Country profiles

Morocco

Overview

Morocco covers an area of 710 850 km² and is located in north-west Africa, between the Mediterranean Sea, the Atlantic Ocean and the Sahara Desert. It shares borders with Algeria to the east and Mauritania to the south.

Morocco is a constitutional monarchy. The official religion is Islam. Administratively, the country is divided into regions which are subdivided into states, provinces, and prefectures. In total, there are 16 large regions and 68 provinces. The regions currently have autonomous management (local governments).

The population of Morocco was about 27 775 000 in 1998. The average population density is 38.4 per km². The population of Morocco is very young: 34.6% are under 15 years old (1997). Additionally, 4.6% of the population are above 65 years of age (1997) [Footnote: The population above 65 years of age was obtained from EMRO statistics.]¹. Urbanization has developed considerably over the past two decades, to the extent that the urban population amounted to 53% of the total population in 1997. In 1995, the total adult literacy rate and the female adult literacy rate were 42.2% and 30.5%, respectively .The infant mortality rate decreased by almost 50% from 94 per 1000 live births in 1982 to 57.4 per 1000 live births in 1992 to 37 /1000 live birth in 1998 . In 1997, the infant mortality rate was estimated at 36.6 per 1000 live births, the maternal mortality rate was 22.8 per 10 000 live births and the under-5 mortality rate was calculated to be 46 per 1000 live births [Footnote: Obtained from EMRO statistics].^* The total life expectancy at birth was 68.8 years in 1997 [Footnote: Obtained from EMRO statistics].^* In the same year, the crude birth rate was estimated to be 23.2 per 1000 population.^*

[footnote: The total adult literacy rate and the female adult literacy rate were obtained from EMRO statistics.].²

The national health system is organized in three main sectors.

The public sector aims to implement prevention, promotion of health and treatment strategies, through two networks.

The primary health care network consists of:

• the rural dispensary

• the community health centre

• the local hospital

• the urban health centre.

The hospital network comprises general hospitals and specialized hospitals and is organized on three intervention levels:

• public health polyclinics and provincial hospitals

• regional hospitals

• academic hospitals.

national fund of social security institutions and mutual fund institutions.

Presently there are 72 general hospitals and 34 specialized hospitals, having a total bed strength of 25 715

There are 1949 primary health care institutions are (563 in rural areas and 1386 in urban areas), corresponding to one establishment per 14 012 inhabitants.

MENTAL HEALTH

In Morocco many psychiatric institutions were built between 1920 and 1995. Berrechid Hospital (near Casablanca) was the first to be operational. It has an asylum structure with a large capacity (2000 beds). Next was Til Mellil Psychiatric Hospital (in the Casablanca region). Regional psychiatric hospitals, with smaller capacities (80 to 100 beds), were founded in Marrakech, Oujda, Fès, Tangiers, Tétouan and Meknès. Since the 1960s, psychiatric services began to be integrated into general hospitals (10 to 30 beds) and development of ambulatory psychiatry services in the public and private sectors started .

The principal law is 1959’s Dahir. It

• created the Central Service for Mental Health and Degenerative Diseases

• created the Mental Health Committee

• organizes and supervises mental institutions and rehabilitation centres of all sectors on a nationally

• specifies manner of patient placement and discharge

• sets forth protective measures for mentally sick people and for their property.

The Mental Health and Degenerative Diseases Service was created in 1959, The Service

• develops plans and programmes for the prevention and treatment of mental illnesses as well as the protection of the mentally ill

• supervises medical care institutions (public and private), health centres and psychiatric institutions

• coordinates different sectors involved in mental health care and with national and international nongovernmental organizations

• oversees continuing education of health professionals

• furthers the goal of mental health

• participates in the fight against drug addiction in coordination with other sectors.

Psychiatric institutions are in four main sectors-public health, academic, military and private. There are also institutes for helping mentally handicapped children.

Academic centres

C.P.U. of Salé, Al Razi, 200 beds

C.P.U. of Casablanca, 120 beds

Public health

Marrakech, 220 beds

Berrechid, 650 beds

Tit Mellil, 160 beds

Tangiers, 100 beds

Tétouan, 200 beds

Fès, 130 beds

Oujda, 130 beds

PSYCHIATRIC SERVICES INTEGRATED INTO GENERAL HOSPITALS

This started after the development of the National Programme for Mental Health in 1972, (revised 1992 1995 ). Currently most of the provincial hospitals offer psychiatric services and the breakup of their bed strength is as follows:

Agadir, 60 beds

Laâyoune, 15 beds

Taroudannt, 40 beds

Beni Mellal, 30 beds

Khouribga, 30 beds

Khenifra, 10 beds

Meknès, 80 beds

Mohammedia, 30 beds

Safi, 26 beds

Taza, 4 beds

El Jadida, 20 beds

Al Hoceima, 60 beds

Military hospitals,

Med V Military Hospital of Rabat, 40 beds

Med V Military Hospital of Meknès, 20 beds

Med V Military Hospital of Oujda, 10 beds

Private sector

63 private surgeries which cover most towns of Morocco with a large concentration in big towns.

AMBULATORY CARE FACILITIES

The development of ambulatory psychiatry within the PHC sector, the policy conducted has allowed people to have easier access to medical care, who previously avoided mental hospitals.

This policy has allowed psychiatry to be demystified on the one hand and on the other reduced the average length of time spent in the hospital . In addition there are 200 health centres spread over the country offer mental health services within PHC.