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Background In Morocco, the national health plan 2025 was developed to promote Sexual and Reproductive Health (SRH) services for all. The principal aim was to achieve the Universal Health Coverage of SRH by 2030. For many years, health authorities’ efforts had focused on reducing maternal mortality through a widespread access to antenatal and obstetric care and family planning services. This has resulted in a significant gap between the availability of SRH components, namely obstetric and family planning care, and access to infertility services including Assisted Reproductive Technology (ART). The objective of this study is to answer two important questions. First, why some SRH programs and services are given priority by international and national political leaders while infertility care receives little attention; second, what are the factors that influence this prioritization? Methods We used Shiffman and Smith’s framework composed of four elements: the strength of the actors involved in the initiative, the power of the ideas they use to represent the health problem, the nature of the political contexts in which they operate and the characteristics of the services. We added a fifth element to the framework, the outcome. We applied this framework to the case of infertility services in Morocco. We conducted a desk review and interviews with actors involved in SRH and infertility care advocates as well as with decision makers involved in implementing Universal Health Coverage (UHC). Results Our results showed that despite the efforts made by the advocates of infertility care; the enactment in 2019 of a law regulating infertility care services; and the presence of two Assisted Reproductive Technology Units in the public sector, infertility services remain at an early stage of development hampered by multiple challenges. Among others, a lack of political entrepreneurs to ensure a strong leadership; the political windows were often missed; community members lacked consensus on a coherent public positioning of the problem, and advocates' perception and power of the idea lacked evidence and precise indicators of the problem. Conclusion To ensure the convergence and alignment of all stakeholders, it is recommended to translate the regulation of infertility into measurable activities with defined human and financial resources, equitable fertility health coverage, and quality fertility care to respond to women and infertile couples’ needs, rights and dignity.

Maternal health (MH) is a national priority of Morocco. Factors influencing the agenda set by the reproductive and maternal health policy process at the national level were evaluated using the Shiffman and Smith framework. This framework included the influence of the actors, the power of the ideas used, the nature of the political context, and the characteristics of the issue itself. Factors were evaluated by a review of documents and interviews with policy-makers, partners and individuals in the private sector, civil society and non-governmental organisations (NGOs) involved in MH, and decision-makers responsible for implementing health-financing strategies in Morocco. Evaluations showed that maternal mortality in Morocco was considered human rights and social development as well as a public health problem. The actors responsible for MH, including members of the government, researchers, national technical experts, members of the private sector, United Nations partners and NGOs, agreed on progress made in MH and universal health care (UHC). Stakeholders also agreed on the prioritisation process for MH and its inclusion in the health benefits package. Prioritisation of MH was found to depend on national health priorities set by the government and its close partners, as well as on the availability of human and financial resources. Interventions at the operational level were based on evidence, best practices, allocation of adequate financial and human resources, and rigorous monitoring and accountability. However, MH and health financing are experiencing difficulties in many areas, related to social and economic and health disparities, and gender inequality, and quality of care.

Currently, about 8% of deaths worldwide are maternal or neonatal deaths, or stillbirths. Maternal and neonatal mortality have been a focus of the Millenium Development Goals and the Sustainable Development Goals, and mortality levels have improved since the 1990s. We aim to answer two questions: What were the key drivers of maternal and neonatal mortality reductions seen in seven positive-outlier countries from 2000 to the present? How generalisable are the findings?We identified positive-outlier countries with respect to maternal and neonatal mortality reduction since 2000. We selected seven, and synthesised experience to assess the contribution of the health sector to the mortality reduction, including the roles of access, uptake and quality of services, and of health system strengthening. We explored the wider context by examining the contribution of fertility declines, and the roles of socioeconomic and human development, particularly as they affected service use, the health system and fertility. We analysed government levers, namely policies and programmes implemented, investments in data and evidence, and political commitment and financing, and we examined international inputs. We contextualised these within a mortality transition framework.We found that strategies evolved over time as the contacts women and neonates had with health services increased. The seven countries tended to align with global recommendations but could be distinguished in that they moved progressively towards implementing their goals and in scaling-up services, rather than merely adopting policies. Strategies differed by phase in the transition framework—one size did not fit all.

Maternal health (MH) is a national priority of Morocco. Factors influencing the agenda set by the reproductive and maternal health policy process at the national level were evaluated using the Shiffman and Smith framework. This framework included the influence of the actors, the power of the ideas used, the nature of the political context, and the characteristics of the issue itself. Factors were evaluated by a review of documents and interviews with policy-makers, partners and individuals in the private sector, civil society and non-governmental organisations (NGOs) involved in MH, and decision-makers responsible for implementing health-financing strategies in Morocco. Evaluations showed that maternal mortality in Morocco was considered human rights and social development as well as a public health problem. The actors responsible for MH, including members of the government, researchers, national technical experts, members of the private sector, United Nations partners and NGOs, agreed on progress made in MH and universal health care (UHC). Stakeholders also agreed on the prioritisation process for MH and its inclusion in the health benefits package. Prioritisation of MH was found to depend on national health priorities set by the government and its close partners, as well as on the availability of human and financial resources. Interventions at the operational level were based on evidence, best practices, allocation of adequate financial and human resources, and rigorous monitoring and accountability. However, MH and health financing are experiencing difficulties in many areas, related to social and economic and health disparities, and gender inequality, and quality of care. La santé maternelle est une priorité du plan national de santé du Maroc. Les facteurs influençant le programme défini par le processus politique de santé maternelle et reproductive au niveau national ont été évalués à l’aide du cadre de Shiffman et Smith. Ce cadre tenait compte de l’influence des acteurs, du pouvoir des idées utilisées pour décrire la question, de la nature du contexte politique, des caractéristiques de la question elle-même et de la priorisation de la santé maternelle dans le panier de soins de santé sexuelle et reproductive (SSR). Les facteurs ont été évalués par un examen de documents et des entretiens avec des décideurs, des partenaires et des personnes appartenant au secteur privé, à la société civile et à des organisations non gouvernementales (ONG) actives dans la santé maternelle, ainsi qu’avec des responsables de la mise en œuvre de stratégies de financement de la santé au Maroc. Les évaluations ont montré que la mortalité maternelle au Maroc était considérée comme un problème ayant trait aux droits de l’homme, au développement social et à la santé publique. Les acteurs responsables de la santé maternelle, notamment des membres du Gouvernement, des chercheurs, des experts techniques nationaux, des membres du secteur privé, des partenaires des Nations Unies et des ONG, étaient d’accord sur les progrès accomplis dans la santé maternelle et la couverture santé universelle (CSU). Ils ont aussi adhéré au processus de hiérarchisation des priorités pour la santé maternelle et son inclusion dans le panier de soins. Il a été constaté que la priorisation de la santé maternelle dépendait des priorités nationales de santéfixées par le Gouvernement et ses proches partenaires, ainsi que de la disponibilité de ressources humaines et financières. Un environnement politique favorable a encouragé le Ministère de la santé à donner la priorité à la santé maternelle en alignant les approches politiques et techniques. Les interventions au niveau opérationnel étaient fondées sur les données, les meilleures pratiques, l’allocation de ressources financières et humaines adéquates, ainsi qu’un suivi attentif et une redevabilité rigoureuses. Néanmoins, la santé maternelle et le financement de la santé connaissent des difficultés dans de nombreux domaines, en particulier ceux qui se rapportent aux disparités sociales, économiques et sanitaires, à l’inégalité entre hommes et femmes, à la qualité des soins et à la nécessité de formuler une stratégie de financement consolidé de la santé. La salud materna (SM) es una prioridad del Plan de Salud nacional de Marruecos. Los factores que influyen en la agenda establecida por el proceso de políticas relativas a la SM Reproductiva a nivel nacional fueron evaluados utilizando el marco de Shiffman y Smith. Este marco incluyó la influencia de los actores, el poder de las ideas utilizadas para plantear el tema, la naturaleza del contexto político, las características del asunto en sí y la priorización de SM en el paquete de beneficios de salud sexual y reproductiva (SSR). Los factores fueron evaluados por una revisión de documentos y entrevistas con formuladores de políticas, socios y personas en el sector privado, organizaciones de la sociedad civil y no gubernamentales (ONG) involucradas en SM, e instancias decisorias responsables de aplicar estrategias de financiamiento de los servicios de salud en Marruecos. Las evaluaciones mostraron que la mortalidad materna en Marruecos era considerada un asunto de derechos humanos y social, así como un problema de salud pública. Los actores responsables de SM, tales como integrantes del gobierno, investigadores, expertos técnicos nacionales, integrantes del sector privado, socios de las Naciones Unidas y ONG, estuvieron de acuerdo en cuanto al progreso logrado en SM y en la cobertura universal de salud (CUS). Las partes interesadas también estuvieron de acuerdo con el proceso de priorización de SM y su inclusión en el paquete de beneficios de salud. Se encontró que la priorización de SM depende de las prioridades de salud nacionales establecidas por el gobierno y sus principales socios, así como en la disponibilidad de recursos humanos y financieros. El entorno político favorable motivó al Ministerio de Salud a priorizar SM alineando los enfoques políticos y técnicos. Las intervenciones a nivel operativo se basaron en evidencias, buenas prácticas, asignación de recursos financieros y humanos adecuados, monitoreo riguroso y rendición de cuentas. Sin embargo, SM y financiamiento de salud están pasando por dificultades en muchas áreas, especialmente aquellas relacionadas con disparidades sociales, económicas y sanitarias, desigualdad de género, calidad de la atención y la necesidad de formular una estrategia consolidada de financiamiento de salud.