Beyond deployment: retaining doctors in Morocco’s health reform

This contrast captures the challenge: in a system under such pressure, a specialist’s value lies not in being posted somewhere, but in being able to stay. That is precisely what the measure announced on 2 June 2026—compulsory regional postings for newly qualified specialists, with three to four years of public service—leaves unaddressed.

International experience is clear: compulsion secures a presence, not retention. Japan, which has combined service requirements with locally rooted training, retains 98% of its rural doctors after five years. France, which has relied on voluntary financial incentives, still leaves—despite assistance its Court of Accounts found to have no tangible effect—more than eight million residents in medical deserts, across nearly 87% of its territory. Neither compulsion alone nor money alone keeps a doctor in place: background, working conditions and support do. Today’s decisions will determine how many of the 530 specialists are still practising in the regions in 2031.

Strategic context

The shortage is first a matter of numbers. The 2024 health map records 32,665 doctors, including 15,452 in the public sector, while the ministry estimates an additional need for more than 96,000 professionals, including 32,000 doctors and 64,000 nurses. The national programme targets a density of 45 health professionals per 10,000 inhabitants by 2030, compared with around 17.4 today.

Above all, it is a matter of distribution. Nearly 25% of health professionals work in just the Casablanca-Settat and Rabat-Salé-Kénitra regions, with the most acute shortages in resource-intensive specialties—anaesthesia and intensive care, radiology and surgery. According to the World Health Organization, this uneven distribution remains a direct obstacle to universal health coverage. The measure comes as Morocco rolls out its territorial health groups through 2026 and has expanded training capacity from 2,700 medical students in 2021 to 6,500 in 2025.

Case analysis: compulsory postings and their blind spots

The measure ends a gap of up to two years between qualification and taking up a post and is accompanied by the opening of around 2,000 residency positions. Its logic is coherent. Three limitations nevertheless restrict its reach: the absorptive capacity of receiving facilities, retention after compulsory service ends, and the evidence base. WHO ranks compulsory service among its less well-supported policy levers, with low-quality evidence and only a conditional recommendation; it is effective only when accompanied by appropriate support and incentives. This combination is what separates success from failure.

Policy pillars and recommendations

Pillar 1 — Recruit for the region before requiring service there

The best-supported determinant of retention is not compulsion but the practitioner’s background. Japan demonstrates this: at Jichi Medical University, which trains rural doctors, prefectures fund all six years of study in exchange for nine years of service, six of them in rural areas; its five-year retention rate reaches 98%, compared with 81% for ordinary scholarship recipients. In South Africa, the Umthombo foundation achieves retention above 70% among the rural-origin graduates it trains and supports, well above rates observed under compulsory service alone.

For Morocco: reserve a share of places at regional faculties for students from underserved provinces and make certain scholarships conditional on return service in the home region. Combined with this geographically targeted selection, compulsory service becomes a lasting connection rather than a temporary interlude.

Pillar 2 — Do not make financial incentives the main pillar

France offers a warning, particularly relevant because its arrangements resemble Morocco’s model. France has multiplied incentives to establish practices in underserved areas. Yet its Court of Accounts found that, over 2016–2023, targeted tax relief had no tangible effect on medical deserts as schemes accumulated and became so poorly targeted that eligible areas eventually covered 45% of the population. Surveys by the Directorate for Research, Studies, Evaluation and Statistics (DREES) confirm that financial incentives are among the least decisive factors in doctors’ choice of practice location; doctors give greater weight to work–life balance.

For Morocco: an area allowance remains useful, provided it is graded against a genuine hardship index, tightly targeted and reviewed—not offered as a general entitlement. Money supports retention; it does not provide its foundation.

Pillar 3 — Make working conditions the decisive lever

If money is not enough, the working environment determines the outcome. France has recognised this by expanding support staff: the number of medical assistant contracts rose from 235 in 2019 to more than 8,500 by mid-2025. In Japan, Jichi University introduced structured research support for young graduates working in isolated rural settings. A national South African study shows that doctors who received professional development during their service were twice as likely to intend to remain in an underserved area.

For Morocco: sequence the rollout of territorial health groups (GST) so that facilities are equipped and teams assembled before specialists arrive; guarantee continuing medical education; connect regional hospitals to university hospitals through telemedicine; and give them an academic affiliation. Specialists stay where they can practise fully and develop professionally.

Pillar 4 — Calibrate the duration and provide individual support

Duration and support matter as much as the requirement itself. South Africa’s one-year community service increased rural postings to around 50%, but many graduates leave these posts at the end of the year, believing they have ‘done their duty’. France, by contrast, has recognised the importance of follow-up: its public service commitment contract (CESP), created by the 2009 HPST law, provides students with an allowance in exchange for subsequently practising in an underserved area and guarantees them individual support during training and when establishing their practice.

For Morocco: the chosen durations—three to four years—fall within a credible range and offer a stronger basis than South Africa’s short-service model. But those years must be used to build a connection through housing access and family integration, and the requirement must come with personalised support rather than a simple administrative posting.

Pillar 5 — Regulate cautiously and measure rigorously

Poorly calibrated requirements generate resistance. In France, the bill regulating practice locations, adopted by the National Assembly in May 2025 and subsequently amended by the Senate, remains strongly contested by some doctors, even though 86% of French people support regulation—showing that a measure backed by public opinion can fail without professional support.

For Morocco: negotiate the arrangements with practitioners’ representatives rather than impose them, and establish national monitoring of the post-compulsory-service retention rate by region and specialty. Without this indicator, the state cannot demonstrate that reform has delivered lasting equity rather than rapid staff turnover.

Institutional challenges and conclusion

Three obstacles will determine success: social dialogue, as the nationwide rollout of GST already prompts reservations among professionals; the fiscal sustainability of the support package, which must be coordinated with compulsory health insurance (AMO) funding as the policy emphasis shifts from coverage to quality; and the data infrastructure without which rigorous evaluation is impossible.

The comparative lesson can be stated simply: no country has retained its doctors over the long term through compulsion alone or money alone. Japan has done so by recruiting and training locally; France, which long relied on financial assistance, is now confronting its limitations for eight million citizens. Morocco has the instrument—compulsory service—and a four-year window before the first cohort completes it. The question for policymakers is not whether the 530 specialists will take up regional posts in August 2026; they will. It is how many will still be practising there in 2031. The answer is being determined now, through the measures that will—or will not—accompany the requirement.