To better understand the current situation in the field of the occupational health in Morocco, it’s imperative to look back a little and outline the historical evolution of the occupational health and safety (OHS) in this country.
Indeed, the OHS situation was not the same before, during and after French protectorate. Before 1912, the beginning of French protectorate, the situation was similar to that of the Middle Ages: working relationships were controlled by manners, prevention concepts didn’t exist, rights were simply ignored and only corporate work prevailed. Between 1912 and 1955, period of the protectorate, the first legislative texts appeared, by a transposition of the French legislation. The majority of these texts are still representing the bases of the current occupational health and safety legislation. From 1955, after the event of independence, Moroccan legislation was packed by several texts among them those creating the occupational medical services in firms.
In Morocco, the first legislative and regulatory texts concerning the health protection of workers, and the hygiene and safety in workplaces were promulgated during the protectorate and in the early years of independence (figure 1).
The Dahir (Law) of 1913, devoted to the general provisions related to the work contract, determined the general conditions of hygiene and safety that employers must provide. The articles, from 749 up to 751, defined the employer responsibilities as regards work contract. The text is obvious; the employer is responsible for accidents that occur in workplace.
The Dahir of 1927 was related to worker’s compensation after an occupational accident. This text recognizes the employer responsibility in the event of accidents that occur in his firm, and gave the recipients of the compensation and its justification. The Dahir of 1943 related to the occupational diseases "…are regarded as occupational diseases, within the meaning of the present Dahir, the clinical manifestations, microbiological infections and affections listed by order of Labour Minister…"
The Dahir of 1947 enacted the first measures concerning the medical organisation in firms and implied, in the article 24, that the employer was the only person in charge for health and safety at work. The order of 1952 enacted the general measures of hygiene and safety on the workplaces and other orders supplemented this regulation for harmful effects or agents present in work environment.
With the purpose of improving the social conditions, the regulations introduced the weekly rest in 1930, the duration of 48 hours work per week and the minimum wage in 1936, the creation of trade unions for French workers in 1936 and it’s extension to Moroccans workers in 1955, the holidays pay in 1937, the collective agreements in 1938 and standard statute in 1948.
After the protectorate, the Moroccan government set up several texts for the social and medical protection of the workers. In particular The Dahir of 1957 and its decree of application of 1958 enact institution of occupational medical services and determine fixed establishments (firms of 50 employees or more and any firm when there is a risk of occupational diseases), the organisation and the operation of occupational medical services: indoor or outdoor services between firms according to the number of hours which the occupational physician must devote to the performance of his duties; the role of the occupational physician which is primarily preventive except in emergency event; the ancillary medical personnel and his mission and the missions of the medical inspection of the factory.
The same year knew the appearance of a text enacting the protection measures of the health of the woman and the children. But, it was necessary to wait until 1972 for the publication of the first list of tables of 35 occupational diseases. Unfortunately it remained unchanged until the year 1999, when it was increased to 95. In parallel,
this time also knew the appearance of texts related to the social protection of the workers. With, in particular: the worker representation in 1962 and the Dahir of 1963 introducing the mode of the mutual insurance companies. Previously, the Dahir of 1959, renovated afterwards by Dahir of 1972, introduced a mode of social security covering maternity, disability, old age, death, family benefits and pension of survivors. This mode was not extended to the workers of the farms, forest and with their dependants until in 1981. These texts were updated in 1996 with a revalorization of the allowed maximal values.
It should be noted that the insurance against the occupational accidents and the occupational diseases is a compulsory insurance only for certain category of firms: primarily firms tendering for the public markets and the maritime firms. Private insurance companies ensure the occupational accident risk.
The system of prevention and protection against occupational hazards is a relatively old device. The texts of 1927 and 1943 are strongly inspired by the French law on occupational accidents (OA) and occupational diseases (OD). The insurance against OA risk and OD is optional, directed exclusively towards the compensation. The services for the victims are ridiculous and in complete disagreement with reality. The process of compensation-length, complex and misfit-makes the compensation very hypothetical. As for the registered number of OAs and ODs, see table 1.
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Table 1. Number of registered occupational accidents and occupational diseases in Morocco,1995 |
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Occupational Accidents (OA) Serious Occupational Accidents Occupational Diseases Average cost to OA (Dirham, Average cost to a serious OA (Dirhams) Cost Insurance Bills (Dirhams) |
65,177 17,799 217 15,000
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The occupational medicine is supposed to be primarily preventive. The nearly exclusive exercise in part-time by doctors (of liberal practice in addition) the majority not graduated, shows quickly the limits of protection and gives the occupational medicine a rather dull image in the firm.
The data recorded into 2000 and reported in table no. 2 shows clearly the gap to be caught up during coming years.
| Table 2. Coverage of occupational
medicine in Morocco, 2000
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Uncovered workers (urban population) Covered workers Occupational Medical Services (autonomous) Occupational physicians Ancillary medical personnel (nurses) |
10,000,000 320,823 |
The observance of the general regulation of the work and the conditions of hygiene
and safety is under the exclusive responsibility of the employer. It relates
only to the private sector. Table no. 3 illustrates clearly that the share of
the administration of work is very insufficient to follow a true prevention
policy of the occupational hazards.
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Table 3. Labour inspection in Morocco, 1995 |
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General labour inspectors Agricultural labour inspectors Number of complaints Visited firms Number of visits |
213 8 |
After the creation of a service of occupational medicine at the Ministry of labour in 1996, it was decided to establish medical inspection in all the 16 economic regions of the country. In 2000, there were offices for medical inspection in three regions, and now (2002) there are such offices in six regions.
The difficulties encountered to promote the health of work in Morocco are numerous and multifactorial. They draw their origins in the political and social history of our country during last century.
In general, industrial legislation and the occupational medicine in particular are old, badly adapted to the Moroccan context, and has been taken largely from French legislation. It is especially centred on the compensation of the occupational injuries and neglects the prevention. It covers the subjects in a general way without defining the methods of application. The workers are unaware of it almost completely, preferring to guarantee an income to defend their rights. The Moroccan constitution give every adult Moroccan the right to work. In reality, however, it is not so. Right now, in 2002, 16% of the working population are unemployed. Therefore, those who have an employment don’t dare to ask for their rights to a safe and healthy work. And their representatives in trade unions give very little support to occupational safety and health. The employers are organised through their trade union. They know the legislation better but very seldom apply it, especially as regards prevention of the occupational hazards.
The medical cover of the workers are lacking in all industry branches. For example, the workers in agriculture sector — the sector of working life which employs most people - do not profit from any really organised medical supervision. It is the same for the civil servant; the State doesn’t ensure any occupational health services for its employees. The workers who profit from the medical cover are only 3 % of the urban working population, as can be seen in table no. 2. The remainder of the working population is without medical supervision in workplaces.
The system of assumption of responsibility of the occupational disease and occupational accidents is obsolete. The services provided by the private insurances are insufficient because they are not related to the cost of living. The process of compensation is a true course of the combatant; it can last several years in the event of compensation of an OD.
The employers are obliged to pay the premium accounts of insurance to cover OA/OD risk, and consider this expensive. The care in the event of the event of OA, is taken by the sickness insurance. The workers are not really conscious of the utility of this system or at least do not regard it as a priority because the revenues and the allowances ridiculous because they are calculated on the basis of wages often very low. The essential thing for the workers is to have a stable income. The workers are under qualified, illiterate and under paid. Therefore, they tend not to insist on payments for OD, by fear of being laid off.
The occupational medicine has difficulties, as a preventive activity, to find its true place in the firms. In an unfavourable socio-economic context, private as well as public enterprises grant little interest to occupational medicine. The law requires that each firm, employing 50 workers or more must have an occupational medical service, with a part-time or full-time doctor according to the size of the firm. However, a few firms have this occupational medical service. The number of the occupational medical service approved, during year 2000 by the medical inspection of factory, is 1340 whereas there are more than 5000 firms of more than 50 workers or more. These services are to more than 70% localised in the centre of the country.
The situation of the occupational physician is very fragile. Indeed, his nomination and his dismissal are totally depending on the authority and the unilateral decision of the employer. The employer recruits this physician to fulfil the requirements of the law without giving him the necessary material and human resources to assure his mission. The physician often applies general medicine in firm rather than occupational medicine and exceptionally occupational health. The employer uses it sometimes to alleviate the social climate in the event of claims of the employees, to justify certain dismissals for health reasons, to exempt care or to control the absenteeism.
The workers regard this physician as a person imposed by the employer. This complicates the relation between the worker and the physician, and constitutes an obstacle for the integration of the physician in the firm.
In 1995, among the 683 physicians working as occupational physicians in firms, only 30 were specialists in occupational medicine. The majority of them are limiting themselves to give curative care to the workers, to control the absenteeism or quite simply to sign the annual medical reports required by the medical inspection of factory.
The occupational medicine is regarded as a full speciality only since 1985. Currently the diploma of speciality in occupational medicine lies within the scope of the specialities organised by the Moroccan Faculty of Medicine. The access to this speciality is by the way of the resident contest of resident and the specialist training which started in 1992.
In 1993, a ministerial decree prohibited the exercise of the occupational medicine by the non-specialists. It started to be applied only in 1999, and indeed we start to require the diploma of occupation health’s specialist to have approval. However, that poses the problem of training in occupational medicine. Currently, there is little attention towards this speciality. The State offers very few training opportunities and the physician places it at the last row of their choices of speciality whereas the national needs of occupational health physicians are considerable: 2,500 occupational physicians. Imagine the situation for the other kinds of occupational health professionals.
Can we really speak about occupational health in Morocco? If the occupational medicine can with difficulties be made a place in the world of work, how about the other disciplines such as ergonomics, occupational hygiene or occupational psychology?
In fact, it is up to the occupational professionals to promote occupational health as an asset for the firm and not as a handicap for the employers.
The occupational medicine in Morocco is dynamic. There is a wish to give this discipline a privileged position in the firm, in the interest of the individuals and the groups who constitute it. With political goodwill, it will be necessary and possible to increase the awareness of the employers and the employees about the important role of occupational medicine in the development of safe, healthy and productive work in Morocco.
Abdeljalil El Kholti
Occupational Health Unit
Faculty of Medicine of Casablanca
Box 9154
Casablanca 20100
Morocco
Tel:+212-22-27 16 30
Fax: +212-22-29 80 70