MOROCCO: HEALTH MINISTER DESCRIBES A CRISIS OF CORRUPTION, NOT CAPABILITY

C O N F I D E N T I A L SECTION 01 OF 02 RABAT 000072 SIPDIS SIPDIS STATE FOR NEA/MAG AND INL/C/CP AID/W FOR GH E.O. 12958: DECL: 01/23/2018 TAGS: PINS SOCI ELAB MO SUBJECT: MOROCCO: HEALTH MINISTER DESCRIBES A CRISIS OF CORRUPTION, NOT CAPABILITY Classified By: Ambassador Thomas T. Riley for reasons 1.4 (b) and (d) -------------- Summary -------------- ¶1. (C) In the course of a courtesy call on Morocco's new Health Minister, Yasmina Baddou, she told the Ambassador that corruption, not capabilities or resources, was the primary reason for Morocco's substandard level of health care provision. She said that fighting graft was her top priority, followed by improving efficiency and professionalizing hospital and health care administration. The largest obstacle to reform continues to be a heavily unionized workforce resistant to change and perceived erosions of privileges and influence. End Summary. -------------- Background and Biographic Note -------------- ¶2. (SBU) On January 16, the Ambassador paid a courtesy call on Yasmina Baddou, Minister of Health in the new El Fassi Government. A lawyer, prominent women's rights activist, and member of the Istiqlal (Independence) Party, Baddou served the previous government in the sub-cabinet role as Secretary of State for Families, Solidarity and Social Development. The Ambassador and Baddou have a strong and long-standing professional relationship. She is generally supportive of the USG and openly appreciative of the warm bilateral relationship between the U.S. and Morocco. Her husband is the brother of Foreign Minister Taieb Fassi-Fihri and is the current head of the Water Development Agency. -------------- Corruption Threatens Morocco's Health -------------- ¶3. (C) Baddou said that corruption within the health sector was the primary reason for the poor state of Morocco's health care infrastructure. Morocco has enough skilled doctors and staff, but supply-chain graft and theft siphon off a significant portion of her Ministry's funds and undermine patient care. As an example, she said that it is now accepted that patients must pay a bribe of approximately 150 Moroccan Dirhams (approximately USD 20) to obtain blankets or basic service in virtually every hospital. In some hospitals, patients must pay additional unofficial "fees" to be admitted or receive testing and drugs. ¶4. (C) As an example of the fatal consequences of systemic inefficiency and corruption, she pointed to a recent media article which placed Morocco's maternal mortality rate at 227 per 100,000 live births, versus 17 in France and 13 in Great Britain. Further, statistics indicated that the infant mortality rate is 40 infants per 1,000 live births in Morocco, as opposed to 33 in Egypt, 24 in Tunisia, and 19 in Libya. She said she was ashamed of these facts and wanted to ensure that, under her watch, the ratios change for the better. -------------- Systemic Improvements Require Bureaucratic Cultural Change -------------- ¶5. (SBU) Strikers were encamped outside the Ministry of Health (MOH) when the Ambassador arrived for his visit, forcing him to enter through the basement. When asked, Baddou said that the protesters were nurses who had completed their studies and were demanding jobs within the MOH. Baddou added that she had ample jobs to offer, but applicants were required to take a national standards test (which the majority of them would pass). However, the group outside the Ministry refused to take any type of examination and insisted on being hired directly. Baddou complained that this view of government jobs as a birth-right, coupled with the almost total unionization of her 50,000 direct employees, hampered her ability to effect change quickly. She emphasized that the MOH needed a corps of professional health care managers, similar to U.S. hospital administrators, in order to allow doctors to focus on medicine, saying that physicians often did not know the first thing about running an enterprise. RABAT 00000072 002 OF 002 Baddou also expressed great interest in exploring the outsourcing of pharmaceutical services. -------------- Nascent Anti-Corruption Program -------------- ¶6. (C) Baddou told the Ambassador that she is in the process of implementing an anti-corruption program. Her goal is to create an internal investigation mechanism that allows MOH corruption cases to be prosecuted by the Ministry of Justice under criminal statutes. She said that currently, cases of corruption within the MOH generally result in an employee's firing, but do not involve further legal sanction. The Ambassador advised that even one, well-publicized conviction would have a significant ripple effect on the Ministry and would serve notice that past behaviors were no longer acceptable. Baddou agreed whole heartedly. ¶7. (SBU) Baddou is cooperating in a broader Dutch-funded pilot project launched by Transparency Maroc (Note: One of several local NGOs that are boycotting official contact with the USG to protest Iraq policy. End Note.),an affiliate of Transparency International, to create a "post box" within the MOH to which employees and members of the public could send reports of corruption and malfeasance. The Ambassador suggested the creation of a parallel telephone hotline that could serve a similar purpose. -------------- Embassy Facilitates Private U.S. Health Donations -------------- ¶8. (U) Baddou expressed appreciation with the Embassy's role in facilitating donations from private U.S. citizens and organizations to the Moroccan health system. Donations include: four bronchoscopes with a total value of USD 20,000 to Ibn Sina Hospital in Rabat, more than quadrupling the facility's bronchial diagnostic capacity; and 200,000 doses of a psychotropic drug prescribed mainly to women with mental health issues worth a total of USD 200,000. Although the Embassy's Self Help Fund is covering some shipping costs, the actual donations were managed by Operation U.S.A., a California based humanitarian organization. -------------- Comment -------------- ¶9. (U) Yasmina Baddou represents the type of professional, dedicated and goal-oriented government official that Morocco will have to depend on to effectively transition toward a more active and engaged executive branch of government. The Mission has a good relationship with Baddou, but it would be worthwhile to strengthen ties through further engagement and consultation. We will continue to follow her progress within the MOH and encourage her efforts. ¶10. (C) Comment Continued: Many interlocutors, both Moroccan and international, have told us that corruption and other forms of administrative malfeasance and impunity are the greatest obstacles to Morocco's continued social, political and economic reform. Several U.S. investors in Morocco have expressed intense frustration to the Ambassador about the difficulties that graft and bribery created as they attempted to open businesses or obtain permits. The Ambassador's meeting with Baddou comes at a time when the Mission is researching the modalities of corruption in Morocco with an eye towards designing and implementing a broad anti-corruption assistance program. Shortly, we will launch an INL-funded judicial corruption training program focusing on judges and court administrators within the Ministry of Justice. End Comment. ***************************************** Visit Embassy Rabat's Classified Website; http://www.state.sgov.gov/p/nea/rabat ***************************************** Riley