Paquet Minimum de Services en Addictologie : Guide National de Référence

Objectives

Morocco’s 2019 national reference guide for the minimum package of addiction-care services supports the National Programme for the Prevention and Management of Addictive Disorders and the Health Plan 2025. It seeks to standardise an equitable, coherent and person-centred package of prevention, harm reduction, treatment, rehabilitation and social reintegration services for people affected by substance-related and behavioural addictions.[1][2][3][4]

• Define a minimum package as an integrated set of essential, effective, feasible and acceptable interventions that communities can access within available public resources.[5]
• Harmonise service standards, technical and functional requirements, intervention norms, equipment and essential medicines across addiction-care structures.[2][6]
• Organise care through a three-level pyramid comprising primary-level local health institutions, secondary hospitals and specialised services, and tertiary university hospitals.[7][5][8]
• Improve early diagnosis, access, quality, continuity and comprehensiveness of care, particularly for underserved, key and marginalised populations, young people and women.[2][3][9]
• Address substance-related and behavioural addictions, including associated physical and psychiatric comorbidities, while involving families and other close contacts where appropriate.[10][11]
• Integrate prevention and management of HIV, viral hepatitis, tuberculosis and other relevant health conditions into addiction services.[9][10]
• Strengthen community responses, including prevention, harm reduction, psychosocial support, protection of the rights of people who use drugs, stigma reduction, and social and vocational reintegration.[12][13]
• Promote abstinence, reduced use or cessation where appropriate through withdrawal management, relapse prevention, treatment of comorbidities and reintegration into family and community life.[14][15]
• Develop specialist university-hospital capacity for complex care, residential treatment, teaching and research.[11][16][17]

Implementation

The guide adopts an integrated medical, psychological, social and community-based delivery model. It combines specialised vertical services with integrated horizontal services, formal care pathways, coordination between clinical and community teams, and differentiated provision from outreach and primary care to specialised hospitals and university services.[6][18][19]

• Use the national reference guide to support managers, health professionals, institutional actors and civil-society organisations in delivering a locally adaptable minimum package aligned with health reforms, human-rights principles, applicable regulations and international standards.[3][6]
• Provide a first point of access through general practitioners, treating doctors, primary-care facilities, level-2 health centres or, where relevant, low-threshold community services.[10][18][12]
• Deliver unconditional reception, registration, motivational interviewing, brief interventions, medical, psychological, social and relational assessment, personalised care planning, clinical follow-up and referral.[20][14][21]
• Establish integrated addiction-care units in locally selected health centres, including methadone dispensing where needs are identified, and connect addiction consultations with mental-health services.[20]
• Provide specialised outpatient, inpatient, crisis and detoxification services through addiction centres, psychiatric hospitals and university hospitals, including management of acute intoxication, overdose and psychiatric or physical complications.[11][15][19]
• Combine pharmacological treatment, opioid-substitution treatment where indicated, medically supervised withdrawal, psychotherapy, peer and mutual-support groups, family work, psychosocial rehabilitation, occupational activities and relapse-prevention support.[14][22][23]
• Operate fixed community units offering psychosocial support, mediation, self-support activities and reintegration assistance, alongside mobile units providing outreach, prevention information, sterile consumption equipment, condoms, infection screening and referral at locations where people use drugs.[24][25][26]
• Formalise internal and external referral and counter-referral pathways linking primary care, addiction centres, general and psychiatric hospitals, social services, laboratories, radiology services, community organisations and other sectors.[6][16][27]
• Develop local inventories of health and social resources, including emergency accommodation, and make contact information available to support referrals.[28]
• Coordinate centre management through joint medical and community planning, shared facilities where appropriate, a single beneficiary code and confidential information sharing.[29][30]
• Apply the tripartite framework involving the Ministry of Health, the Mohammed V Foundation for Solidarity and the Association RDR-Maroc, supported by centre-level, provincial and regional coordination committees.[29]
• Maintain required infrastructure, staffing, technical platforms, medicines, medical devices, information tools and consumables, with Regional Health Directorates responsible for sustaining core supplies in primary-care consultations.[31][32][33]
• Make methadone, buprenorphine, buprenorphine-naloxone and naloxone available through addiction services; supply naloxone on annual estimates validated by the national programme and distribute it to addiction, community, emergency medical and hospital emergency teams.[34][35]
• Use patient records, referral forms, stock and accounting records, activity logbooks, monthly reports and a progressively centralised digitised information system to support service management and monitoring.[36][37][38][39]
• Monitor service-user profiles, demand, service-activity indicators, emerging trends and adverse events; notify and investigate intoxications, overdoses and deaths associated with psychoactive substances, including notification to regional public-health services and the Moroccan Poison Control and Pharmacovigilance Centre.[12][24][40]
• Support quality improvement through risk mapping, improvement plans, staff training, self-assessment, user-satisfaction assessment, audits, research and evaluation of territorial inequalities.[5][30]

Monitoring & Evaluation

The guide establishes a multi-level monitoring, information and accountability approach for addiction services, combining routine activity reporting, surveillance of drug-related harms, patient-pathway documentation, service-quality improvement and progressively digitised information systems.[36][37][38][39]

• Monitor service-user profiles, changes in demand, activity-production indicators, emerging phenomena, new trends and adverse events associated with care across community, outpatient, hospital and university services.[24][26][11][22][21][40][16]
• Record patient care through beneficiary health cards, individual medical records, consultation and hospitalisation files, laboratory-result sheets, treatment manuals, care protocols, referral forms and counter-referral documentation.[38][39]
• Maintain institutional records on activities, essential-medicine and input stocks, equipment inventories, accounting, personnel, meetings, supervisory visits, community activities and support activities.[36][37][38][39]
• Compile monthly service and institutional reports, use activity logbooks and supervision records, and maintain semi-annual addiction information reports while progressing towards a shared central database.[36][37]
• Use semi-annual activity-monitoring tools and quarterly or semi-annual activity reports and summaries within community and addiction-centre services.[25][26]
• Develop a common, centralised and computerised information system with differentiated access for local services, addiction centres, regional health-delegation services and the central Ministry of Health.[36][37][8]
• Apply digitised questionnaires to capture beneficiary profiles, contact dates and times, and preventive, curative, social and health activities delivered by facilities and community hubs.[37]
• Strengthen monitoring and follow-up of care pathways, supported by internal and external coordination tools and formal referral and counter-referral arrangements.[6][18][28]
• Address informal referral practices, which contribute to losses between levels of care, and improve pathway visibility where stigma and limited information impede access.[9]
• Notify regional public-health services and Morocco’s Poison Control and Pharmacovigilance Centre of intoxications, overdoses and deaths related to psychoactive substances.[12][24][26][21][40]
• Investigate deaths among people who use drugs systematically, including through verbal autopsy, and participate in studies and research to support surveillance and service development.[12][24][26][40]
• Update maps of drug-consumption locations regularly to guide mobile outreach deployment.[26][40]
• Monitor naloxone provision through collaboration between the National Programme for the Prevention and Management of Addictive Disorders and the Moroccan Poison Control and Pharmacovigilance Centre.[34][41]
• Support quality improvement through risk mapping for activities and care pathways, improvement plans, staff training, self-assessment, anonymous user-satisfaction assessment and a shared data-collection system with a unique beneficiary code.[30]
• Maintain coordination records, with meeting minutes circulated within seven days, validated at the next meeting, archived and shared by the medical and community teams.[30]
• Use the minimum service package to support internal and external organisational audits, assess territorial inequalities and inform scale-up, service upgrading, strategy revision, training and research.[5]
• Include evaluation of addiction-service components in certification procedures implemented by regional health directorates.[8]

No consolidated numerical indicator framework, performance targets, universal evaluation timetable or fully specified reporting-accountability structure is provided in the available material.[42][43][44][5][36][8]

Costing & Financing

The guide identifies substantial resource requirements for implementing an integrated minimum package of addiction services, but provides no overall budget, costing methodology, funding-gap estimate, allocation framework or economic assumptions.[5][36][19][38]

• Mobilise adequate human, material and financial resources, backed by commitment from public authorities, to implement the service package effectively.[5]
• Recognise that staffing has major budgetary, training and human-resources-management implications, while preserving the defined quality of care.[28]
• Provide infrastructure, equipment, medical and technical materials, essential medicines, medical devices, consumables and information-system capacity across primary, secondary, tertiary and community services.[45][43][46][47][48]
• Maintain required equipment, medicines, products and medical devices in primary-healthcare consultations through Regional Health Directorates and their technical services.[32][33][47][49][41][50]
• Supply psychotropic medicines, withdrawal-treatment medicines, opioid-substitution treatments, naloxone, rapid drug-detection tests, sterile injection equipment, condoms and basic laboratory examinations.[51][34][52][35]
• Ensure secure methadone storage and dispensing capacity, including supervised-consumption cups, secure take-home bottles, dispensing rooms and urine-sampling facilities.[32][46][53]
• Address the absence of a dedicated operating budget for each addiction centre and resource constraints affecting staffing, medicine availability, equipment maintenance, methadone-dispensing sites and service expansion.[7]
• Support workforce retention through continuing training, suitable facilities or accommodation and possible salary incentives.[5]
• Cover purchases of medicines outside the essential medicines list, including medicines used for withdrawal treatment, and paraclinical examinations for people most in need.[25][13]
• Use financial support from the Health Systems Strengthening Programme of the Global Fund to Fight AIDS, Tuberculosis and Malaria; no associated monetary value is provided.[2]

Specified operational quantities include methadone concentration, projected treatment numbers, an average daily dose as written in the source, screening-test estimates and annual naloxone requirements. These are supply assumptions rather than monetary costs, and no currency or unit price is provided.[33][49]