title: Actions on social determinants and interventions in primary health to improve mother and child health and health equity in Morocco.
abstract: BACKGROUND
  Over the last two decades, Moroccan authorities launched a number of actions and strategies to enhance access to health services and improve health outcomes for the whole population in general and for mother and child in particular. The Ministry of Health launched the action plans 2008-2012 and 2012-2016 and created the maternal mortality surveillance system. The Moroccan government opted for national health coverage through a mandatory health insurance and a scheme of health assistance to the poorest households. Other initiatives were devoted indirectly to health by acting on social determinants of health and poverty reduction. In this paper, we present results of an evaluation of interventions and programmes and their impact on health inequity in Morocco.
  
  
  METHODS
  We used data provided by national surveys over the last decades, information released on the website of the Ministry of Health, documentation published by the Moroccan government and international reports and studies related to Morocco and published by international bodies like the World Health Organisation, United Nations Development Programme, United Nations Population Fund, UNICEF, UNESCO and the World Bank. A short review of scientific publications was also carried out in order to select papers published on health equity, social determinants, health system and interventions in primary health in Morocco. Inferential and descriptive statistics (including principal component analysis) were carried out using software SPSS version 18.
  
  
  RESULTS
  The findings indicate that substantial achievements were obtained in terms of access to health care and health outcomes for the whole Moroccan population in general and for mothers and children in particular. However, achievements are unfairly distributed between advantaged and less advantaged regions, literate and illiterate women, rural and urban areas, and rich and poor segments of the Moroccan population.
  
  
  CONCLUSIONS
  Studies have shown that it is difficult to trace the effect of a primary health intervention on the access to health care due to synergetic and overlapping effect of interventions and initiatives aiming to improve the wellbeing of the Moroccan population. Descriptive and inferential statistics were used to illustrate the correlation existing between different variables measuring access to health and health outcomes on one side and variables like income, education, employment and health staff on the other side.
  
  
  CONCLUSIONS
  In Morocco, average access to health care and services as well as health outcomes have improved during the last decades. However, socio-economic inequalities and health inequity are persistent. The present study indicates that urgent and efficient actions on social determinants of health are needed in order to sustain average achievements and improve health equity for the whole Moroccan population.
authors.affiliation: URAC04, LaMSD, Department of Mathematics and Informatics, Faculty of Sciences, University Mohamed Ist, Oujda, Morocco. Wiam.boutayeb@gmail.com.
authors.forename: Wiam
authors.initials: W
authors.lastname: Boutayeb
authors.affiliation: URAC04, LaMSD, Department of Mathematics and Informatics, Faculty of Sciences, University Mohamed Ist, Oujda, Morocco. mohamed.lamlili@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lamlili
authors.affiliation: ISPITS Oujda, Health Ministry, Oujda, Morocco. abdellatifm@hotmail.com.
authors.forename: Abdellatif
authors.initials: A
authors.lastname: Maamri
authors.affiliation: ISPITS Oujda Annex Nador, Health Ministry, Oujda, Morocco. souadbenelmostafa@hotmail.fr.
authors.forename: Souad
authors.initials: S
authors.lastname: Ben El Mostafa
authors.affiliation: URAC04, LaMSD, Department of Mathematics and Informatics, Faculty of Sciences, University Mohamed Ist, Oujda, Morocco. x.boutayeb@menara.ma.
authors.forename: Abdesslam
authors.initials: A
authors.lastname: Boutayeb
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D009018:Morocco; D009035:Mothers / Q000706:statistics & numerical data; D009313:National Health Programs / Q000592:standards*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012923:Social Class
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