VitaVox Institute

Reform of the Territorial Health Groups

The Territorial Health Groups reform regionalizes the management of public health facilities in Morocco, with issues of governance, resource pooling and implementation.

By:
ET
Editorial team
Health reforms

Territorial Health Groups reform in Morocco

Territorial Health Groups (GSTs) represent a structuring reform of Morocco's health system, aimed at decentralizing and regionalizing the management of health facilities. This reform, governed by Law No. 08-22 and supported by the New Development Model (NMD), recently passed a key milestone with the publication of Decree No. 2.23.1054 on April 7, 2025.

Presentation of the GSTs

GSTs, or Territorial Health Groups, are a new model for organizing public health facilities at the regional level. They replace the Regional Health Directorates (DRS) and act as regional steering instruments for health.

Each GST has legal personality, financial autonomy and management autonomy, while remaining under state supervision, which appears to indicate autonomous management that is nevertheless dependent on public funds, as discussed in a previous analysis.

Exceptions include military hospitals, collective health offices and establishments governed by specific regulatory texts.

Structure and Governance Under the New Decree

Decree No. 2.23.1054, published on April 7, 2025, implements Articles 3, 6 and 20 of Law No. 08-22, adopted in July 2024 with subsequent amendments. This decree formalizes the creation of 12 GSTs, one for each Moroccan region, with the following headquarters: Tangier-Assilah (Tangier-Tetouan-Al Hoceima), Oujda-Angad (Oriental), Fez (Fez-Meknes), Rabat (Rabat-Sale-Kenitra), Beni Mellal (Beni Mellal-Khenifra), Casablanca (Casablanca-Settat), Marrakech (Marrakech-Safi), Errachidia (Deraa-Tafilalet), Agadir Ida-Outanane (Souss-Massa), Guelmim (Guelmim-Oued Noun), Laayoune (Laayoune-Sakia El Hamra), and Oued Eddahab (Dakhla-Oued Eddahab).

Each GST is made up of all public health facilities in its territory, except for the exclusions mentioned. The board of directors of each GST is chaired by the head of government or a delegated authority, and includes:

  • A representative of the head of government.
  • A representative of the health authority.
  • A representative of social protection.
  • A representative of vocational training.
  • A representative of higher education and research.
  • A representative of the Royal Armed Forces health service.
  • A representative of the High Commission for Planning.
  • Three teacher-researchers in medicine and dentistry, elected by joint decree of the health and higher education authorities.
  • Three other health professionals, one from the Council of the Order of Physicians, Dentists and Pharmacists and two from nurses and health technicians, also elected.
  • Three independent members with medical expertise, appointed by decree of the health authority.

The transfer of assets, including movable and immovable property used in health centers, is governed by Article 20 of Law No. 08-22 and set by joint decree of the finance and health authorities.

Principles and Objectives of the GSTs

The main objectives of the GSTs include regionalizing health to ensure better coordination between facilities, optimized management of human and material resources, a smoother care pathway, and stronger public health. Their missions cover five areas: the care offer, public health, training for health professionals, research and innovation. Health students will complete internships in the various accredited units (CHU, CHR, CHP), supervised by university professors (CHU) or trained department heads (CHR/CHP).

Strengths and Weaknesses

The GSTs have several strengths, including:

  • Resource pooling: By pooling resources, they optimize the use of available means.
  • Coherent organization: Bringing all facilities under a single authority facilitates care-pathway management, resource allocation and patient orientation, reducing waiting times.
  • Stronger public-private partnership: By combining public resources, GSTs increase the weight of the public sector in relation to the private sector, encouraging more balanced collaboration.

However, major challenges remain:

  • Large scale: For example, in Rabat-Sale-Kenitra, more than 350 health facilities are included, making management complex and risking overburdening the structure.
  • Cultural differences: University hospitals, focused on tertiary care (complex care and student training), and regional/provincial hospital centers, focused on primary care (prevention and simpler procedures), have divergent mindsets, complicating integration.

Conclusion

In short, GSTs offer a unique opportunity to regionalize and optimize health in Morocco, but their success will depend on the ability to turn these ambitions into concrete results on the ground. How, then, can public actors, private actors, health professionals and citizens collaborate to make GSTs a lever for equity and innovation, while overcoming the tensions between centralization and regional autonomy?