The role of contractual arrangements in improving health sector ...

Morocco
The number of patients currently receiving treatment is about 3500, of which 1420 are
in the public sector. Another 2135 patients are in need of treatment and are on the waiting lists
of public haemodialysis centres.
Treatment for end-stage renal disease is provided in two ways: kidney transplantation
and haemodialysis. In Morocco, haemodialysis constitutes the principal treatment, with
kidney transplantation limited to a few cases per year. Morocco has about 95 haemodialysis
centres, of which 28 are in the public sector. The equipment of these centres includes 1023
artificial kidneys, of which 351 are in the public sector.
A haemodialysis generator cost between US$ 12 500 and 16 500. The water treatment
unit costs about US$ 4000. Treatment for end-stage renal disease in a hospital costs about
3
US$ 187 20TP PT. Care for the 2135 patients waiting treatment will cost, as a recurring cost,
4
US$ 40 000 000 a year plus an initial investment of US$ 6 450 000TP PT.
The high cost of infrastructure and treatment for renal disease makes it difficult to
respond to the expressed need within a context of competitive priorities and budgetary
constraint.
In order to provide haemodialysis services required by patients with end-stage renal
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disease two different forms of contractual arrangements were consideredTP PT:
1) Contracting for support from non-profit associations
This form of contracting was to support treatment provision to end-stage renal disease
patients. The partnership with the non-profit associations is organized as follows:
The Ministry of Health assigns staff to the centre and covers some fixed charges (water,
electricity, etc.), blood products and some medicines and pharmacy products (heparin).
The associations cover expenses related to equipment, medicines and consumables, including
equipment maintenance.
The majority of patients contribute to their care expenses (200 to 500 Moroccan dirhams per
session, depending on the case).
This arrangement depends largely on the availability of an association willing to
undertake the investment. The number of beneficiaries of care is often limited, and does not
include all patients in need of treatment. This contracting option basically amounts to
participation in end-stage renal disease care, and is not sustainable.
2) Contracting for the lease of equipment and supplies
3 Etude sur l’analyse des coûts par activité à l’hôpital d’Agadir, PFGSS, DHSA, Ministère de la Santé du Maroc.
4 Cost of 336 generators and 50 water treatment units.
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The care strategy regarding final kidney deficiency includes also prevention and kidney transplantation that are not
discussed in this paper.
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