Morocco's advanced epidemiological transition is marked by economic growth, reduced fertility rates, and shifts in disease patterns, with a decrease in communicable diseases occurring alongside a rise in chronic illnesses such as cardiovascular disease, diabetes, and cancer.[1] Despite notable reductions in maternal and infant mortality, healthcare challenges persist, including workforce shortage uneven resource distribution, high medicine prices, and geographical accessibility issues, with 20 percent of the population living beyond 10 kilometres from a primary care facility. [2] Furthermore, childhood cancer care was hindered by insufficient planning, non-standardized practice, and inequitable access to treatment, particularly in palliative care. Reacting to these challenges, Morocco, in line with WHO's Thirteenth General Programme of Work and collaborating with St. Jude Children’s Research Hospital in the context of the WHO Global Initiative for Childhood Cancer, initiated implementation of Morocco’s National Plan to Combat Childhood Cancer. This plan will focus on improving treatment accessibility and standardizing care practices. As a result, between 2020 and 2022, the national childhood cancer 3-year survival rate rose from 68.2 to 72.2 percent, significantly improving healthcare outcomes and saving numerous lives.[3][4][5]

How did Morocco, with the support of WHO, achieve this?

In 2012, a health system review revealed significant deficiencies in Morocco's health system.[7] This led to Morocco collaborating with the World Health Organization (WHO) to implement reforms aimed at achieving universal health coverage (UHC). Following this, in 2018, the WHO Global Initiative for Childhood Cancer was launched, setting a goal to increase the global childhood cancer survival rate to 60 percent by 2030.[8] Morocco, already at a 60 percent survival rate, joined this initiative as focus country to further enhance outcomes, reduce in-country inequities and improve the quality of life for children.[9]

A subsequent health system review in 2020 identified specific areas for improvement.[10] Equipped with this baseline knowledge, in 2021, WHO provided technical and financial assistance to Morocco's Ministry of Health and Social Protection to develop the national plan to fight childhood cancer. This comprehensive plan includes conducting economic studies for childhood cancer care, developing pediatric hemato-oncology and palliative care programs, assessing medical practices, and establishing care delivery standards within hemato-oncology services. These initiatives' findings were crucial for advocating at the decision-making level and ensuring that treatments are available and accessible to all children, regardless of their geographical or economic status.

"Improving the prognosis for children with cancer requires early and accurate diagnosis, followed by effective treatment. What is encouraging and should motivate us is that most childhood cancers, once diagnosed and treated, can be cured."

Dr Maryam Bigdeli, WHO Representative in Morocco

With assistance from regional and headquarters offices, WHO Morocco's technical experts carried out financial assessments critical in garnering investments for childhood cancer care. Consequently, the Moroccan government, along with fundraising efforts by the Ministry of Health, Lalla Salma Foundation, university hospitals, and local NGOs, committed substantial funds to the national plan. These funds were channelled into enhancing infrastructure and equipment at paediatric cancer centres, as well as into training healthcare professionals in paediatric oncology, thereby equipping them with the necessary skills for delivering quality care. In collaboration with St. Jude Children's Research Hospital, WHO helped develop guidelines for palliative care and co-organized training sessions with the Ministry of Health, targeting healthcare professionals. These sessions were based on the newly developed guidelines, which WHO also printed and distributed. 

Furthermore, the Moroccan government and the Lalla Salma Foundation spearheaded numerous public education campaigns on childhood cancer, while WHO facilitated webinars for healthcare professionals and the community, particularly around World Health Day and International Childhood Cancer Day. These concerted efforts have significantly raised awareness about childhood cancer, reduced stigma, and promoted early diagnosis and treatment, thereby bolstering the community-level impact of the National Plan. As a result of these awareness campaigns, an increasing number of Moroccan families are seeking early diagnosis and treatment for childhood cancer.

“Global Initiative for Childhood Cancer implementation ensures treatment availability and accessibility for all children.”

WHO Global Initiative for Childhood Cancer

Ongoing evaluation projects and survival studies, supported and co-financed by WHO and St. Jude, are pivotal in continuously enhancing healthcare services. These initiatives critically assess medical practices and set care standards, crucial for the effective management of childhood cancer. A financial analysis of childhood cancer, completed in 2022 as part of the National Action Plan, provides valuable insights into the cost implications and resource allocation for childhood cancer management.[11][12]

^{Institutional and governmental partners during the presentation of the axes of the Childhood Cancer Plan 2021-2030.}
Photo credit: WHO Morocco/Marouane Bendraif

Implementation of the National Plan led to a doubling of the number of paediatric cancer treatment centres, from five to ten, and an expansion of public health insurance coverage. These improvements, along with enhanced support programs and palliative care guidelines, have substantially upgraded the healthcare infrastructure, access, and quality. Approximately 1500 new cases are diagnosed annually in Morocco, with treatment now reaching around 1000 children, reflecting the Plan's profound impact in revolutionizing paediatric cancer care.

Morocco's National Plan exemplifies the impact of well-crafted cancer control strategies, highlighting the importance of strategic planning, international collaboration, and national commitment. It has significantly advanced childhood cancer care in Morocco, positioning it as a model for global healthcare strategies. As Morocco aims for an 80 percent survival rate, the Global Initiative for Childhood Cancer will continue, introducing new projects that will build on previous successes, requiring further funding to realize ambitious healthcare goals.