Morocco’s health reform: when decentralisation precedes regulation
Territorial health groups are being rolled out ahead of Morocco’s High Authority for Health. This gap raises questions about care quality, evaluation and equity between regions.
In major state reforms, the sequence of implementation is often as decisive as the policy itself. Morocco’s overhaul of its national health system currently offers a striking example of an inverted timetable. While territorial health groups (GSTs) are being rolled out rapidly across the regions, the national regulatory body intended to oversee and evaluate them, the High Authority for Health (HAS), is struggling to complete its operational establishment. This timing gap raises a central health economics question: can the supply of care be decentralised effectively before the standards used to assess it have been established?
Strategic context: a two-speed timetable
The institutional sequence since the adoption of the founding legislation reveals two distinct timelines. On one side, the operational shift to territorial organisation is moving quickly. The first GST board meeting, in Tangier–Tétouan–Al Hoceima, took place as early as July 2025, followed by approval of the launch decrees for the eleven other groups in December of the same year. In 2026, several GSTs are already fully operational.
On the other side, the establishment of the High Authority for Health (HAS), created by Law 07-22 in November 2023, faces a structural delay. Its board members were appointed only in July 2026, nearly three years after the law’s promulgation and almost two years after its president’s appointment. This mismatch means that Morocco has seen the territorial organisation of care precede the full establishment of the national institution responsible for defining quality standards and ensuring evaluation.
The risk of regional fragmentation
Decentralisation without a robust national standards framework carries a major economic and health risk: ending up with a dozen regional health systems operating in silos. According to Najib Diouri, an international health economics expert, the immediate danger is that each GST will define its own performance standards.
Without a national quality framework established by HAS, objective comparison of clinical performance or administrative management between the Casablanca and Laâyoune GSTs becomes impossible. In systemic regulatory terms, this turns administrative decentralisation into fragmented care provision, undermining the principle of equity that ‘the same patient is entitled to the same quality of care’ throughout the country.
Case analysis: territorial management in a standards vacuum
GST governance concerns the territorial organisation of care, while HAS has responsibility for standards-based governance: evaluation, quality and accreditation. International comparisons, such as the Australian and French models, where certification rests on a single public framework, show that management can be territorial, but the definition of medical quality must remain strictly national.
Without this binding framework, GSTs exercise their autonomy without an independent counterweight. The principle of subsidiarity does justify central government delegating management to the regions, but that delegation in turn requires an independent information and evaluation system to assess results. ‘Decentralising without an independent evaluation mechanism does not eliminate centralisation: it replaces administrative centralisation with fragmented information,’ summarises the expert consulted.
Policy pillars and recommendations
First pillar: establish national standards before evaluating regional performance. Although it is too late to reverse the rollout timetable, HAS’s absolute priority must be the rapid publication of a common set of quality indicators binding on all GSTs.
Second pillar: clarify the division of roles between management and regulation. It is essential to establish institutionally that HAS is not an administrative supervisory body above GSTs, but a cross-cutting authority responsible for setting the rules. GSTs organise care; HAS evaluates the system against explicit standards.
Third pillar: establish a national system for comparing performance. To prevent regional autonomy from making results opaque, a national health data observatory must centralise clinical and financial indicators from the twelve GSTs, enabling transparent benchmarking.
Fourth pillar: align public and private provision under the same quality standard. HAS must take a cross-cutting approach, applying equally to public facilities managed by GSTs and to private care provision, to ensure consistent health safety for all citizens.
Institutional challenges and conclusion
The choice to prioritise the rapid establishment of a tangible regional structure over a standards-based regulatory structure illustrates the classic tension between political time, which demands visible results such as buildings or transferred budgets, and technical time, which requires the complex development of doctrines and evaluation methods.
The Moroccan state’s current challenge is no longer to justify this timetable, but to make up for lost time. The reform’s success will be measured neither by the number of boards installed nor by the volume of budgets transferred. It will be assessed by the system’s ability to improve access, safety and equity of care for patients in concrete terms, criteria whose objective measurement required HAS to be ready well before GSTs.
Limitations and objections
The argument that regulation must necessarily precede territorial action may encounter the reality of urgent local health needs. Waiting for a national authority to be fully established before addressing access problems in certain isolated regions could have worsened existing territorial divides. The government may legitimately have considered that the urgency of a local response justified an early rollout, with the standards framework adjusted subsequently through learning by doing.