cce

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ici

: The

of the P

of Al Haouz

Najoua Eloualhani

and Ahmed Maghni

National School of Business and Management, University Abdelmalek Esaadi Tangier, Morocco

Laboratory of Management, Strategy, and Governance,

National School of Business and Management,

Tangier Morocco

Keywords: Teleconsultation, Al Haouz, Human Resources, Covid-19.

Abstract: The field of healthcare is increasingly making use of information and communication technologies (ICT)

to address epidemiological changes, meet the growing demands for care related to chronic diseases and

an aging population, combat medical deserts, and rectify inequalities in the distribution of healthcare.

In Morocco, the reform of the healthcare system largely hinges on the restructuring of healthcare services

and the digitization of the healthcare system. The digitization is a key pillar of the healthcare sector reform,

as established by Law 06.22 instituting this reform. The aim of this study is to understand how

teleconsultation has facilitated access to healthcare in the Marrakech-Safi region, specifically in the province

of Al Haouz. This is an exploratory and descriptive study of the pilot telemedicine experience, employing

a qualitative approach based on interviews with project stakeholders. Telemedicine has proven its utility,

especially during the Covid-19 pandemic, by enabling the continuity of remote consultations.However, the

experience in Al Haouz has revealed constraints, particularly in terms of human resources engagement,

coordination across different levels of care, and organizational.

1 INTRODUCTION

The healthcare sector is one of the main sectors to be

making increasing use of information and

communication technologies, and is achieving major

successes in many countries with a view to

accompanying epidemiological changes, refocusing

interest on new care demands linked to chronic

diseases and an ageing population, combating

medical deserts and correcting geographical

inequalities in care provision.

Telemedicine its debut in 1906 with the telephone

transmission of electrocardiograms by Dr. Willem

Einthoven; today it is practiced in various forms, such

as teleconsultation, tele regulation, telediagnosis or

tele-expertise, with the aim of extending healthcare

services to the most remote or isolated areas.

In Morocco, health system reform is largely based

on restructuring the health care offering, on the one

hand and digitizing the system, on the other. The

latter is an essential pillar of the reform, explicitly

stipulated by the provisions of Law 06.22 on health

sector reform It calls for major innovations in the way

care is delivered at the various levels of intervention.

The use of information and communication

technologies broadens the scope of patient care and

contributes to the development of new forms of work

within healthcare structures.

One of the pilot projects undertaken by the

Moroccan health authorities in 2020 was the

introduction of telemedicine in the Marrakech-Safi

region. The experiments were carried out under an

agreement with a telecommunications operator, with

technical support from the Mohammed VI University

Hospital in Marrakech and financial backing from the

regional council.

The aim of this paper is to describe the

deployment of this experiment, and to assess its

impact on access to healthcare in the Marrakech-Safi

region.

2 METHOD

In order to better understand how teleconsultation

improves access to healthcare services in a certain

area, this study uses an exploratory and descriptive

approach to the ground reality, bolstered by social

research instruments such as data gathering,

Eloualhani, N. and Maghni, A.

Accessibility to Care Through Telemedicine: The Case of the Province of Al Haouz.

DOI: 10.5220/0012753400003854

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International e-Health Forum (IeHF 2023), pages 14-17

ISBN: 978-989-758-711-5

questioning, and direct communication with

collaborators and authorities.

3 RESULTS

3.1 Challenges and Context for

Telemedicine Deployment in the

Marrakech-Safi Region

The Marrakech-Safi region covers an area of 39,167

km2, representing 5.5% of the national territory, and

is home to 4.521 million inhabitants (RGPH2 2014),

representing a density of 115 inhabitants per km2.

The region has eight provinces and one

prefecture: Chichaoua, Al Haouz, El Kelâa des

Sraghna, Essaouira, Rehamna, Safi, Youssoufia and

the prefecture of Marrakech. It is a predominantly

rural region (84% of the population of the province of

Al Haouz in particular is rural). The high population

density of the Al Haouz province justifies the

deployment of teleconsultation in this province.

3.1.1 Health Care Provision in the

Marrakech-Safi Region

The province reports an evolution over the period

2019-2022 with an increase in the number of primary

healthcare facilities from 437 to 464, of which 77%

are located in rural areas and 28% are non-

medicalized.

In terms of private facilities, there are 46 in the

region, with a total bed capacity of 1,376. However,

no clinics or medical practices operate in the province

of Al Haouz.

3.1.2 Hospital Personnel in the

Marrakech-Safi Region

Human resources in the Marrakech-Safi region total

6469, 51% of whom work in hospitals, with a 69%

feminization rate and an average age of 41 (meaning

that half the staffs are under 40).

The per capita density is 1.76 doctors per 10,000

inhabitants and 7.13 nursing staff per 10,000

inhabitants; these rates are well below the

international norm, since according to WHO

reference standards, the critical threshold for medical

and paramedical density is 2.5 nursing staff per 1,000

inhabitants. Morocco as a whole reports 1.64

healthcare professionals per 1,000 inhabitants.

3.2 Telemedicine Pilot Projects in the

Marrakech Safi Region

The shortage of human resources, the isolation of

certain areas of the region, the desire to reduce the

flow of patients to hospitals and to avoid delays in

patient care were the reasons that led the health

authorities in the Marrakech-Safi region to rethink the

way in which patients are cared for.

To this end, an agreement was signed between the

regional council of the Marrakech-Safi region, the

region's health and social protection directorate, the

Mohammed VI university hospital and the Marrakech

faculty of medicine and pharmacy. The aim of the

agreement is to support and disseminate telemedicine

technology at regional level, with all the technical

facilities required to carry out remote clinical

examinations.

The first phase of the project involved connecting

all the region's hospitals to the Mohammed VI

University Hospital in Marrakech. The second phase

of the project involved extending the link to health

centers, i.e. 27 sites.

According to data compiled by the Marrakech-

Safi regional health and social protection department,

there is a marked disparity in the number of

teleconsultations carried out between the provinces

and the prefecture of Marrakech, as shown in the table

below by province

Table 1: the number of tele-consultations by province in the

Marrakech Safi region.

Province

Number of

teleconsultation

Al Haouz

Safi

Chichaoua

Youssoufia

Rehamna

Marrakech

El Kelaâ

Essaouira

Total

121

In its implementation phase, the telemedicine

project in the region encountered a number of

organizational and structural constraints, such as the

difficulty of connecting certain sites via the Internet;

the non-connection of certain hospitals; and the

unavailability of human resources due to their

commitment to the Covid-19 pandemic response

plan.

Accessibility to Care Through Telemedicine: The Case of the Province of Al Haouz

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

365

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IeHF 2023 - International e-Health Forum

implementation and deployment methods, as well as

coordination mechanisms between the various

stakeholders.

5 CONCLUSION

Telemedicine can help to improve access to

healthcare, but it requires that the structural and

organizational dysfunctions of the health sector be

taken into account. The experience of the Al Haouz

province highlights the need to raise awareness and

train human resources, as well as to improve

coordination between the various healthcare players.

Telemedicine can be a starting point for reorganizing

healthcare provision in Morocco, particularly in rural

areas.

The pilot experience in Al Haouz province

revealed a number of organizational and functional

constraints, particularly in terms of human resources

and coordination between the different levels of care.

This calls for a review of implementation and

deployment methods, as well as coordination

mechanisms between the various stakeholders; the

question now is whether Moroccan decision-makers

will be guided by a strategy that takes into account all

the lessons learned from the pilot experiences, to

ensure the success of the Royal Convention project

on telemedicine in rural areas in Morocco?

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Accessibility to Care Through Telemedicine: The Case of the Province of Al Haouz