Health workforce trends and planning in Morocco: a READ-based systematic document analysis

Abstract

Objective

Morocco faces persistent shortages and unequal distribution of health workers, limiting progress toward universal health coverage and global targets. This study analyzed official data to describe Morocco’s health workforce and training pipeline, compare them with international benchmarks, and identify priority gaps for policy. A READ-based document analysis was applied to national strategies, statistical yearbooks, and planning reports from the Ministries of Health and Higher Education, with structured selection, extraction, and validation to ensure systematic synthesis.

Results

In 2023, Morocco had 0.80 physicians and 1.03 nurses or midwives per 1000 population, below reference values of 1.72 and 4.5. Between 2000 and 2023, physician density nearly doubled, and nursing density rose substantially. Training capacity expanded, with enrollment increases of 171% in paramedical programs and 96% in medicine and pharmacy. Growth remains uneven, with physician concentration in urban areas, shortages in remote regions and retention challenges. Beyond expanding training, stronger governance, equitable deployment, and financing are needed to translate supply gains into equitable services. This study provides the first national synthesis using a READ-based approach and establishes a reproducible baseline to guide forecasting, fair distribution, real-time registry development, and governance reforms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-025-07578-5.

Introduction

Strengthening the health workforce is a cornerstone of universal health coverage (UHC) and a recurring priority in global and regional strategies. The WHO Global Strategy on Human Resources for Health (HRH) [1] and the Eastern Mediterranean Region’s strategic directions [2] both call for evidence-informed planning, better governance, and sustained investment to address shortages, maldistribution, and skills mismatches. Morocco shares these challenges: despite recent gains, workforce densities remain below international reference points, specifically the Sustainable Development Goals (SDG) benchmarks of 1.72 physicians and 4.5 nurses or midwives per 1000 population, and important urban-rural and public-private disparities persist [3, 4]. In 2021, the national average coverage was 1 physician per 1356 inhabitants [4]. This ranged from 1:897 in Casablanca-Settat to 1:3396 in Drâa-Tafilalet, indicating a ∼3.8-fold regional gap in physician availability. Moreover, 50.9% of physicians practice in the private sector, while 57.4% of public physicians are concentrated in Casablanca-Settat, Marrakesh-Safi, and Fès-Meknès, underscoring urban concentration and public-private imbalance. In this context of ongoing national health system reforms, decision-makers need a concise, reliable picture of current workforce stock and the training pipeline that will feed the system over the next several years. Health-workforce projection models are central to planning and to achieving the “six rights” (right numbers, skills, services, time, place, resources) [5]; this study supplies the descriptive, policy-ready baseline those models and intake targets require. A similar pattern is evident in behavioral health, where access is unequally distributed, especially in rural settings, underscoring the importance of distribution-sensitive planning in addition to aggregate density targets [6].

Reliable and up-to-date figures on Morocco’s health workforce and education pipeline are therefore needed to inform workforce planning, financing, and deployment decisions. Routine administrative information exists but is dispersed across systems, reported with different periodicities, and not always synthesized for planning cycles. To provide a policy-relevant snapshot that can be readily consulted and updated, we collated routine administrative data from two official sources: the Ministry of Health and Social Protection’s (MHSP) HRH registry and the Ministry of Higher Education’s (MHE) statistics portal, which reports annual student intake and graduates in medical and paramedical programs. We also reviewed recent national policy documents to contextualize the numbers within current planning efforts and to ensure their alignment with the national health reform agenda.

This study aims to describe and contextualize Morocco’s health workforce stock and education pipeline (2000–2024) using official sources, and to compare these indicators against international reference points to identify priority gaps for workforce planning and policy. It provides a reproducible national baseline, triangulating public datasets and comparing Morocco’s progress with SDG and UHC benchmarks, thereby complementing existing sectoral reports with actionable evidence for training, distribution, and governance reforms. Health workforce stock refers to the headcount of active personnel recorded in the national HRH registry, used here to describe availability over time. The COVID-19 pandemic showed that workforce stock and deployment underpin system resilience (illness, burnout, and attrition strained care) highlighting Morocco’s need for stronger retention, distribution, and surge-capacity planning [7]. In addition, COVID-19’s multisystem burden and the rapid expansion of remote/tele-enabled care reconfigured tasks, roles, and deployment, underscoring the importance of tracking stock, pipeline, competencies, and distribution [8, 9].

Methods

This study adopted the READ (Readying materials; Extraction of data; Analyzing data; and Distilling findings) approach, a structured method for conducting document analysis in health policy research, particularly for developing HRH policies and strategic plans [10]. The READ framework ensures a systematic and transparent synthesis of documentary evidence by clearly defining document sources, inclusion criteria, and validation steps (see Supplementary file 1 for full methodological details).

The review addressed the following question: what is the current state and future outlook of health workforce development in Morocco, and what critical evidence informs related policies and strategic plans?

Official documents were identified through systematic searches of the Ministry of Health and Social Protection (MHSP) and Ministry of Higher Education, Scientific Research and Innovation (MHE) websites, complemented by a Google Scholar query (February 2025) and a brief key-informant consultations with the HRH Directorate to locate internal or unpublished materials. Documents published Between 2018 and 2024 and containing quantitative HRH data were included; earlier benchmark reports (2000, 2007, 2011, and 2017) were retained for trend analysis.

Data on the health workforce stock were extracted from the national Healthcare Map platform [11], and education pipeline indicators was obtained from the MHE platform [12], both on the 4 February 2025. ‘Planning’ in this paper thus refers to the monitoring of enrolment and graduation trends rather than full labor market forecasting.

Data were cleaned and checked for consistency and accuracy, and key findings were synthesized into descriptive tables and figures. A detailed account of document selection, data extraction, validation procedures, and the adapted PRISMA flow diagram are provided in the supplementary file 1.

Results

Aggregated data for the five occupational groups (medical doctors, dentists, pharmacists, nursing & health technician personnel, and administrative & technical staff) indicate a total of 62,651 health workers in the public health sector in 2023. Notably, nursing and health technician personnel comprise 62% of the total healthcare workforce. Compared with 2019, this stock has increased by 27% globally, a rate more than six times higher than the population growth of 4.2% over the same period. This pace of workforce expansion signals greater potential service capacity particularly at primary care, where nursing and health-technician roles are central. Distributions of personnel, pipeline and graduates by year are shown in the supplementary file 2 (Tables: S1-S5).

Medical doctors totaled 29,904 in 2023 (14,510 public; 15,394 private), for a national density of 0.80 per 1000, nearly double 0.43 per 1000 in 2000 (Fig. 1). The physician stock thus grew 2.4-fold, with the sharpest rise in 2000–2017 (+ 58%), followed by a further + 16% in 2017–2023. Dentists numbered 5414 in 2023 (529 public; 4885 private), or 0.14 per 1000 (up from 0.07 per 1000 in 2000). Pharmacists totaled 10,149 in 2023, yielding 0.27 per 1000 versus 0.17 per 1000 in 2000; an increase of 95%.

Fig. 1.

Trend of density and number of physicians in Morocco in public and private sector (2000–2023).

Source: Healthcare Map platform

Nursing and health technician personnel remained the largest group in 2023 (38,725; 1.03 per 1,000) (Fig. 2). The sharpest expansion occurred in 2017–2022, when density rose by 26%. Within this category, midwives increased from 1132 to 6430, an almost six-fold rise reflecting sustained investment in maternal health [13, 14].

Fig. 2.

Trend of density and number of nurses in Morocco in public sector (2000–2023). Total paramedical personnel include nursing and health technician staff.

Source: Healthcare Map platform

As comparative benchmarks, Morocco’s 2023 densities (0.80 physicians and 1.03 nurses/midwives per 1000 population) remain well below the SDG reference values of 1.72 physicians and 4.5 nurses/midwives per 1000 [1]. Regional assessments by WHO/EMRO indicate higher average densities across the Eastern Mediterranean Region; for example, recent EMRO reports estimate physician and nurse/midwife densities on the order of magnitude of approximately 1.0–1.5.0.5 physicians and 1.5–2.5 nurses/midwives per 1000, respectively [15, 16].

Administrative & technical personnel amounted to 8677 in 2023; 6392 technical staff and 2285 administrative officers, for a combined density of 0.23 per 1000 inhabitants (Table S3). Since 2019 (the first year with disaggregated data) technical roles have expanded by 69%, whereas administrative posts have risen by only 13%, explaining the modest overall density gain from 0.20 to 0.23/1000.

Between 2019 and 2023, enrollment in health-sector training programs rose sharply. Registered students more than doubled in both the public (+ 132%) and private (+ 130%) sectors (Fig. 3). In the public sector, medical and pharmacy programs increased by 96%, while paramedical enrollment grew by 171%. Graduates from medicine and pharmacy rose by 43%, with an even larger gain in paramedical fields (+ 72%) (Table S5). By sector, public institutions produced over 50% more graduates than in 2019, whereas private institutions more than doubled their output.

Fig. 3.

Trend of number of students (new registrants) in Morocco in medical and paramedical higher education (2018–2024).

Source: MHE platform

Discussion

Morocco’s health workforce has expanded appreciably in recent years, with the fastest gains among nursing and technical cadres that now anchor day-to-day service delivery. At the same time, the education pipeline has scaled up across medical and paramedical tracks, indicating intentional efforts to secure future supply. Taken together, the patterns point to a system that is growing its clinical capacity while investing in longer-term sustainability, yet still facing gaps in overall availability and distribution relative to international reference levels.

Emigration of Moroccan medical students and physicians to high-income countries undermines UHC and deepens rural shortages [17–19]. Despite training expansion, weak retention leaves a persistent graduate service gap. Similar brain drain across EMRO countries, driven by comparable push-pull factors, creates critical local shortages and slows progress toward equitable services and health-related SDGs [20–22]. Countermeasures will require improved working conditions, competitive incentives, and clear career pathways at home.

Morocco faces a critical nursing and midwifery deficit that impedes UHC, with recruitment and retention shortfalls, especially in remote areas, driven by limited training capacity, weak professional development, and suboptimal working conditions that fuel burnout [23]. Migration further depletes supply, mirroring EMRO-wide patterns [21, 24–26], and without targeted investment in education, workforce planning, and retention, equitable, high-quality care and UHC targets will remain out of reach. Moreover, medical secretaries, central to scheduling, records, and care coordination, remain underdeveloped due to limited recognition, training, and digital integration, causing inefficiencies and shifting workload to clinicians [27]. Targeted professionalization and modernization of this workforce would boost system performance.

Morocco’s workforce planning should adopt an integrated time frame: recent training and hiring expansions target short-term shortages, yet burnout, job dissatisfaction, urban-rural maldistribution, and ongoing physician emigration persist [23, 28]. A balanced strategy must pair quick wins (accelerated training and recruitment) with medium-term organizational reforms and long-term retention policies, aligned with contemporary health system strengthening frameworks.

Morocco’s public health workforce has expanded in recent years, yet densities remain below international reference thresholds, so closing the gap will require a coordinated, multisectoral strategy. Priorities include scaling up training capacity, strengthening faculty and clinical placement infrastructure, and modernizing curricula toward competency-based education; these actions should be paired with continuous professional development, evidence-based task sharing, and a deliberate move toward a more balanced nurse-to-physician skill mix to translate headcount growth into productivity and quality. Equitable distribution is essential: bundled rural-retention measures (targeted admissions, supervised rural internships or time-bound compulsory service linked to career progression, hardship/housing allowances) and strategic purchasing or contracting with private providers can secure minimum coverage in underserved areas. The reform package anchored in Framework Law 06–22 (governance, human-resources development, upgrading of care provision, and digitalization) provides concrete levers to implement these measures [29]. In parallel, strengthening the national HRH registry is a near-term priority: adopt a unified data dictionary and unique identifiers; add full-time-equivalent status, contract type, and practice-location history; establish secure, routine linkages with licensing boards (for licensure, renewal, and disciplinary events); and integrate higher-education graduate tracking. Together with a real-time HRH observatory, these enhancements will support multi-year workforce forecasting, updated skill-mix benchmarks, and more precise regional deployment and retention decisions. Recent government programs (2018–2025) that finance hospital and primary-care upgrades further reinforce capacity for training scale-up and supervised rural placements [30].

Evidence from comparable settings supports the proposed policy levers. In EMRO, Pakistan’s Lady Health Worker program shows how structured task-sharing and community-based deployment can extend primary care when referral and supervision are in place [31]. Iran’s Family Physician program underscores the value of PHC gatekeeping and rural posting, contingent on retention supports and financing alignment [32]. Beyond EMRO, Thailand’s CPIRD demonstrates that rural-origin recruitment plus rural clinical training improves rural placement and retention of physicians, and Ethiopia’s Health Extension Program shows how standardized training and supervision can scale task-sharing [33, 34]. Together, these experiences reinforce Morocco’s focus on rural recruitment and incentives, task-sharing, PHC-first deployment, and stronger information systems to translate workforce growth into equitable coverage.

Limitations

Using an officially published dataset strengthens credibility, but several limitations apply. First, reliance on pre-existing administrative data may constrain the scope of analysis; the dataset may lack variables of interest, offer limited granularity, or reflect collection biases. Missing information on migration, attrition, and detailed age distributions precluded projection models. The sources also do not fully capture intra-regional maldistribution or public-private dual practice, which are critical for equity; distributional inequities may therefore be underestimated. On measurement, indicators are headcounts rather than full-time equivalents (FTE), and cadre definitions may have changed over time; reporting lags further affect timeliness. In addition, a quantitative stock approach does not assess qualitative determinants (professional satisfaction, working conditions, workload, retention) known to shape workforce stability [23, 35]. Finally, findings were not triangulated with surveys/interviews nor systematically cross-checked against international repositories (e.g., OECD, WHO), limiting external validation and comparability. We partially mitigated these risks through source cross-checks and cadre-title harmonization. Going forward, we recommend linking the HRH registry with professional licensing boards (licensure/renewal events), integrating OECD mobility and graduate-tracking data, and adding FTE and age-cohort fields to improve precision and forecasting.

Conclusions

This study provides the most up-to-date, policy-ready synthesis of Morocco’s health-workforce stock and training pipeline, filling a near-term planning gap. Workforce growth, led by nursing/technical cadres, persists alongside distribution and productivity challenges. Priorities are to align intake with service needs, deploy bundled rural-retention incentives, contract private providers for underserved areas, and strengthen the HRH registry within a real-time observatory. Forward-looking, multi-year forecasting should guide adaptive deployment and retention.

Abbreviations

EMRO

Eastern Mediterranean Regional Office

HRH

Human Resources for Health

MHE

Ministry of Higher Education

MHSP

Ministry of Health and Social Protection

OECD

Organization for Economic Co-operation and Development

UHC

Universal Health Coverage

WHO

World Health Organization

Author contributions

WA: Conceptualization, Methodology, Data curation, Formal analysis, Writing– original draft. YE: Conceptualization, Data curation, Formal analysis, Validation, Writing–review and editing. C.N: Conceptualization, Formal analysis, Validation, Supervision, Writing–review and editing. ABA: Conceptualization, Formal analysis, Writing–review and editing.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The Ministry of Health data portal: http://cartesanitaire.sante.gov.ma/and the Ministry of Higher Education data portal: https://www.enssup.gov.ma/en/statistiques, provide access to all health workforce data reported, which were used in this article.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.