The impact of service provision contracts on the quality of healthcare in rural areas of Morocco: a case study of the province of Khouribga

Abstract

The structural shortage of human resources in Morocco’s public health sector has led to an increasing reliance on service delivery contracts, particularly in rural areas where medical and paramedical staff are most needed. This study examines the impact of these contractual arrangements on healthcare quality in the province of Khouribga, focusing on three key dimensions: accessibility, continuity, and quality of care. Using an in-depth case study approach, this research adopts a mixed-method design that combines semi-structured interviews with healthcare actors (physicians, nurses, and provincial managers) and quantitative analysis of local health reports. Preliminary findings reveal that such contracts have temporarily improved geographic access to healthcare services, yet raise critical challenges regarding staff stability, service continuity, and professional motivation. The study ultimately aims to inform policymakers on how to better integrate contractual personnel into the national health strategy, ensuring greater efficiency, equity, and sustainability in public health human resource management.