An analysis of the documentation provided by the
Al Haouz site managers showed that the province has
demonstrated a high level of capacity to carry out the
project successfully. This was demonstrated by the
performance achieved over the last two years in the
province; indeed, the 2021 and 2022 progress, reports
show an increase in the number of teleconsultation
from 121 to 1179.
Figure 1: Report on teleconsultations in the province of Al
Haouz 2022.
There is also strong demand for certain
specialties, such as rheumatology, endocrinology,
neurology and internal medicine. According to
project managers, raising awareness among human
resources is essential to ensure the project's long-term
success. Efforts will have to be made by hospital
managers and the general public (associations, media,
etc.).
Still according to the project managers, the system
offers many advantages and can be improved and
extended to primary health care establishments
through the practice of tele-notification in specialized
consultations, according to a work schedule shared
between the hospital level and the health centers, in
particular the Amizmiz and Asni health centers,
which already have the necessary equipment.
4 DISCUSSION
Telemedicine proved its usefulness, particularly
during the Covid-19 pandemic, enabling the
continuity of remote consultations to be maintained in
several countries around the world. In France, during
containment, the number of teleconsultations
exploded to over 5 million during April 2020 (Simon
& Moulin, 2021), in reactivity to the pandemic, but
also in response to the challenges of accessibility and
territorial inequalities in healthcare provision.
In Morocco, the province of Al Haouz and, more
generally, the Marrakech-Safi region have
demonstrated a remarkable capacity for resilience,
according to the 2021-2022 assessment.
In terms of access to specialist consultations, the
use of telemedicine in the province of Al Haouz has
made it possible to avoid long journeys to second- or
third-level hospital structures, as well as long waiting
times to obtain an appointment, which in all cases
represents a saving in time, effort and money for
patients; This situation is identical in France,
particularly in areas faced with an unavailability of
specialist doctors, making delays incompatible with
continuity of care (Moulin & Salles,2017).
Telemedicine is particularly useful in areas where
access to medical services is limited by geographical
accessibility. It offers high-quality care, improving
the management of chronic diseases while reducing
travel costs for patients.
However, experience has revealed a number of
functional and organizational constraints. Based on
interviews with project managers, a number of
constraints can hamper the operationalization of
telemedicine in the experimental sites. These include
the non-adherence of human resources due to a lack
of training or appropriation; the under-use or non-use
of all technological equipment due to a lack of
technical skills; and organizational constraints linked
to the system of healthcare provision in Morocco; this
situation was similarly evoked in France at the start
of telemedicine pilot experiments, with the
coexistence of constraints of a technical, logistical or
training-related nature (Maxime Durupt, 2016).
In addition, the lack of coordination between the
different levels of healthcare provision (primary,
secondary and tertiary) is a real obstacle to the
implementation of remote specialist consultations,
particularly given the mismatch between the
availability of public health professionals and doctors
at Marrakech University Hospital.
Research into coordination and communication
between the secondary level (the hospital) and the
primary level (the health center) in the case of
telemedicine practice (Robert Harrison, 1996), shows
that few serious technical problems have been
encountered where coordination between levels of
care has been strengthened; in this case, patients,
hospital specialists and general practitioners even
report high levels of satisfaction with consultations
carried out remotely.
The experience in Al Haouz province has revealed
constraints, notably in terms of human resources buy-
in, coordination between different levels of care, and
organizational constraints. This calls for a review of
IeHF 2023 - International e-Health Forum
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