Strengthening Health Systems in the Maghreb: Supporting Services and Reforms in Morocco and Tunisia

Since 2015, multiple World Bank projects have supported strengthening health systems in the Maghreb region, particularly in Morocco and Tunisia, focused on strengthening delivery for selected priority services, establishing the building blocks of a strong system that delivers a wide range of services, with a human-centric orientation that improves wellbeing.

Development Challenge

Geographical variations in access to services, limited human resources and financial sustainability of expanded health coverage are challenges for Morocco. Strengthening governance, coordination, and digitalization are necessary to improve efficiency, data management, and overall quality of health services.

Tunisia needed to reinforce surveillance and early‑warning systems to better detect, prevent, and respond to health emergencies. Patients seek services at hospitals rather than lower-cost options, driving up operating costs and placing pressure, particularly in harder-to-reach areas.

WBG Approach

In Morocco, World Bank support aimed to reduce maternal, neonatal, and child mortality in rural areas in nine regions, prevention and control of non-communicable diseases, strengthening mobile health to serve hard-to-reach populations, boosting primary care, and developing and implementing a new Health Management Information System (HMIS) in at least one region.

WB supported access to quality services for early childhood development in rural areas, and establishing mechanisms to strengthen monitoring and evaluation of these services. It provided technical assistance for policy design and institutional capacity building.

A series of policy loans supported reforming the country’s health financing mechanisms, including universal health and social protection coverage, also improved governance, digitalization, and performance of human resources.

In Tunisia, the World Bank focused on primary health care. Multiple projects since 2021 enhanced clinical, emergency, and surgical care, expanding infrastructure for chronic disease management and pandemic preparedness.

Results and Outcomes

By June 2025, the “Improving ECD Outcomes in Rural Morocco” PforR had enabled 511,180 new beneficiaries to receive at least one health or nutrition service offered by the community-based health and nutrition model. The community model allowed 86 percent of women in target rural areas to receive at least one health or nutrition service during pregnancy in the past 12 months, up from 0 percent in 2021. The SBCC campaigns have reached over 13.50 million people across the country by June 2025.

Morocco’s Development Policy Loans (DPL) helped increase health insurance coverage to 80 percent of the population by June 2023, up from 70 percent in June 2022.

The Health System Reform PforR supported the rehabilitation of 200 primary health care facilities between January 2024 and December 2025. It supported deconcentrated governance, a roadmap for health financing mechanisms for health facilities in the context of universal health coverage, and a communication platform between the central and regional levels and across regional health networks.

The COVID-19 Response project supported Tunisia’s national efforts to expand vaccination and strengthen health facilities. By December 2024, the project exceeded its target for the second PDO indicator, with 54 percent of the total population fully vaccinated, and over 70 percent of adults. PPE was distributed to all 228 facilities and laboratories. It also enhanced the capacities of 75 health facilities across all 24 governorates, with delivery of over 1,000 medical equipment units. Hemodialysis equipment was delivered to 57 health facilities. In addition, 40 public laboratories were strengthened to improve pathogen detection capacity.

Contribution to WBG Targets and Jobs

By rehabilitating 200 primary health care facilities and improving infrastructure, the Morocco Health System Reform PforR enhanced working conditions for health professionals. It also facilitated training of an additional 10,500 nurses and health technicians.

Tunisia’s COVID-19 Response project provided job training to more than 1,700 medical and technical professionals on the operation, maintenance, and usage of new technology and equipment in the improved 75 health facilities. Both of these projects contributed to the WBG Health and Social Protection Targets.

Hanae Afrouh is one of many community health workers in Morocco who benefitted from project training. ’My role is to engage with people living in isolated villages far from health centers. Thanks to the training I received, I have learned how to communicate effectively with communities. We no longer want to see a divide between villages and cities—we want access to the same quality services.’’

Another health worker, preferring to remain anonymous, said, "When I first began working with the communities, many women were giving birth at home, putting both themselves and their babies at great risk, including infant deaths and complications for mothers such as hemorrhage. Since we started raising awareness, the community has become much more informed, and we are now seeing positive results.’’

Lessons Learned

Focusing on sustained engagement over time through multiple projects achieves more than just individual project results. The investments in systems was enabled by strong engagement around analytical capacity and ongoing relationships of trust with government partners in Morocco and Tunisia, allowing the World Bank to have laid the foundations for continued progress in building up overall health systems. Focusing also on rural areas enabled support to reach the most vulnerable and especially the improved results for women and girls. Maintaining key partnerships with UNOPS in Tunisia and WHO in Morocco helped with procurement and delivery, leveraging their global specialist networks.

Next Steps

In Morocco, the World Bank will continue to promote strengthened institutional capacity through a new deconcentrated governance system. It aims to support healthcare workers, the digitalization of the health system, and the rehabilitation of public primary health care facilities. It also aims to strengthen health prevention, especially for non-communicable diseases, and continue improving maternal and child health outcomes.

In Tunisia, the World Bank will continue to focus on strengthening surveillance systems and laboratory capacity for pandemic preparedness and health-threat responses. It aims to provide support for primary health care services to improve quality, efficiency of distribution, and emergency medical services.