing software, as they guide on-site health professionals accompanying patients in rural health centers.⁵

Implementation

The telemedicine program is part of Morocco’s national plan to expand Internet networks and coverage in rural areas within the framework of the e-Morocco 2010 (2005-2010), Maroc Digital 2013 (2009-2013), and the Maroc Digital 2020 (2015-2020) strategies. Telemedicine also continues to be integrated into the 2025 Strategy of the Ministry of Health.

Telemedicine was first introduced in 2015 under Law No. 131-13, which enabled the practice of telemedicine in health clinics. Under the governing framework, telemedicine could only be performed in medical centers, hospitals, and clinics that had the authorization of the Ministry of Health, and a health professional had to be present with the patient during all teleconsultations. However, uptake was minimal until 2018 when the government installed new rural health centers specifically equipped for the practice of telemedicine, in order to reduce travel time to the nearest hospital.

After the legislation was passed, the implementation of the program began with a pilot project in 2018,⁶ which aimed to roll out telemedicine in six rural communities, covering thirty-five non-medically serviced health units. During the pilot stage, teleconsultations were conducted by specialized health professionals from the Mohammed VI University of Health Sciences in Casablanca, who advised rural health practitioners in their efforts to examine patients from rural health centers.

Following the success of the pilot phase, Phase 2 of the program included implementation across forty rural communities during 2020-21. Phase 3 is the nationwide rollout of telemedicine, scheduled to be completed by 2025. By 2025, the policy is expected to provide access to improved health services to 120 rural communities consisting of 1.3 million people who were previously unable to access specialized health services locally.⁷

In order to expand telemedicine, the government procured an integrated telemedicine platform from a European start-up company named HOPIMEDICAL. The platform enabled doctors to conduct remote consultations, while also managing health records, prescriptions and appointments, and complying with data privacy and security standards.

Cost

Telemedicine services are covered by Assurance Maladie Obligatoire, the mandatory health insurance funded by employers and the government. The insurance covers all Moroccan citizens and includes public and private healthcare systems. Specific information regarding the associated costs of telemedicine was not identified.

Assessment

Telemedicine promises gains for rural populations to achieve access to high-quality health care, especially rural and low-income populations who may not have the time or resources to travel long distances to access necessary healthcare. It also offers more access to higher-quality health services for persons with disabilities.⁸

Telemedicine was instrumental in maintaining access to health services during the COVID-19 pandemic. During the onset of the pandemic, the Ministry of Health deployed a free digital health monitoring system for chronic patients, called tbib-24, which had the capacity to connect COVID-19 patients to more than 100 specialists through a video conferencing software.⁹

Due to the short time span of telemedicine’s existence and its overlap with the COVID-19 pandemic, which slowed the distribution of equipment to health centers, it is difficult to evaluate its success. However, a 2022 survey conducted by Mohammed V University in Rabat revealed that 82 percent of medical practitioners believed that e-health mechanisms improved patients’ access to care, while 70 percent believed that they facilitated improved doctor-patient contact.¹⁰

There are still obstacles that need to be overcome for telemedicine to realize its full potential in providing rural areas with access to high-quality health services, including a lack of awareness of telemedicine among patients and practitioners, and a shortage of trained technicians.¹¹

Additional Information

The Nephrology Department of the Hassan II University Hospital in Fez relies on telemedicine to monitor about thirty-three patients from remote areas with chronic end-stage renal failure through the process of peritoneal dialysis. The patients use new equipment that allows automated dialysis and a telemedicine system that reduces the need for patients to travel to the hospital. Monitoring is done through a station installed in the nephrology department of the university hospital to follow up on the patients and adjust treatment remotely.¹²

Photo Caption  “Portrait of doctor posing at clinic,” ©Adobe Stock/Prostock-studio

Tags

• Health
• Information-Communication-Technology (ICT)
• Middle East & North Africa
• Middle-Income Country
• Morocco
• Rural Areas
• Spatial Inequality