Last week, I attended a conference in Rabat entitled “Reducing Maternal Mortality in Morocco: Sharing Experiences and Sustaining Progress”. Morocco is one of the few developing countries that can legitimately argue that it is on track to achieve MDG5 – a three quarters reduction in maternal mortality from 1990 to 2015 – so I was very excited to get first hand knowledge of what I could learn from the Moroccan experience that could then be generalized to other countries.

In the early 1990s, the maternal mortality ratio (MMR) in Morocco was estimated in the vicinity of 330. According to the most estimates, the MMR in Morocco is now around 112 – which means that they have reduced their MMR by a whopping 60%! Much of the reduction has actually taken place during the past 5-7 years, coinciding with intensified efforts on the part of the government to reduce MMR. Given its trajectory, many people think that it will be able to go the rest of the way and actually achieve MDG5.

At this point I am sure a lot of you are thinking about measurement and data issues and whether or not we can actually say that Morocco has reduced its maternal mortality. This is a valid concern (and one which will plague all assessments of performance against MDG5) but all of the currently available sources of data on the MMR in Morocco seem to suggest that real declines have occurred: the UN Intra-Agency estimates, the IHME estimates (i.e. Hogan et al. 2010), and Morocco’s own estimate all point to similar trends.

So how did Morocco do it? After decades of incremental efforts there was a big shift in priority given to maternal mortality in 2008 when the government launched the ambitious strategy for accelerating reduction in maternal and child health (PARMMI). The strategy involves three major components: addressing physician and financial barriers, improving quality of care, and improving the management of governance of the programs themselves.

The government implemented just about every programmatic activity that has ever been thought to be effective using a “whole-of health-systems” approach: making obstetric care free, rolling out ambulances, training of health workers, increasing the number and distribution of health workers, implementing a mobile phone enable monitoring system, launching efforts to improve service quality, increasing awareness of the issues, and dramatically strengthening the information base available to the government to monitor progress. This last point also included a very intensive effort to track and audit all maternal deaths – a system one international expert called the “Cadillac” national maternal mortality surveillance system. They did it all and they did it quickly and effectively using resources from mainly the government but also from their development partners.

Given the number of interventions that were simultaneously launched it is difficult to tease out exactly what work, when, for whom, and why. The academic in me me wished there had been more evaluation of their experience and was left really wondering which interventions had been the most effective and why — but we we may never know.

But I did not leave the country disappointed as in the end I did learn why Morocco was able to achieve such a miraculous decline in maternal mortality: strong political commitment. During the conference the Minister of Health, a young woman not too much older than myself, stated that maternal mortality was the most important priority that her Ministry was attempting to address. So much so that victory for her was not achieving MDG5 but rather achieving an even lower MMR that she felt was more appropriate to their level of development. What sets Morocco apart from many other developing countries is the extent to which they have placed maternal mortality on the top of their list of priorities and have exerted significant effort and allocated substantial resources towards the issue. For maternal mortality, it seems that if there is a will, then there is a way.

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22 Responses to “Morocco’s Maternal Mortality Miracle”

  1. Karen Grepin says:

    Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  2. RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  3. Tom Murphy says:

    Morocco’s Maternal Mortality Miracle via @karengrepin

  4. Globalcpal says:

    Strong political commitment VITAL. Grt piece. RT @viewfromthecave: Morocco’s Maternal Mortality Miracle via @karengrepin

  5. Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  6. PSI says:

    Maternal mortality rates drop in #Morocco thnx to govt action. @KarenGrepin’s blog – #maternalhealth #globalhealth

  7. PSI says:

    Maternal mortality rates drop in #Morocco thnx to govt action. @KarenGrepin’s blog – #maternalhealth #globalhealth

  8. Zuma says:

    Maternal mortality rates drop in #Morocco thnx to govt action. @KarenGrepin’s blog – #maternalhealth #globalhealth

  9. RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  10. Maternal mortality rates drop in #Morocco thnx to govt action. @KarenGrepin’s blog – #maternalhealth #globalhealth

  11. bouchra assarag says:

    merci beaucoup chère Karen pour cette note qui montre vraiment les étapes que le Maroc a mis pour arriver à ces réalisations en matière de réduction de la mortalité maternelle , il faut se dire que c’était un défi pour notre pays et notre ministère d’améliorer cet indicateur qui n’a pas cesser de nous perturber malgrés le développent que connait notre pays dans tous les domaines .
    notre stratégie à mon sens était tributaire en premier lieu d’un engagement politique sérieux et effective par notre ministre qui avait la devise qu’il ya pas de raison que des femmes meurent en donnant la vie et donc 0 tolérance devant chaque décès , mais cela en mettant à disposition les moyens pour faire face , il faut se dire que notre stratégie c’était une stratégie globale intégrée avec l’implication forte et fédération des prestataires à tous les niveaux et de la communauté . en conclusion je ne peux qu’encourager la communauté pratique car à travers cet organe il ya le rapprochement entre les décideurs et les chercheurs afin de prendre des décisions éclairée basée sur l’évidence

  12. OperationOF says:

    RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  13. RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  14. RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  15. sethcochran says:

    RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  16. hashtag4aid says:

    #4aid RT @KarenGrepin: Morocco’s Maternal Mortality Miracle (blog post): #globalhealth #maternalhealth

  17. Morrocco's Maternal Mortality Miracle: where there's (political) will, there's a way another blog post frm @karengrepin

  18. Rob Yates says:

    #uhc supply side reforms and free maternity services reduce MMR by 60 % in Morocco @KarenGrepin

  19. Melissa says:

    A good article on maternal health issues. I am writing on behalf of Women and Children First, who also advocate maternal health concerns, seeking to raise awareness and reduce the number of mothers and babies that die in childbirth in the developing world.
    There is a web link to the organisation, if you require further information.

    Women and Children First

    Thank you for your support!

  20. Mohamed Salem says:

    Thank you Karen for this nice overview on the MMR in Morocco. Actually their experience is a very strong argument on the success of vertical programs.
    Although the global trend is moving towards integration of vertical programs into a wider scope of strengthening the health services and tackling the social determinants of health. The Moroccan experience in MM proves that the vertical programs are more effective in achieving the national and the global targets.

    The counterargument might be that this improvement occur on the short term or it might shift resources from other health priorities in this country. As you said there should have been a strong evaluation research on the impact of this efforts on the Maternal Health and the other health priorities in Morocco

    • Karen Grepin says:

      I agree. Vertical programs have their places and when well managed might do a lot of good. But the decision on how to design a given program should be country and target specific as there is no such thing as a one sized fits all solution.

  21. […] in Morocco on the topic of maternal mortality. Karen Grepin, from NYU, attended the conference and reports: The [Moroccan] strategy involves three major components: addressing physician and financial […]

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