The RAMED Project

Best
Practices
#22
Towards social inclusion and protection of
informal waste pickers and recyclers
The RAMED Project: MOROCCO
Key Points:
 Government program that covers informal workers equally to salaried workers.
 Identification system based on personal degree of vulnerability between rural and
urban populations
 Program 75% financed by the Moroccan government
Background...................................................................................................................................... 2
Operation ........................................................................................................................................ 2
Strengths ......................................................................................................................................... 3
Weaknesses ..................................................................................................................................... 3
Financial, Social and Economic Feasibility ....................................................................................... 4
Sources ............................................................................................................................................ 4
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Best
Practices
#22
Towards social inclusion and protection of
informal waste pickers and recyclers
completely free care, while 4.5 million in
vulnerable status will be required to pay
an annual fee of 120 dirhams (10 euros),
capped at 600 dirhams (54 euros) per
year and per family.2
Background
Operation
RAMED’s budget is estimated at 2.7
billion dirhams (241.6 million euros) and
is 75% financed by the government,
19% by beneficiaries’ annual fees and
the remaining 6% by local authorities.
Categories are identified through a form
“filled out by the heads of families who
must
provide information
on
the
household composition, the number of
dependents and the income and assets
they possess. A dedicated committee will
make appropriate decisions based on the
applications filed. Eligibility is granted
through the issuance of a three-year
family card allowing for care based on a
well-defined basket of services.”3 In
towns, those having revenue less than
3,767 dirhams (337 euros) per year are
considered to be in absolute poverty;
those with annual revenue between
3,767 dirhams (337 euros) and 5,650
dirhams (505 euros) are considered
vulnerable. On the other hand, in rural
areas, the difference between absolute
poverty and vulnerability are determined
based on criteria such as “agricultural
land operated, livestock, henhouse, farm
and transportation equipment, means of
Source: Visoterra website
There are two health care programs in
Morocco: Mandatory Health Insurance
(Assurance Maladie Obligatoire, AMO),
created in 2002 for salaried workers, and
the Health Insurance Program (Régime
d’Assistance Médicale, RAMED), which
was implemented in 2001 after a pilot
project launched in 2008 in the TadlaAzilal region. This second program
benefits impoverished people (informal
workers, penitentiary residents, orphans,
unemployed people, etc.). RAMED allows
these people to benefit from free care
and medical benefits obtained in public
hospitals, medical centers and health
services.1 The project’s goal is to cover
8.5 million Moroccans (28% of the
population). Among this 28%, an
estimated group of 4 million people living
in extreme poverty will benefit from
2 Daily newspaper Aufait website, “RAMED Launch:
Towards a More Fair Health Care System”
(Lancement du RAMED : Vers un système de santé
plus équitable); 03/14/2012
3 Morocco Ministry of the Interior (Ministère de
l’Intérieur) website; RAMED “Régime d’assistance
médicale”; accessed July 2013
1 Morocco Ministry of the Interior (Ministère de
l’Intérieur) website; RAMED “Régime d’assistance
médicale”; accessed July 2013
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personal
transportation,
telephone
equipment and health equipment.”4
countries where two such plans exist,
the benefits offered to taxpayers are
more extensive than those offered to the
impoverished population.
A wide range of care is covered:
 Preventive care: vaccinations,
pregnancy care, mother and baby
care, family planning;
 General medical consultations
(including emergency) in medical
centers;
 Medical
and
surgical
hospitalization,
including
hospitalization for childbirth;
 Available radiology and medical
imaging;
 Available functional exploration
(endoscopy,
neurological
exploration, etc.)
 Medicine
and
pharmaceutical
products
administered
during
care;
 Available medical devices and
implants necessary for various
medical and surgical procedures;
 Available orodental care;
 Functional
rehabilitation
and
physical therapy;
 (etc.)5
Weaknesses
Certain limitations came to light a few
months
after
the
project’s
implementation:
 The first, brought up by the Minister
of Health Houcine El Ouardi, is “the
lack of patient intake structures and
the lack of coordination with local
authorities from the Department of
the Interior (le département de
l’Intérieur).”
 The Minister also pointed out “long
wait
times
for
some
public
laboratories,” a lack of medicine and
inadequate training of some medical
staff.6 Only the lack of medicine was
handled by the government, who in
2013 allotted 2 billion dirhams (179
million euros) to this mission, against
675 million dirhams (approximately
60 million euros) at the launching of
the project.
 There is also a discrepancy between
urban areas, with quality health
facilities,
and
the
rural
areas,
especially the more isolated ones. To
solve this problem, the government
Strengths
In addition to being able to offer health
care coverage to impoverished people,
RAMED’s main advantage is the quality
of the services offered. This plan
effectively offers the same basket of
services as those offered to people
covered by AMO. This is a unique
element of the system because, in most
6
Mohammed Jaabouk; “Morocco: RAMED’s
Spread not Happening Soon” (Maroc : La
généralisation du RAMED n'est pas pour bientôt);
12/14/12
4 L’économiste; “RAMED now Widespread” (Le
RAMED généralisé aujourd’hui); 03/13/2012
5 Morocco Ministry of the Interior (Ministère de
l’Intérieur) website; RAMED “Régime d’assistance
médicale”; accessed July 2013
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Best
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Towards social inclusion and protection of
informal waste pickers and recyclers
will dedicate part of the budget to
better equipping its spaces.7
able to contribute, at their revenue
amount, could allow the voluntary
program to receive additional subsidies.
Nevertheless, it must be noted that the
main source of the RAMED program’s
revenue is governmental (75%). In
Colombia, there is also an identification
system (SISBEN), which is not very
effective. Therefore, the identification of
different levels of beneficiaries is
complicated.
Financial, Social and
Economic Feasibility
RAMED
is
a
national
program
implemented by the government and
therefore
has
the
administrative
jurisdiction necessary to conquer the
difficulties encountered. The government
would like to implement public-private
partnerships to overcome the lack of
infrastructure and human capital. One
part of the plan will take place in
regional centers aiming to tackle the
discrepancies between urban and rural
areas, while medical caravans will be
deployed in remote regions.8
Replicating
Experience
Sources
 Morocco
Ministry of the Interior
(Ministère
de
l’Intérieur)
website;
RAMED “Régime d’assistance médicale”;
accessed July 2013
 Daily
newspaper Aufait website,
“RAMED Launch: Towards a More Fair
Health Care System” (Lancement du
RAMED : Vers un système de santé plus
équitable); 03/14/2012
the
 L’économiste; “RAMED
Widespread” (Le RAMED
aujourd’hui); 03/13/2012
This type of mixed program resembles
those implemented in Colombia and in
Vietnam. In the two countries, it would
be
worthwhile
to
implement
the
identification system used for the RAMED
program.
Regarding
Vietnam,
the
voluntary program is facing financial
difficulties that are preventing the
system’s
beneficiaries
from
being
covered at the same level that the
mandatory plan participants (salaried
workers) are covered. Therefore, making
a
distinction
between
the
most
vulnerable people and those who are
now
généralisé
 Morocco
Ministry of the Interior
(Ministère
de
l’Intérieur)
website;
RAMED “Régime d’assistance médicale”;
accessed July 2013
 Mohammed
Jaabouk;
“Morocco:
RAMED’s Spread not Happening Soon”
(Maroc : La généralisation du RAMED
n'est pas pour bientôt); 12/14/12
 Hafida Khanouchi; “The Reality of Fair
Access to Care and Medicine” (Accès
équitable aux soins et aux médicaments
: Quelle réalité)
7
Hafida Khanouchi; “The Reality of Fair Access to
Care and Medicine” (Accès équitable aux soins et
aux médicaments : Quelle réalité)
8
Daily newspaper Aufait website, “RAMED Launch:
Towards a More Fair Health Care System”
(Lancement du RAMED : Vers un système de santé
plus équitable); 03/14/2012
Author: Laura Bigard, Enda Europe
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Best
Practices
#22
Towards social inclusion and protection of
informal waste pickers and recyclers
This publication has been produced with the assistance of the European Union. The
contents of this publication are the sole responsibility of Enda Europe and can in no way
be taken to reflect the views of the European Union.
This document is available in 3 languages: English, French and Spanish at
www.iwpar.org. For more information or feedback on this document, or if you know of a
similar experience in the field of social inclusion and protection of popular waste pickers
and recyclers, please contact:
Enda Europe
5 rue des immeubles industriels
75011 Paris – FRANCE
contact @ enda-europe.org
0033 (0)1 44 93 87 40
www.enda-europe.org
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