A Cooperation Crisis: Should Young Doctors Be Forced to Serve in Rural Areas?
Floating through the ACCESS Health Rabat office windows comes the rhythmic sound of thousands of feet hitting the pavement, of chanting, of police whistles. Rows and rows of white clad protesters file past with banners held high and voices raised in anger. Our offices are very close to the Parliament of the Kingdom of Morocco, and it is there that the protesters want their voices heard.
An estimated ten to fifteen thousand medical and paramedical students marched in protest yesterday against the Ministry of Health proposal to introduce a compulsory medical service. The proposal aims to overcome the lack of doctors in the poor and rural areas by obliging medical students to work there for two years. Doctors will not receive their diplomas until they have completed their medical service.
The Ministry of Health has long been trying to tackle the imbalance in the geographical distribution of doctors and paramedics. Forty five percent of doctors are installed in just two regions in Morocco, where the cities of Casablanca and Rabat are.
The protest yesterday comes after two months of heavy disagreement between medical students and the Ministry. Since Sept. 1, medical students have been boycotting classes and are on strike in hospitals. This new standoff comes as no surprise. The relationship between the Ministry and doctors has been strained for years. Tensions have been building, and now it looks like they are set to explode.
There is no denying the challenge the Ministry is facing. There are not enough doctors in Morocco. (Then again, where are there enough doctors and nurses?) Those that are there are are mostly pooled in the big cities. Access to basic care for those living in rural areas is still very poor. Corruption remains rife in many healthcare centers. And Morocco faces the most basic, common, and profound of challenges: There is a lack of financial resources in public health. It is not a national political priority. There is only so much that introducing new medical coverage programs such as RAMED can do. You have to have the infrastructure to back these initiatives up.
On the other hand, the students have a point. The suggested pay of less than 350 dollars a month for two years, after eight years of study, is very low. The students will have no choice where they are sent. Many doctors struggle to get a job after they graduate from medical school. With almost no possibilities for career advancement, almost no continuous education or training programs, stressful and difficult working environments, and no financial incentives, what is there to motivate staff? Why should young people dream of becoming doctors?
The students’ determination to improve salaries, working conditions, job opportunities, and above all, oppose compulsory medical service has been impressive. Their protests and communications have been peaceful, well organized and effective. They have succeeded in making their voices heard. Here are some of their campaign posters:
Although I see both sides of this argument, the thing I find most encouraging is that the debate is happening. Through highlighting the human resources issue, medical students have helped provoke a national conversation about public health in Morocco. It is time to face up to the deep structural issues that exist, and the price the people pay for them. Last night, after the protests, I sat in a café to drink my mint tea. All around me, debates were taking place about how these problems are going to be solved. There is no doubt: there are many more debates to be had and there is much more work to be done.