GST: Morocco’s New Territorial Health Architecture

At the start of 2026, Moroccan health is no longer merely reforming; it is reinventing itself. After the foundations laid by Framework Law 06-22 and Law 08-22, the Territorial Health Groups (GST) are entering their active generalization phase. With a record budget of MAD 42.3 billion allocated to health in the 2026 Finance Bill, a 30% increase compared with 2025, the issue is no longer legislative; it is operational.

1. Where Do GSTs Come From?

The emergence of GSTs is the result of a legislative process accelerated by the pandemic crisis and the royal vision of 2021. To understand what is at stake, it is necessary to retrace the trajectory of this regional sovereignty:

• The founding framework (2022): Framework Law No. 06-22 (promulgated by Dahir No. 1-22-75) established the four pillars of the reform: governance, human resources, upgrading the care offer and digitalization.
• The birth certificate (2023): Law No. 08-22 (promulgated by Dahir No. 1-23-50 on June 28, 2023) creates GSTs as public establishments with legal personality and financial autonomy. Historically, the system was fragmented between Basic Health Care Services (ESSB) and autonomous university hospital centers (CHUs). Law 08-22 merges these entities into a single regional structure, ending direct management by the Ministry of Health (SGG).
• The pilot phase (2024-2025): The Tangier-Tetouan-Al Hoceima region served as a stress test. It showed that administrative merger, between the CHU and regional hospitals, is more complex than expected, particularly in terms of merging budgets.
• The 2026 momentum: As reported by Le Matin, the government is accelerating the operationalization of the other 11 GSTs to cover the entire territory.

2. Why Is This Model Economically Disruptive?

Each GST is an autonomous public establishment. It manages its own human and financial resources. This is the application of the subsidiarity principle: "those on the ground decide." In health economics, GST introduces a radical transformation of the financing model:

1. Activity-Based Pricing (T2A)

The global-allocation model is replaced by financing linked to real activity. The GST becomes a service provider billing its procedures to the CNSS.

This shift to T2A forces facilities into an unprecedented level of accounting rigor. Financial balance now depends on the GST’s ability to code its procedures accurately, transforming the hospital from a cost center into a value-production unit.

2. Regional Pooling of Resources

The GST acts as a regional purchasing center. By consolidating the needs of an entire region for medicines and medical devices, it strengthens its negotiating power.

ROI on technical platforms: Pooling makes it possible to rationalize the installation of heavy equipment, such as MRI machines and scanners, according to the real needs of the population catchment area, thereby avoiding costly duplication.

Finally, there is a hierarchical care pathway: The model imposes a referral system. Patients first access primary care before being referred to the CHU at tertiary level, thereby optimizing the cost of care.

3. The Weak Spots: The Reform’s "Gray Areas"

The History of Delays in the Shared Patient Record

A GST without an integrated information system is a blind structure. This is where the problem has historically been most acute. As a pivotal investigation by Le Desk pointed out, the Shared Patient Record (DPP/DMP) project has suffered chronic delays since 2012.

• The missed gains: The absence of a shared medical history between rural and urban areas has generated an estimated waste of billions of dirhams over a decade through redundant tests. Without a fully integrated information system between rural health centers and CHUs, pathway fluidity remains theoretical.
• The technology debt: In 2026, the success of GSTs depends on information-system interoperability. The history of delays shows that the resistance was not technical, but organizational, particularly around data governance. The GST must now clear this debt to enable smooth AMO billing.

Human Resources and Social Dialogue

The reform cannot succeed without the buy-in of human capital. Law No. 09-22 on health professionals creates a status that departs from the traditional civil-service framework.

• Performance allowance: The introduction of a variable component linked to performance aims to improve the attractiveness of the public sector.
• Identified risks: As regularly reported by Le Matin, although the increase in allowances (MAD 500 for nurses in 2025-2026) is a first step, regional mobility management remains a major point of friction with unions. Unions fear that regional autonomy could create treatment disparities between "rich" and "poor" GSTs.
• Finally, activity-based financing (T2A) and the shift from an allocation budget to actual billing of care to the CNSS require an unprecedented increase in managerial skills among GST directors.

4. What Citizens Should Expect from 2026

The purpose of GSTs is not accounting; it is human. Moroccan citizens have the right to expect:

1. Territorial equity: A resident of Midelt should be able to benefit from the same expertise as a resident of Rabat, thanks to telemedicine and specialist mobility within the Draa-Tafilalet GST.
2. The end of the obstacle course: Thanks to the unified information system, patients should no longer have to carry paper files or repeat costly tests from one hospital to another.
3. Shorter delays: Management autonomy should make it possible to recruit locally and maintain equipment, such as scanners and MRI machines, without waiting for central administrative approval.

In short, for the GST reform not to be added to the list of unfinished projects, three levers for action are needed: first, publicly evaluate the pilot before generalizing it, by publishing a readable assessment of Tangier’s successes and bottlenecks to dispel union distrust. Second, guarantee the attractiveness of vulnerable territories through concrete incentives, such as housing, career pathways and telemedicine, to prevent regionalization from becoming a way of managing shortages. Finally, invest in useful digital tools that simplify administration rather than making it more complex, so that technology frees up medical time instead of adding to practitioners’ workload. The success of 2026 will not be decided by the law, but by this ability to reconcile the state’s accounting ambition with the realities faced by health workers and patients on the ground.