Stratégie Nationale Multisectorielle de Prévention et de Contrôle des Maladies Non Transmissibles

Objectives

Morocco’s 2019–2029 National Multisectoral Strategy for the Prevention and Control of Non-communicable Diseases aims to make non-communicable diseases a national development priority and reduce associated morbidity, disability and premature mortality through an integrated, equitable and multisectoral response.[1][2][3]It is aligned with the Health 2025 strategy, Sustainable Development Goal 3 and World Health Organization commitments on prevention, health-system strengthening, surveillance and tobacco control.[4][5][6]

• Promote healthy lifestyles and prevent non-communicable diseases by addressing tobacco use, harmful alcohol use, unhealthy diets, physical inactivity, air pollution and related behavioural, environmental and socioeconomic determinants.[7][8][9]
• Prioritise cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, mental disorders and chronic renal failure, while extending action to oral and eye health, addictions, haemophilia, thalassaemia, rheumatic fever, rare diseases, chronic inflammatory diseases, hearing impairment and neurodegenerative conditions.[4][6][10]
• Improve equitable access to person-centred prevention, screening, diagnosis, treatment, palliative care, rehabilitation, essential medicines, technologies and specialised services regardless of gender, income, social status or place of residence.[11][2][10]
• Strengthen governance of non-communicable diseases and their risk factors, including legislation, multisectoral coordination, community participation, individual responsibility and accountability for quality of care.[2][3][12]
• Develop surveillance, monitoring, evaluation and research to inform decisions, update epidemiological evidence, assess socioeconomic impacts and measure progress against national targets and World Health Organization indicators.[8][12][13]
• Achieve 2029 targets including lower tobacco use, physical inactivity, salt intake, hypertension, harmful alcohol use and premature mortality, alongside slower growth in diabetes prevalence, improved access to essential medicines and greater cardiovascular-risk prevention coverage.[3][14][15]

Implementation

Implementation uses a participatory, whole-of-government and whole-of-society model led by the Ministry of Health, combining prevention in healthier settings with integrated primary, provincial and specialised care pathways.[16][2][17]The strategy contains four action axes: healthy lifestyles and prevention; improved access to care; improved governance; and strengthened surveillance, monitoring, evaluation and research.[8]

• Coordinate implementation through a Ministry of Health steering committee chaired by the Secretary-General and a technical committee chaired by the Director of Epidemiology and Disease Control, with participation from central and regional health administrations, government departments, learned societies, non-governmental organisations, the private sector and agri-food industry representatives.[2]
• Engage public institutions, territorial and regional actors, health-insurance and social-protection bodies, civil society, professional organisations, international partners and sectors affecting food, education, sport, environment, taxation and social development.[18][16]
• Integrate prevention and chronic-disease management within approximately 2,800 primary healthcare establishments through a minimum service package, family medicine, patient-care pathways, mobile services and rural health planning.[19]Primary care centres provide promotion, screening, selected treatment, therapeutic education and follow-up, while provincial reference centres and regional or interregional hospitals provide progressively more specialised care.[17]
• Establish provincial reference centres, centres of excellence and one diabetes centre for young people in each region; institutionalise care pathways in regional health-service plans; and strengthen oncology, oral, ocular, palliative, supportive and emergency services.[17][10]
• Deliver prevention through communication campaigns, professional training, smoke-free settings, tobacco-dependence and alcohol-cessation support, healthier food policies, reduced salt, sugar and fat consumption, physical-activity promotion, hepatitis B and human papillomavirus vaccination, and action on air pollution.[9]
• Strengthen legal and regulatory measures on tobacco, taxation of harmful products, medicines, dental practice, drug policy, mental health and air pollution, including advocacy for ratification of the World Health Organization Framework Convention on Tobacco Control.[20][12]
• Operate surveillance through regular Stepwise surveys, cancer and rare-disease registries, mental-health prevalence surveys, air-quality monitoring, dashboards at all levels and computerised information systems.[13]Indicators draw on the World Health Organization’s 25 global indicators and nine global targets, with verification through surveys, screening systems, oncology-centre systems, vaccination records and routine health information.[12][21][14]
• Monitor specific cancer-control targets of 80% participation in breast and cervical cancer early-detection programmes, treatment for 100% of cancer patients and human papillomavirus vaccination for 90% of eligible girls.[21]
• Finance implementation through stronger medical coverage, rationalised budget allocations, additional resource mobilisation, public-private partnerships and fiscal measures affecting harmful products.[16][20]The estimated strategy cost is 5,430,590,000 Moroccan dirhams, excluding human-resources expenditure; 4,344,472,000 Moroccan dirhams is allocated to strengthening care and new programmes, and 705,976,700 Moroccan dirhams to surveillance, monitoring, evaluation and research.[13]Financing sources, funding gaps and a detailed resource-mobilisation plan are not specified in the available material.[13]

Monitoring & Evaluation

Monitoring, evaluation and research constitute one of the strategy’s four strategic axes. The framework aims to strengthen surveillance of non-communicable diseases (NCDs) and their risk factors, generate evidence for decision-making, assess interventions, and report against the World Health Organization’s 25 global monitoring indicators and nine global targets.[8][12][21]

• Develop a national monitoring and evaluation system for NCDs and risk factors, supported by targets for 2029.[3]
• Conduct regular epidemiological surveys, including Stepwise Approach to NCD Risk Factor Surveillance (STEPS) surveys, alongside health, family-health, tobacco and oral-health surveys.[19][13]
• Strengthen disease registries, including cancer and rare-disease registries, the Grand Casablanca Cancer Registry, and the Magredial renal-failure registry.[6][19][13]
• Monitor mental-health disorders, air quality and NCD risk factors, including through eco-epidemiological air-pollution surveillance and prevalence surveys among adults, children and adolescents.[13]
• Revise and computerise NCD information systems across all levels of care, and establish programme dashboards for NCDs and risk factors at all levels.[13]
• Undertake socio-economic, biomedical, behavioural, socio-anthropological, knowledge-attitude-practice and intervention-evaluation research, including periodic assessments among people who inject drugs.[13]

Existing evidence sources include the World Health Organization Global Health Observatory, the 2017–2018 national STEPS survey, the Grand Casablanca Cancer Registry for 2008–2012, and the 2018 World Health Organization country profile.[6][7]The 2018 STEPS survey recorded 21.1% insufficient physical activity, estimated average salt intake of 12 grams, 13.4% tobacco use among adults, 29.3% hypertension, 10.6% diabetes and 10.4% pre-diabetes.[14][15]

Core 2029 targets include reducing tobacco consumption among people aged 15 years and over by approximately 20%, insufficient physical activity by 10%, salt consumption by 10%, hypertension by 10%, harmful alcohol use by 10%, and premature NCD mortality by 25%.[3]Additional targets include reducing the increase in diabetes prevalence by 15%, ensuring 80% access to essential medicines in primary healthcare facilities for people followed for diabetes and hypertension, and providing preventive treatment for myocardial infarction and stroke to 50% of eligible people.[3]

Cancer-related targets include 80% participation in breast- and cervical-cancer early-detection programmes, treatment for 100% of cancer patients, and human papillomavirus vaccination for 90% of girls in the target age group.[21]Reported baselines were 36% for breast-cancer screening, 8% for cervical-cancer screening and 71% of patients receiving care in 2017; no baseline was available for the human papillomavirus vaccination indicator.[21]

Verification mechanisms include a planned 2025 NCD risk-factor prevalence survey, routine health information systems, screening information systems, oncology-centre information systems and the vaccination information system integrated within the national immunisation programme.[21][14][15]The source does not specify reporting schedules, indicator definitions, evaluation cycles, indicator ownership, surveillance governance or formal accountability mechanisms beyond the proposed monitoring system, dashboards, targets and verification sources.[3][13][14][15]

Costing & Financing

The strategy’s implementation is estimated at 5,430,590,000 Moroccan dirhams, excluding human-resources expenditure.[13]The budget is principally directed towards strengthening NCD care and developing new programmes, with further allocations for surveillance, monitoring, evaluation and research; healthy-lifestyle promotion and prevention; and governance.[13]

• Allocate 4,344,472,000 Moroccan dirhams to strengthen NCD care and develop new programmes.[13]
• Allocate 705,976,700 Moroccan dirhams to surveillance, monitoring, evaluation and research on NCDs and their risk factors.[13]
• Allocate 271,529,500 Moroccan dirhams to healthy-lifestyle promotion and NCD prevention.[13]
• Allocate 108,611,800 Moroccan dirhams to improve governance of NCDs and their risk factors.[13]

Financing priorities include strengthening basic medical coverage, rationalising NCD resource allocations, mobilising additional funds, expanding public-private partnerships and improving collaboration with civil society, professional bodies and national and international organisations.[20]The strategy also identifies increased medicine budgets, wider facility coverage with NCD medicines, greater use of generic medicines, revision of the essential-medicines list and price controls as measures to improve access and medicine financing.[22]

Funding for NCD prevention and control is described as insufficient, while high treatment costs and limited compulsory health-insurance coverage for long-term conditions constrain access to care.[23]Fiscal and taxation measures are envisaged to reduce consumption of harmful products, including tobacco and alcohol, alongside exemption of certain long-term-condition medicines from value-added tax.[16]Medical coverage was reported to reach 62% of Morocco’s population through compulsory health insurance and the Medical Assistance Scheme.[18]

The World Health Organization provided technical and financial support to the Ministry of Health for strategy development and implementation of the Stepwise survey.[1]The source identifies no financing sources for the overall strategy budget, detailed resource-mobilisation plan, quantified funding gap or economic assumptions beyond the exclusion of human-resources costs.[13]