Final Paper

Running head: MOROCCO 1
Morocco
HSC 3201 CRN 10347
Alyssa Leaf
Julia Poynter
4/42016
Dr. Daramola

MOROCCO LEAF/POYNTER 2
Section 1
1. Global Community- Country
Morocco is known as having one of the most diverse population in the region. Morocco
is located in the northwest edge of Africa and is central to many European and Mediterranean
cultures due to the accessibility of trade ships with geographic climates ranging from warm
deserts to temperate mountains and vast Atlantic coastlines (World Health Organization, 2016).
Of the 33 million people that inhabit Morocco, 50.6% of the population are female
(World Bank Group, 2016). The most widely practiced religion in Morocco is Muslim with
Arabic being the primary language (Central Intelligence Agency, 2016). Although education in
Morocco is free, many citizens are illiterate (WHO, 2016). However, female literacy has been
increasing by almost 14% within the last 20 years which is allowing more of them to enter the
workplace (WHO, 2016). Morocco gained independence from France in 1956 and three years
later created a healthcare reform initiative that would make healthcare free to individuals that
make a salary or have an incoming pension (CIA World Factbook, 2016). Unfortunately, many
rural areas have limited, if not any, access to treatment facilities.
2. Healthcare System
Increasing population size has led to the development of “tin cities” which has limited
water supply resulting in poor sanitation. This has created a great health concern as
communicable diseases become more widespread and with no foreseeable way to combat the
illnesses with their limited outreach programs. The issue seems to stem from under education,
limited access to healthcare, and overpopulation of large cities. To determine what the
community of Morocco needed, we conducted research using personal testimonies from

YouTube as well as information from the Center for Disease Control, and the World Health
Organization.
3. Stakeholder Issues
Key stakeholders that influence many of the healthcare reform policies include the
Ministry of Health which is headed by El Houssaine Louardi. M. Lahcen Chtibi, the Inspector
General. The Inspector General is under the guidance of the ministry and, among other things,
his primary responsibility is to consolidates resources to healthcare facility development and
inspects medical training (Minitere de la Sante, 2013).
For 25 years, the health leaders of Morocco have promoted a plan that would help
develop, consolidate, and implement a National Public Health Institute as growing health
concerns plague Morocco. With the successful implementation of this program, Morocco would
be better equipped to track the spread of diseases, balance healthcare costs across facilities,
create an emergency action plan for natural disasters and epidemics, and become a key entity in
global healthcare development (The International Institution for National Public Health
Institutions, 2016). The current system focuses on data collection for tuberculosis and influenza;
however, their epidemiological reports will broaden with the expansion of a web-based
surveillance system (IANHPI, 2016).
In addition to bringing the NPHI to Morocco, the healthcare leaders are also trying to
implement a program from the Center for Disease Control (CDC) called Field Epidemiology and
Laboratory Training Program (IANPHI, 2016). This program analyzes Health Ministry
credentials as well as capacities within the community, epidemiology department, surveillance,
and their capacity to train others (Department of Health and Human Services, 2016).

4. Major Public/ Community Health Issues
The primary issue is overpopulation which inhibits much of the population from attaining
a job; thus, preventing millions of people from attaining adequate healthcare. Rural villages have
limited access to healthcare as the closest clinic may require a several hour hike. According to
The Global Health Workforce Alliance (2010), approximately 11% of the population, or 3.6
million people, reside more than 10 km from the closest healthcare facility. With the clinic radii
being so widespread in many parts of the country, citizens often die attempting to seek care for
an injury or illness and much of the population is reliant on midwives to have children at home.
Because healthcare is so inaccessible, many children are born with congenital heart defects that
could be treatable with surgical intervention.
5. Resources and Solutions
Because Morocco is notorious for having inadequate accessibility to healthcare, many
children and adults suffer from treatable cardiovascular diseases such as congenital heart failure.
The World Health Organization (2016) notes that clinical care is inadequately accessible by the
more impoverished population. No more than 17% of the population of Morocco is included in
healthcare coverage with one third of that amount being employees of the state and private sector
(WHO, 2016). Current inclusion criteria for receiving free healthcare is contingent upon salary
and/or pension whereas citizens living in poverty are expected to directly pay the healthcare
professionals upon treatment (WHO, 2016).
Policy makers implemented two new legislatures in 2005 to improve accessibility of
healthcare. L’Assurance Maladie Obligatoire extended insurance to more private- and public-
sector employees whereas the Regime d’Assistance Medicale would allow healthcare coverage

for impoverished citizens (Ruger, 2016). In addition to mandating new legislatures to extend
healthcare, there is a non-profit called the International Children’s Foundation. This coalition
originates in the United States but travels to underdeveloped countries, including Morocco, to
perform free surgeries to children born with cardiovascular diseases (The International
Children’s Foundation, 2016).
6. Importance to Local Community
The US Department of State (2014) notes that medical treatment in any part of Morocco
is not as standardized as the United States, most clinics do not have an English-speaking worker,
deposits must be paid in cash, and emergency responses are unreliable. Therefore, it is
imperative to have any health concerns addressed by a primary care physician and make
necessary medical preparations before going to Morocco. If your primary care physician is not
locally available, students can get a physical and necessary vaccinations from their university
wellness center or at any walk-in clinic.
It is imperative to get vaccinated before traveling to other countries, especially
developing countries such as Morocco. The Center for Disease Control and Prevention (2016)
encourages travelers to get vaccines from their primary care physician within 4-6 weeks of travel
to allow ample time for the immune system to become protected. In addition to being current
with routine vaccines that are pertinent to the country of primary residence, travelers to Morocco
are strongly encouraged to be protected with the hepatitis A and typhoid vaccines as both of
these illnesses can be present in food, particularly in rural areas (CDC, 2016). Furthermore, the
CDC (2016) also recommends that travelers are equipped with immunity from rabies if they plan
on adventuring outdoors and to acquire the hepatitis B vaccine if the traveler is planning on
getting a tattoo, piercing, or engaging in sexual intercourse with a new partner. Most of the

diseases in Morocco are present year round; therefore, the best time to travel is contingent upon
the climate preference of the traveler.
Section 2
Service to the Local Community
Study and Travel Abroad Health Resources
1. Country and CDC link (4 links)
https://www.cia.gov/library/publications/the-world-factbook/geos/mo.html
http://wwwnc.cdc.gov/travel/destinations/clinician/none/morocco
http://www.who.int/countries/mar/en/
http://morocco.usembassy.gov/
2. Health concerns based on specific region of the country
Disease/ Illness How do you get it? Signs and symptoms to look for: How do you treat it?
Spotted fever Tick bites Fever
Headache
Rash
Muscle aches
Eschar at site of tick bite
Antibiotic doxycycline
Patients should get treatment
within 3 days of bite.
Duration: 7-14 days
Yellow fever Infected mosquito bite Majority of cases have no
symptoms or mild illness.
3-6 days after bite:
Sudden fever
Back pain- fatigue
Nausea/ vomiting
No known treatment.
Treatment is only done for
severe fever and symptoms
management.
Malaria Infected mosquito bite Symptoms range from mild, to
sever, or death.
Common signs:
Elevated temperatures
Perspiration
Important to see a doctor as
soon as symptoms arise.
Several medications are used
to treat the parasite.

Mild jaundice (yellowing of eyes
and skin)
Measles (Rubeola) Contagious virus spread
through droplet
transmission (coughing or
sneezing) from an infected
person.
Fever
Runny nose
Cough
Sore throat
Rash on the entire body
No antiviral treatment for it.
Illness can be prevented with
a vaccine.
Rabies Through bite of a rabid
mammal (ie. Raccoon,
feral dog/ cat, squirrel, bat,
rat, etc.)
Flu-like symptoms
General discomfort
Headache
Severe symptoms include:
Anxiety, hypersalivation,
hydrophobia, restlessness, and
death.
Early treatment is
imperative. If you have been
bitten by any animal seek
medical attention
immediately. It is a
progressive, deadly disease.
Tuberculosis (TB) Transmitted from droplet
transmission of an infected
person
Latent TB: no symptoms occur
in this stage. Most people do not
realize they have it until it
progresses.
TB disease: bad cough (lasting
3+ weeks), pain in chest, blood
in cough, weakness/ fatigue, and
chills/ fever.
Latent TB treatment is
important for decreasing the
spread to the population.
TB disease requires
extensive medication
regimen for 6-9 months.
Information for this section was retrieved from http://www.cdc.gov/globalhealth/countries/
morocco/
3. Concerns for special groups
Study Abroad students Seniors Pregnant women Cruise travelers
Eating &
Drinking
Dont:
-Drink tap water
-Eat food from street
vendors
-Drink unpasteurized milk
Eat raw/ undercooked meat
or fish
Do:
-Canned/ bottled drinks
- Drink hot coffee/ tea
-Washed fruits/ veggies
- Drink pasteurized milk
Dont:
-Drink tap water
-Eat food from street
vendors
-Drink unpasteurized
milk
Eat raw/ undercooked
meat or fish
Do:
-Canned/ bottled drinks
- Drink hot coffee/ tea
-Washed fruits/ veggies
Foodborne illnesses for
pregnant women can be
detrimental. Follow the
safety guidelines under
the “Study Abroad” tab
for food and drink
consumption. In case of
diarrhea, do not take
pepto-bismol or
kaopectate. Instead, take
imodium. Drink plenty
of fluids.
Generally safer to
consume food and
drink on the ship.

-fully cooked and warm
food
- Drink pasteurized milk
-fully cooked and warm
food
Reduce
exposure to
germs
Use good hygienic practice
when studying abroad and
wash hands frequently
before eating.
Use good hygienic
practice and wash hands
frequently before eating.
Use good hygienic
practice and wash hands
frequently before eating.
Outbreaks of
diarrhea and
respiratory illness
are common.
Wash hands
frequently before
eating.
Medical
attention
The longer you spend
abroad, the increased
likelihood of needing
medical attention. Research
where you will be staying,
where to closest clinic is,
and if you you will need
more/ what insurance to
pay for it. Get a medical
check-up before arriving.
Be sure to pack enough
medication to last the
duration of the trip.
*Note: talk to your
doctor about getting the
Typhoid vaccine while
pregnant*
Cruise ships are
equipped with
clinics that have
adequate health
care capabilities.
Transportation Motor vehicle accidents are
the highest cause of injury
during travel. It is
recommended to use the
safest form of
transportation (bus, train,
walking) or consider
buying a bike or vehicle for
personal travel with
appropriate permits.
Be aware of how
elevation affects oxygen
saturation in the blood.
Wear seatbelts and use
the safest form of
transportation.
Wear seat belts across
the pelvic region, not the
lower abdomen. If in an
accident (even a minor
one) consult your doctor.
Carry paperwork of the
babies due date and your
blood type.
Use tour guides
and buses when
traveling at port.
4. Vaccines
Any vaccines needed should be administered within 4-6 weeks of travel date.
Information for this section was retrieved from
http://wwwnc.cdc.gov/travel/destinations/traveler/none/morocco
Recommended for all travelers Recommended for most travelers Recommended for some travelers
-Measles-mumps-rubella (MMR) vaccine
-Tdap (tetanus-diphtheria-pertussis vaccine
-Varicella (chickenpox) vaccine
-Polio vaccine
-Hepatitis A
-Typhoid
-Hepatitis B
-Rabies

-Flu (annually)
5. Where to get vaccines locally
http://lee.floridahealth.gov/programs-and-services/wellness-
programs/immunizations/adult-travel-imm.html
Florida Dept. of Health (research Medicare/ Medicaid, BCBS, Tricare, Aetna, AARP
prices for vaccines)
Vaccine (for 18+) Where to get it
(near zip code 33912)
Cost without insurance Covered by insurance?
Medicare Medicaid Aetna
MMR Walgreens $100
T-Dap Publix Pharmacy $70
Chickenpox Walgreens $150/ dose (need 2)
Polio Walgreens $70
Flu Shot Publix Pharmacy $30   
Typhoid Walgreens $100
Hepatitis A Walgreens $114/ dose
(need 2)
Hepatitis B Walgreens $90/ dose
(need 3)

Rabies Walgreens $160
http://vaccine.healthmap.org/
Walgreens vaccine prices were retrieved from http://www.walgreens.com/topic/healthcare-
clinic/price-menu.jsp#preventionFocus. For more information about other vaccines offered and
different prices and doses depending on age visit this website.
6. Stay healthy and safe in Morocco– what actions need to be taken to be healthy and safe
Where to get medical care by city Casablanca
 Atfal (Trama, orthopedic, pediatric)
0522-942-000
 Dentaire Ghandi (Dentist)*English speeking*
0522-983-333
Rabat
 Clinique la Capitale (clinic)
0537-76-7272
Note:
Bring a list of medical problems, a list of
prescriptions currently taking, blood type, and
payment.

Eating and drinking Don’t:
Drink tap water
Eat food from street vendors
Drink unpasteurized milk
Eat raw/ undercooked meat or fish
Do:
Canned/ bottled drinks
Drink hot coffee/ tea
Washed fruits/ veggies
Drink pasteurized milk
Fully cooked and warm food
Insect precautions Wear long sleeved clothing
Use 20% DEET bug repellant
Stay in air conditioned and closed units while sleeping
If bitten, do not scratch bite and use hydrocortisone
Germ exposure Use good hygienic practice and wash hands frequently
before eating.
For a full list of hospitals, clinics, and specialty health centers please visit
http://morocco.usembassy.gov/service/professional-services/medical-information.html
For more information on health precautions when traveling to Morocco, visit
http://wwwnc.cdc.gov/travel/destinations/traveler/none/morocco?s_cid=ncezid-dgmq-
travel-single-001
7. Healthy Travel Packing List – Prescription medicines, medical supplies, OTC –provide
most important under sub-headings or specific to country.
http://wwwnc.cdc.gov/travel/destinations/morocco/traveler/packing-list
Prescriptions: Your prescriptions, traveler's' diarrhea antibiotic, altitude sickness
medicine
Optional over-the-counter medicines: Antacid, diarrhea medicine, antihistamine,
motion sickness medicine, cough drops, medicine for pain and fever
Supplies to prevent illness or injury: Hand sanitizer or wipes, water purification tablets,
insect repellent (20% DEET), sunscreen, sunglasses and a hat
Personal safety equipment: Latex condoms, spare glasses and/ or contact lenses
First-aid kit: 1% hydrocortisone cream, antifungal ointments, antibacterial ointments,
antiseptic wound cleanser, bandages, moleskin for blisters, elastic/compression bandage
wrap, eye drops

Documents: Health insurance documents, Copies of all prescriptions, Contact card
*If medically necessary: Syringes, diabetes testing supplies, insulin, inhalers,
Epinephrine auto-injectors (EpiPens), medical alert bracelet
8. Country Travel Health Notices
According to the Center for Disease Control and the State travel health notices website,
Morocco has no current notable health concerns.
http://wwwnc.cdc.gov/travel/destinations/traveler /none/morocco
http://travel.state.gov/content/travel/en.html
9. How to enroll in the Smart Traveler Enrolment Program (STEP)
The process to enroll in the STEP program are as follows: (Note: will need to have
passport available to complete the inform on the questionnaire) Information for this section
was found on the frequently asked questions section.
(https://step.state.gov/STEP/Help/Create_Account_Start_Screen.htm)
1. Select “Create Account” from the main menu of the STEP website:
https://step.state.gov/step/
2. Review the “Privacy Act Notice” and select that you acknowledge the terms of the
agreement.
3. Select “Account Information” on the selection tab
4. Complete the account information sections: username/ password, security questions and
answer.
5. Select the “Traveler Information” tab
6. Enter traveler information
7. Select “Emergency Contact Information” tab
8. Enter emergency contact information of a reliable point of contact
9. Select the “Next” button
10. A confirmation page will display all of the information you provided; if the information
is correct, select “Finish”; if the information is incorrect, edit the information by selecting
“Previous”
10. Location and contact information for Embassy or Consulate location in the country
The Moroccan- United States embassy is located in Souissi, Rabat and can be contacted
Monday through Friday between the hours of 8am- 5pm via:
Phone: (212) 0537 637 200
Office location: Km 5.7, Avenue Mohamed VI Souissi, Rabat 10170, Morocco

For more information about the US embassy in Morocco, visit
http://morocco.usembassy.gov/news.html
11. After your trip, what signs and symptoms to worry about
(http://wwwnc.cdc.gov/travel/page/getting-sick-after-travel)
Note: When seeking medical attention, tell the doctor where you traveled, how long you
stayed, and any activities you did including any interaction with animals.
 Skin irritations: bug bites, fungal infections, and rashes
 Most common reported symptom after traveling
 Fever
 Diarrhea lasting more than 2 weeks
Section 3
I. Global Study Abroad Planning using VMOSA (Community Tool Box) for The
International Children’s Heart Association.
a. Vision
“Our goal is to make the need for ICHF obsolete. We work toward this goal
through our medical mission trips, where we operate on children and educate local
healthcare professionals.” (International Children’s Heart Foundation, 2016)
b. Mission
“The mission of the International Children’s Heart Foundation (ICHF) is to
bring the skills, technology and knowledge to cure and care for children with
congenital heart disease in developing nations. ICHF does this regardless of country
of origin, race, religion or gender.” (International Children’s Heart Foundation, 2016)
c. Objectives

The International Children’s Heart Foundation strives to create a healthy and
sustainable healthcare environment by:
a. Provide care to as many children as possible
b. Sending medical supplies to local hospitals
c. Training medical staff so they can continue providing care.
d. Strategies
Utilize a three-step approach:
1. Providing direct care to as many children as possible in the short term
2. Sending medications, surgical supplies and diagnostic equipment to
medical facilities in developing countries
3. Training surgeons and medical staff so they ultimately can provide care
for their own people
(International Children’s Heart Foundation, 2016)
e. Action Plan
What change will happen:
a. Decrease number of heart defects in children of developing countries
b. Treat and care for children born with heart defects
c. Provide timely treatment at no cost to the family
Who will do what?

a. ICHF Staff and volunteer medical teams will send the surgeons to
(International Children’s Heart Foundation, 2016)
II. Local Community Planning using MAP-IT (Healthy People 2020) for The American
Heart Association.
a. Mobilize
Vision and Mission of the coalition
Mission: “Our mission is to build healthier lives, free of cardiovascular
disease and stroke.” (American Heart Association, 2015)
Vision: “We are working toward improving the cardiovascular health of
all Americans by 20 percent, and reducing deaths from cardiovascular
diseases and stroke by 20 percent, all by the year 2020.” (American Heart
Association, 2015)
Why do I want to bring people together?
“We are dedicated to fighting heart disease and stroke through funding
innovative research, fight for stronger public health policies, and providing
critical tools and information to save and improve lives.” (American Heart
Association, 2015)
Who should be represented?
Those that should be represented should be those that are overcoming
heart disease and the researchers that are helping find a cure.

Potential partners (organizations and businesses) in the community
Healthcare providers, local hospitals, lawmakers, and people that have a
passion for helping others with heart diseases would be great partners for the
coalition.
b. Assess
There is an American Heart Association office located in Bonita Springs
which have resources the community would need if they wanted to learn more
about the disease and how to prevent it. In addition, many local fire departments
host CPR training classes that are run by the Association. Since the Southwest
Florida region is home to many elderly residents it is important for people to be
aware of how to prevent cardiovascular diseases and what to do if someone has a
heart attack or a stroke.
c. Plan
The goal is to save and improve lives of those who are affected by
cardiovascular disease. The American Heart Association focuses on funding research
that will ultimately gain insight into heart disease. This information is made available
to the public so they can better understand the disease. In addition, they advocate for
more effective public health policies to advocate for this common disease. Those that
would be passionate to aid the American Heart Association in their endeavors would
be family, friends, and the community because everyone at some point in their life
will either be affected by this disease or know someone that has heart disease.

The organization wishes to improve cardiovascular health by 20% and reduce
death due to cardiovascular illness and related illnesses by 20% by the year 2020
(American Heart Association, 2015).
d. Implement
The American Heart Association is considered as one of the leaders in
cardiovascular health with over 22.5 million volunteers and 150 office locations
(American Heart Association, 2015). In addition, the American Heart Association serves
as an excellent resource for learning CPR, attaining healthy lifestyle guides such as cook
books and exercise classes, they host seminars to educate the community, and conducts
research on cardiovascular health.
To improve their outreach objectives, the coalition can try to reach more people
and get the communities more active and involved in their health, as well as implement
preventative measures for people that do not currently have cardiovascular issues.
e. Track
By evaluating national trends and the communities they work with directly, the
American Heart Association can compare their efforts to previous years and determine if
there needs to be any alterations. The American Heart Association has previously met
their goal in 2010 and they are anticipating meeting their 2020 goal as well.

In hopes of reaching out to more people, the American Heart Association
implemented more heart-healthy conventions, continued funding research, and introduced
the program Life’s Simple 7 which uses seven steps to maintaining a healthy
cardiovascular system including not smoking, maintaining physical activity, and eating
healthier (The American Heart Association, 2015). As more people are reached out to
everyday, attaining the 2020 goal is foreseeable.
Heart diseasehas
decreased by 20%
People have
increased their
awareness of what
factors increasethe
likelihood of
getting
cardiovascular
disease.

References
American Heart Association. (2015). About us. Retrieved from
http://www.heart.org/HEARTORG/General/About-Us---American-Heart-
Association_UCM_305422_SubHomePage.jsp
Central Intelligence Agency. (2016). CIA world factbook, Central Intelligence Agency.
Retrieved from https://www.cia.gov/library/publications/the-world-
factbook/geos/mo.html
Department of Health and Human Services. (2016). Field epidemiology and laboratory training
Program, Centers for Disease Control and Prevention. Retrieved from
http://www.cdc.gov/globalhealth/healthprotection/fetp/fetpdevhandbook/assess/fetp_strat
egic_planning_tool_v5.pdf
Department of State. (2014). Morocco, U.S. Passports and International Travel. Retrieved from
http://travel.state.gov/content/passports/en/country/morocco.html
The Global Health Workforce Alliance. (2010). The Morocco country case study, The Global
Health Workforce Alliance. Retrieved from
http://www.who.int/workforcealliance/knowledge/PPE_Morocco_CaseStudy.pdf
The International Association for National Public Health Institutions. (2016). Plan for NPHI
development, IANPHI. Retrieved from http://www.ianphi.org/whatwedo/projects/
morocco.html
International Children’s Heart Foundation. (2016). Our missions. Retrieved from
http://www.babyheart.org/missions/
Ministere de la Sante. (2013). (Translated). Accueil, ROYAUME DU MAROC. Retrieved from
http://www.sante.gov.ma/Pages/Organigramme.aspx

Ruger, J. (2007). Health financing and insurance reform in morocco, Health Affairs, 26(4), p.
1009-16. doi: 10.1377/hlthaff.26.4.1009
The World Bank. (2016). Morocco overview, The World Bank. Retrieved from
http://www.worldbank.org/en/country/morocco/overview
World Health Organization. (2016). Health systems profile, Regional Health Systems
Observatory. Retrieved from
http://apps.who.int/medicinedocs/documents/s17303e/s17303e.pdf

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