Evolution of rural–urban health gaps in Morocco: 1992–2011

BACKGROUND: Moroccan authorities carry out regular surveys on population and family health (NSFFP 1980, NSPH 1992, SPFH 2004, NSPFH 2011). These surveys constitute valuable resources for monitoring socio-economic and health indicators. They provide an evidence base for health decision makers to help them to optimize health strategies in order to improve the health conditions of the whole population. They also provide updated measures on geographic disparities, socio-economic inequalities and health inequity. The most recent Moroccan population and family health survey (NSPFH 2011) was carried out between November 2010 and March 2011. The final report and the database are not yet accessible, but a preliminary report was released early March 2012. This report does not allow for a complete evaluation of the present health situation in Morocco. A partial equity analysis can, however, be devoted to the comparison of health indicators especially in terms of rural–urban gaps. RESULTS: The 2011 survey shows that Moroccan population is in the last phase of the demographic transition. The total fertility rate decreased from 5.6 children per woman in 1980 to 2.5 per woman in 2011. The mean age of first marriage increased from 24 years for men and 17.5 years for women in 1960 to 31.5 years and 26.3 years in 2011 for men and women, respectively. The age structure shows a trend of ageing population. A comparison with the 1992 NSPH indicates that adult illiteracy has decreased from 53% in 1992 to 37.6% in 2011. During the same time period, women’s access to maternal care and health services improved significantly. For instance, the proportion of deliveries assisted by skilled health personnel increased from 31% in 1992 to 73.6% in 2011. Between 1992 and 2011, neonatal, postnatal, infant and under-five mortality rates were reduced by 44%, 65%, 54% and 64%, respectively. CONCLUSION: This paper shows that average health indicators improved noticeably during the last two decades but rural–urban disparities are still a challenge for health decision makers. Socio-economic indicators, like illiteracy rate and unemployment, also demonstrate large gender inequalities. This preliminary analysis is designed to assist Moroccan health authorities to evaluate the current health situation in order to adopt cost-effective strategies that improve “health for all” and reduce the gaps between advantaged and disadvantaged populations.