## 2. Health Sector Capacity Indicators

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---

### A. Health — key findings and capacity indicators
- Health-adjusted life expectancy (HALE) at birth: 62.34 years (up from 60.69 years in 2000).
- Infant mortality rate: fell from over 28 deaths per 1000 live births in 2010 to below 16 in 2023.
- Current health spending: 5.7 percent of GDP.
- Government health spending: 2.3 percent of GDP.
- Out-of-pocket share of total current health spending: around 43 percent (WHO recommendation: 25 percent).
- Health worker density (national average, 2021): 16.09 health workers per 10,000 inhabitants.
- WHO minimum critical density: 23 medical professionals per 10,000 inhabitants; level to achieve SDGs: 45 per 10,000 inhabitants.
- Hospital bed capacity: 7.3 beds per 10,000 inhabitants in 2020 (desirable level: 20 beds per 10,000 inhabitants).
- Regional disparities: some regions have only three medical doctors per 10,000 inhabitants.
- Public spending efficiency in health: efficiency gap estimated at around 0.27 (outcomes could be higher by about 27 percent with better efficiency given the same public spending).
- Investment share of public health spending: about a fifth of total public health spending; investment execution rate: around 70 percent in recent years.
- Universal health coverage progress: AMO increased coverage from 42 percent of the population in 2021 to 88 percent in 2025.

### A. Health — reforms, bottlenecks, and policy priorities
- Ongoing reforms and targets:
  - New Development Model (NDM) integration and comprehensive social protection reform launched in 2018; COVID-19 increased focus.
  - Target: reach 45 health workers per 10,000 inhabitants by 2035 (consistent with WHO SDG target).
  - Framework Law No. 06-22 (2022): upgrade and incentivize careers in public healthcare, allow pay based on performance, improve complementarity with private sector.
  - Law No. 33-21 on practice of medicine: incentives to attract foreign doctors and Moroccan physicians abroad.
  - Expanded training capacity: increased enrollment in medical, pharmacy, dental faculties, and higher output from nursing and technical health institutes.
  - Digital health initiatives: integrated health information system and patient-level electronic medical records.
  - Governance reforms: establishment of an independent High Authority for Health (Haute Autorité de la Santé, HAS); creation of territorial health networks (Groupements Sanitaires Territoriaux, GSTs) to decentralize management.

- Remaining constraints and implementation gaps:
  - Insufficient human and logistical resources and inadequate regional distribution.
  - Weaknesses in public healthcare provision and public-sector hospital infrastructure.
  - Irregular assessment of health facilities and limited availability/use of data for decision-making.
  - Disconnect between health financing arrangements and service delivery; low patient satisfaction.
  - Redistribution and performance management challenges for health staff.
  - Key governance bodies (HAS, GSTs) need full operationalization—only one GST currently in place.
  - Fragmented data systems; need for unified, interoperable health information system with mandatory data‑sharing protocols.
  - Fiscal risks to mandatory health insurance (AMO) require tighter expenditure control, diversified revenue sources, and better anticipation of fiscal risks.
  - Investment budget under‑execution and slow deployment of health workers in underserved areas.

- Policy recommendations (implementation priorities):
  - Fully operationalize HAS and GSTs and strengthen regional governance capacity.
  - Strengthen data and financial management systems, including unified interoperable health information system with mandatory data sharing.
  - Improve human‑resource management: accelerate recruitment, deploy incentives, expand training, and improve redistribution to high-need areas.
  - Link greater autonomy of regional networks to clearer accountability and performance management.
  - Tighten expenditure control and diversify financing sources to safeguard AMO financial sustainability.
  - Accelerate execution of investment budgets and communicate reform details (AMO financing, co‑payment, reimbursement rules) to manage expectations and rebuild trust.

### B. Education — key findings and capacity indicators
- Public expenditure on education: around 6 percent of GDP.
- Gross primary enrollment: around 115–117 percent (reflects broad access plus repetition and late entry).
- Secondary and tertiary gross enrollment: increased by 27 and 34 percentage points of population respectively from 2010 to 2024.
- Preschool enrollment: notable increase for children aged 4 to 5, with enrollment expected to reach 88 percent by 2026–27 and universalization targeted by 2028.
- Education attainment (mean years of schooling and share with upper secondary or some post‑secondary education): remains low compared to MENA peers and emerging markets.
- International assessment performance: Morocco scores at the bottom of PISA in science, mathematics, and reading (improvements in PIRLS and TIMSS noted).
- Public spending efficiency in education: efficiency gap in 2024 estimated at roughly 37 percent (education outcomes could be 37 percent higher with existing resources if used more efficiently).
- Investment execution rate in education: around 70 percent in recent years; particularly low execution in higher education, scientific research and innovation.

### B. Education — reforms, bottlenecks, and policy priorities
- Reform architecture:
  - Education Strategic Vision 2015–2030 (launched 2015).
  - New Development Model (NDM) and Roadmap 2022-26 provide implementation plan.
  - Roadmap pillars and key targets: expand access, accelerate preschool universalization, improve quality and relevance, scale up "Pioneer School" model, strengthen infrastructure, and reform student financial support and school services.

- Reform specifics and targets:
  - Expanding access and equity: expand preschool coverage, reduce territorial and socio-economic disparities, lower dropout rates; improve boarding/catering, school transport, and targeted financial support.
  - Accelerating universal preschool: enrollment expected to reach 88 percent by 2026–27; full universalization by 2028; rehabilitation of preschool classrooms over 2026–27.
  - Improving quality and relevance: modernize teacher initial and continuous training, upgrade assessment systems, update curricula and pedagogical practices, modernize vocational education, promote STEM and innovation tracks.
  - Scaling up “Pioneer School” model: expected to be fully generalized in 2027–28; emphasizes structured evidence‑based teaching, stronger leadership, intensive teacher support.
  - Strengthening infrastructure: construct around 200 new educational establishments per year and continue rehabilitation of existing facilities; invest in digital equipment and learning environments, especially in underserved areas.
  - Reforming student support: shift from in‑kind assistance to direct financial transfers, improve boarding and catering services (internats and Dar Taliba), expand school transport.

- Remaining constraints and implementation gaps:
  - Persistent regional inequities between urban and rural areas in access, progression, and completion.
  - Skill mismatches: higher education concentrated in social sciences rather than technical/STEM fields demanded by labor market.
  - Teacher constraints: need for improved incentives, training, and tackling absenteeism.
  - Governance and efficiency weaknesses at regional, provincial, and school levels; limited decentralization and slower-than-planned implementation of Deconcentration charter (Decree No. 2-17-618) to transfer decision-making to Regional Education and Training Academies (AREFs).
  - Under‑execution of investment budgets, particularly in higher education, scientific research, and innovation.

- Policy recommendations (implementation priorities):
  - Accelerate operationalization of governance reforms and decentralization (AREFs and related authorities) to tailor resources to local needs.
  - Improve teacher incentives, initial and continuous training, and performance monitoring to reduce absenteeism and raise teaching quality.
  - Reorient higher education toward technical, STEM, and labor-market‑relevant fields to address skill mismatches.
  - Improve investment execution, prioritizing higher education, research, and infrastructure in underserved areas.
  - Continue scaling preschool and Pioneer School initiatives and shift social support toward direct transfers to improve equity and retention.

### Implementation and governance (section 10) — key findings, tools, and recommended reforms
- Key findings:
  - High spending and an ambitious reform agenda coexist with weak governance arrangements and limited progress on decentralization, undermining effectiveness.
  - Regional Academies (AREFs) and schools face constrained financial autonomy, complex approval processes, and uneven capacity, particularly for capital investment and infrastructure management.
  - Weak integration of regional and provincial planning into the budget framework.
  - Limited alignment between territorial plans and performance contracts.
  - Absence of systematic feedback loops to inform budget preparation.
  - Need for improved coordination among key stakeholders and enhanced capacity of AREFs in financial governance and internal control.

- Progress and tools:
  - Deployment of an integrated financial management information system (GID) at AREFs level since June 2025.
    - GID represents a spending module and an integral part of the government’s financial management system.
    - Expected to help strengthen budget execution, transparency, and monitoring.

- Recommended governance reforms (to strengthen implementation):
  - Clarify roles and responsibilities across central, regional, and school levels.
  - Streamline procurement and approval processes.
  - Enhance technical capacity of regional education authorities, notably in financial and infrastructure management.
  - Grant greater school-level autonomy linked to performance and accountability.
  - Improve data systems to systematically link resources to learning outcomes.

- Expected outcomes:
  - Strengthening governance is essential to ensure that increased public spending translates into gains in quality, equity, and efficiency.

*Source: sipea2026027 - 10.*

### 2. Health Sector Capacity Indicators ________________________________________________ 3

### 2. Health Sector Capacity Indicators

### A. Health — key findings and capacity indicators
- Health-adjusted life expectancy (HALE) at birth: 62.34 years (up from 60.69 years in 2000).
- Infant mortality rate: fell from over 28 deaths per 1000 live births in 2010 to below 16 in 2023.
- Current health spending: 5.7 percent of GDP.
- Government health spending: 2.3 percent of GDP.
- Out-of-pocket share of total current health spending: around 43 percent (WHO recommendation: 25 percent).
- Health worker density (national average, 2021): 16.09 health workers per 10,000 inhabitants.
- WHO minimum critical density: 23 medical professionals per 10,000 inhabitants; level to achieve SDGs: 45 per 10,000 inhabitants.
- Hospital bed capacity: 7.3 beds per 10,000 inhabitants in 2020 (desirable level: 20 beds per 10,000 inhabitants).
- Regional disparities: some regions have only three medical doctors per 10,000 inhabitants.
- Public spending efficiency in health: efficiency gap estimated at around 0.27 (outcomes could be higher by about 27 percent with better efficiency given the same public spending).
- Investment share of public health spending: about a fifth of total public health spending; investment execution rate: around 70 percent in recent years.
- Universal health coverage progress: AMO increased coverage from 42 percent of the population in 2021 to 88 percent in 2025.

### A. Health — reforms, bottlenecks, and policy priorities
- Ongoing reforms and targets:
  - New Development Model (NDM) integration and comprehensive social protection reform launched in 2018; COVID-19 increased focus.
  - Target: reach 45 health workers per 10,000 inhabitants by 2035 (consistent with WHO SDG target).
  - Framework Law No. 06-22 (2022): upgrade and incentivize careers in public healthcare, allow pay based on performance, improve complementarity with private sector.
  - Law No. 33-21 on practice of medicine: incentives to attract foreign doctors and Moroccan physicians abroad.
  - Expanded training capacity: increased enrollment in medical, pharmacy, dental faculties, and higher output from nursing and technical health institutes.
  - Digital health initiatives: integrated health information system and patient-level electronic medical records.
  - Governance reforms: establishment of an independent High Authority for Health (Haute Autorité de la Santé, HAS); creation of territorial health networks (Groupements Sanitaires Territoriaux, GSTs) to decentralize management.

- Remaining constraints and implementation gaps:
  - Insufficient human and logistical resources and inadequate regional distribution.
  - Weaknesses in public healthcare provision and public-sector hospital infrastructure.
  - Irregular assessment of health facilities and limited availability/use of data for decision-making.
  - Disconnect between health financing arrangements and service delivery; low patient satisfaction.
  - Redistribution and performance management challenges for health staff.
  - Key governance bodies (HAS, GSTs) need full operationalization—only one GST currently in place.
  - Fragmented data systems; need for unified, interoperable health information system with mandatory data‑sharing protocols.
  - Fiscal risks to mandatory health insurance (AMO) require tighter expenditure control, diversified revenue sources, and better anticipation of fiscal risks.
  - Investment budget under‑execution and slow deployment of health workers in underserved areas.

- Policy recommendations (implementation priorities):
  - Fully operationalize HAS and GSTs and strengthen regional governance capacity.
  - Strengthen data and financial management systems, including unified interoperable health information system with mandatory data sharing.
  - Improve human‑resource management: accelerate recruitment, deploy incentives, expand training, and improve redistribution to high-need areas.
  - Link greater autonomy of regional networks to clearer accountability and performance management.
  - Tighten expenditure control and diversify financing sources to safeguard AMO financial sustainability.
  - Accelerate execution of investment budgets and communicate reform details (AMO financing, co‑payment, reimbursement rules) to manage expectations and rebuild trust.

### B. Education — key findings and capacity indicators
- Public expenditure on education: around 6 percent of GDP.
- Gross primary enrollment: around 115–117 percent (reflects broad access plus repetition and late entry).
- Secondary and tertiary gross enrollment: increased by 27 and 34 percentage points of population respectively from 2010 to 2024.
- Preschool enrollment: notable increase for children aged 4 to 5, with enrollment expected to reach 88 percent by 2026–27 and universalization targeted by 2028.
- Education attainment (mean years of schooling and share with upper secondary or some post‑secondary education): remains low compared to MENA peers and emerging markets.
- International assessment performance: Morocco scores at the bottom of PISA in science, mathematics, and reading (improvements in PIRLS and TIMSS noted).
- Public spending efficiency in education: efficiency gap in 2024 estimated at roughly 37 percent (education outcomes could be 37 percent higher with existing resources if used more efficiently).
- Investment execution rate in education: around 70 percent in recent years; particularly low execution in higher education, scientific research and innovation.

### B. Education — reforms, bottlenecks, and policy priorities
- Reform architecture:
  - Education Strategic Vision 2015–2030 (launched 2015).
  - New Development Model (NDM) and Roadmap 2022-26 provide implementation plan.
  - Roadmap pillars and key targets: expand access, accelerate preschool universalization, improve quality and relevance, scale up "Pioneer School" model, strengthen infrastructure, and reform student financial support and school services.

- Reform specifics and targets:
  - Expanding access and equity: expand preschool coverage, reduce territorial and socio-economic disparities, lower dropout rates; improve boarding/catering, school transport, and targeted financial support.
  - Accelerating universal preschool: enrollment expected to reach 88 percent by 2026–27; full universalization by 2028; rehabilitation of preschool classrooms over 2026–27.
  - Improving quality and relevance: modernize teacher initial and continuous training, upgrade assessment systems, update curricula and pedagogical practices, modernize vocational education, promote STEM and innovation tracks.
  - Scaling up “Pioneer School” model: expected to be fully generalized in 2027–28; emphasizes structured evidence‑based teaching, stronger leadership, intensive teacher support.
  - Strengthening infrastructure: construct around 200 new educational establishments per year and continue rehabilitation of existing facilities; invest in digital equipment and learning environments, especially in underserved areas.
  - Reforming student support: shift from in‑kind assistance to direct financial transfers, improve boarding and catering services (internats and Dar Taliba), expand school transport.

- Remaining constraints and implementation gaps:
  - Persistent regional inequities between urban and rural areas in access, progression, and completion.
  - Skill mismatches: higher education concentrated in social sciences rather than technical/STEM fields demanded by labor market.
  - Teacher constraints: need for improved incentives, training, and tackling absenteeism.
  - Governance and efficiency weaknesses at regional, provincial, and school levels; limited decentralization and slower-than-planned implementation of Deconcentration charter (Decree No. 2-17-618) to transfer decision-making to Regional Education and Training Academies (AREFs).
  - Under‑execution of investment budgets, particularly in higher education, scientific research, and innovation.

- Policy recommendations (implementation priorities):
  - Accelerate operationalization of governance reforms and decentralization (AREFs and related authorities) to tailor resources to local needs.
  - Improve teacher incentives, initial and continuous training, and performance monitoring to reduce absenteeism and raise teaching quality.
  - Reorient higher education toward technical, STEM, and labor-market‑relevant fields to address skill mismatches.
  - Improve investment execution, prioritizing higher education, research, and infrastructure in underserved areas.
  - Continue scaling preschool and Pioneer School initiatives and shift social support toward direct transfers to improve equity and retention.

*Public Spending Efficiency in the Health and Education Sectors (March 5, 2026), International Monetary Fund*

### 10.      To support effective implementation of the reforms, the authorities should strengthen

### 10.      To support effective implementation of the reforms, the authorities should strengthen

### Key findings
- High spending and an ambitious reform agenda coexist with weak governance arrangements and limited progress on decentralization, undermining effectiveness.
- Regional Academies (AREFs) and schools face:
  - Constrained financial autonomy.
  - Complex approval processes.
  - Uneven capacity, particularly for capital investment and infrastructure management.
- Weak integration of regional and provincial planning into the budget framework.
- Limited alignment between territorial plans and performance contracts.
- Absence of systematic feedback loops to inform budget preparation.
- Need for improved coordination among key stakeholders and enhanced capacity of AREFs in financial governance and internal control.

### Progress and tools
- Deployment of an integrated financial management information system (GID) at AREFs level since June 2025.
  - GID represents a spending module and an integral part of the government’s financial management system.
  - Expected to help strengthen budget execution, transparency, and monitoring.

### Recommended governance reforms (to strengthen implementation)
- Clarify roles and responsibilities across central, regional, and school levels.
- Streamline procurement and approval processes.
- Enhance technical capacity of regional education authorities, notably in financial and infrastructure management.
- Grant greater school-level autonomy linked to performance and accountability.
- Improve data systems to systematically link resources to learning outcomes.

### Expected outcomes
- Strengthening governance is essential to ensure that increased public spending translates into gains in quality, equity, and efficiency.

*Source: sipea2026027 - 10.*

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_Source: https://www.imf.org/-/media/files/publications/selected-issues-papers/2026/english/sipea2026027.pdf_