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Maghreb Life Sciences



Market Study Morocco

Jenni Mäkipää, Senior Consultant
October 2011
Contents

1.    Morocco in brief
2.    Market characteristics: Economy & Trade
3.    Ecosystem & main players
4.    Development Policy
5.    Doing Business in Morocco

6.    Health Care System
7.    Hospital framework and case studies
8.    Hospital Technology
9.    E-Health
10.   Health Care Expenditure
11.   Pharmaceutical Market
12.   Dental Care
13.   Health Tourism
14.   Retail Market

15. Business Opportunities
16. Morocco LS SWOT

                               2                © Finpro
Kingdom of Morocco
       Population
       31,5 million (50% less than 25)

       Area
       710 850 km2 (excl. W. Sahara)

       Capital
       Rabat (largest city Casablanca)

       Languages
       Arabic (French, Berber)

       Currency
       Moroccan Dirham (1€ ≈
       11MAD)

       GDP
       €65 446 million
       (per capita €2 076)

       Minimum salary
       0,90 € per hour
                                                              Largest cities: Casablanca (3 m inhabitants), Marrakech (2), Fes (1), Tangier (0,9), Rabat (0,8), Meknes (0,8)
       Government
       Constitutional monarchy
Sources: Haut-Commissariat au Plan, Chiffres Clés 2009; HCP
Recensement 2004.
                                                                                         3                                                                         © Finpro
Economic indicators
                                                                                                        Evolution of GDP/Capita in €
                                                                      2009          2008         2500

       Unemployment                                                   9,1%           9,6%        2000

                                                                                                 1500
       GDP growth                                                     4,9%           5,6%
                                                                                                 1000
       Growth of primary
       sector
                                                                      29%           16,6%         500

       Growth of                                                                                    0
       secondary sector
                                                                      - 4,7%         3,6%
       Growth of tertiary
       sector
                                                                      3,9%           4,1%                Moroccan GDP per sector

       FDI & private loans                                      2 367 M€          3 137 M€                              Primary
                                                                                                                         16 %
       Transfers from
       migrants
                                                                4 465 M€          4 717 M€
       Income from                                                                                      Tertiary
       tourism
                                                                4 696 M€          4 938 M€               55 %
                                                                                                                           Secondary
                                                                                                                             29 %



                                                                                Healthcare
                                                                               5,4% of GDP
Sources: HCP, Direction de la statistique 2009; Office des Changes.

                                                                                             4                                         © Finpro
Trade

                                            •       Growing trade deficit
                                                      – Imports 2,5 times larger than exports
                                            •       60% of Moroccan exports from
                                                      – Raw and processed phosphates (acids & fertilizers)
                                                      – Cloth and footwear
                                                      – Food products (mostly fresh and processed fish, fruits and vegetables)
                                            •       46% of Moroccan imports are capital goods and energy
                                                      – Rising share of capital goods (from 22 to 25%)
                                                        and consumer goods (from 16 to 20%)
                                                                                                                   Main exports
                                                                                                                      (in MMAD)
                                                      Evolution of Moroccan trade
                                                                                                  180 000
                                       350 000,00
                                                                                                  160 000
                                       300 000,00
                                                                                                                                  Phosphate
                                                                                                  140 000
                       Value in MMAD




                                       250 000,00                                                                                 products
                                                                                                            51 394
                                       200 000,00                                                 120 000                         Cloth & Footwear
                                                                                        Exports   100 000             18 810
                                       150 000,00
                                                                                                            27 877                Food
                                                                                        Imports    80 000             26 536
                                       100 000,00
                                                                                                   60 000   26 164                Electrical
                                        50 000,00                                                                     23 961
                                                                                                            14 328                machinery
                                             0,00                                                  40 000             12 316
                                                                                                                                  Others
                                                                                                   20 000   35 976    30 343
                                                                                                       0
Sources: Office des Changes.
                                                                                                            2008       2009

                                                                                    5                                                      © Finpro
Trading partners

                             •   In 2009 EU countries received 65,6% of Moroccan exports and supplied 56,4% of
                                 its imports
                                    – France and Spain are the main trading partners
                                               • 24,5% of Moroccan exports and 15,7% of imports for France; 21,2% of exports and
                                                 12,1% of imports for Spain
                                   – China is now its 3rd largest supplier, ahead of USA, with respectively 7,8% and
                                       7,1% of Moroccan imports
                             •   Finland represented 0,65% of Moroccan exports and 0,53% of its imports
                                   – Finnish exports to Morocco were 78 M€ and imports 19 M€
                                               • Wood & paper (50%) and electric devices (21%) were the main exports
                                               • Clothes (37%) and phosphates (33%) were the main imported products


                                      Morocco Main Clients                           Morocco Main Suppliers
                             Europe    Asia     America   Africa   Others       Europe   Asia   America     Africa   Others



                                            7%                                                 5%
                                          7%                                               13 %

                                        14 %
                                                                                         22 %             60 %
                                                      70 %




Sources: oc.gov.ma; Tulli.

                                                                            6                                                 © Finpro
Trade Practice & Regulations

                                        Duration
       Import Procedures                           US$ Cost
                                        (days)

       Documents
                                           10         300
       preparation
                                                               2008
       Customs clearance                                          A new risk-based inspections
                                            2         250
       and technical control                                      system was introduced,
                                                                  causing the time to export to
       Ports and terminal                                         decrease by 2 days, and
                                            2         350
       handling                                                   import by 4 days.

       Inland transportation                                   2009
                                            3         100
       and handling                                               Document requirements for
                                                                  importing and exporting were
       Totals                              17        1000         simplified, reducing the time
                                                                  to import by 1 day.

Source: World Bank; doingbusiness.org

Date                                                © Finpro                                      7
Fast Railway Connections

       •   TGV Tanger – Casablanca
       •   The first high speed train in the African continent
       •   200 km / 2h10
       •   20 billion MAD investment
       •   Dec 2010 Tanger station opened
       •   The works to be completed by 2015




Date                                           8                 © Finpro
Key Moroccan Companies

                                                     1                                 2                                 3

                                            Groupe ONA                             Samir                      Maroc Telecom
                                                                            turnover 2009: 2 637M€            turnover 2009: 2 055 M€
                                           turnover 2009: 3 393 M€
                                                                       Oil refining and distribution      Former state-owned
                                      Holding company with a           company owned by the               monopoly, now a subsidiary
                                      portfolio of 20 firms in         Saudi Corral Group                 of the French group Vivendi
                                      • distribution (Marjane,
                                      Acima, Optorg)
                                      • food industry (Lesieur
                                        Cristal, Cosumar)
                                      • mining (Managem)
                                      • telecom (Wana)                                 LS                              LS
                                      • finance (Attijariwafa Bank)

                                      In Jun 2010 ONA and SNI                  Laprophan                          Eramedic
                                                                             turnover 2010: 86 M€            turnover 2010: 5-10 M€ (?)
                                      merged. Exit from stock
                                      exchanges. International         The biggest Moroccan               Hospital technology importer
                                      subsidiaries mainly in Africa.   pharmaceutical company             and distributor specialized in
                                                                       located in Casablanca. Staff       operating theaters. Part of
                                                                       over 600. Own research             Cofimag Group, an investment
                                                                       facilities and modern logistics.   holding company active in new
                                                                                                          technologies.




Sources: Corporate websites; les500.com.
                                                                                   9                                                       © Finpro
Development Policy

                            The King has set 2 main objectives:
                                 – developing the economy around the sectors where
                                    Morocco has some competitive advantages
                                 – reducing Morocco‟s energy dependence

                            5 years Health Action Plan 2008-2012                                                           King Momammed VI
                                  – Main objectives to expand infrastructure and reduce costs
                                  – 181 priority actions divided into 4 strategy axis:
                                                         1.   Strategic repositioning of the health sector players
                                                         2.   Developing healthcare offering with quality care, easy access and covering
                                                              populations needs by quantity and geographically
                                                         3.   National plans for preventions and healthcare
                                                         4.   Safety in healthcare

                            Tourism Vision 2020 / Plan Azur
                                           – 100% growth in 10 years
                                           – the top 20 destinations in the world by 2020
                                           – 8 new tourism destinations financed


Sources: emergence.gov.ma; Ministère de l‟Energie, des
Mines, de l‟Eau, et de l‟Environnment, mem.gov.ma.                               © Finpro                                               10
Doing business in Morocco

                              •         Exporting to Morocco
                                          – Today tariffs are applied on many imported products
                                          – EU trade agreement to be ratified in 2012 > EU imports easier with less
                                             customs
                              •         Investing in Morocco
                                          – Morocco is highly accommodative to foreign investors
                                          – Creation in 2009 of the Moroccan Investment Development Agency (AMDI),
                                             under the Ministry of Industry, Trade and New Technologies
                                          – Designed to inform and assist foreign investors throughout the different
                                             phases of their project
                              •         Corruption
                                          – In 2009 Morocco ranked 89th out of 180 in the Corruption Perception Index
                                             scoring 3,3*, below the world‟s average (4) and median (3,35)
                                          – Morocco has set up a commission and voted several laws to fight corruption
                                          – www.transparencymaroc.ma
                              •         Travel & safety issues
                                          – No visa required to enter the country
                                          – No particular risk and political situation relatively calm
                                          – The Maghreb revolution has not had major effects in Maroc thanks to the
                                             Kings prompt decision to shift power from himself to the parliament and the
                                             government. Constitutional Refererendum 1.7.2011 (98% voted yes)

Sources: AMDI; Transparency International; business-
anti-corruption.com
*The country ranking 1st is the least corrupt., New
Zealand in 2009, scoring 9,4.
                                                                    © Finpro                                          11
Household Expenditure
                                                           Casablanca is the business capital
•      Median household disposable income was 5445         • Wealthiest region
       USD/year in 2007                                    • Medical services concentrated here
•      Income growth rate average 2,3% (2001-2007).
                                                                             Rabat is the
                                                                             administrative capital
•      The highest average household disposable
       incomes are found in the greater Casablanca
       area, where expenditure average was 10 589
       USD in 2006.

•      The same region is also the single most
       important in terms of total spending, accounting
       for slightly more than a fifth of nationwide
       household expenditure in 2006 – more than
       double the contribution made by the second-
       most important region, the area around the
       administrative capital Rabat.

•      The remaining proportions of household
       spending are spread relatively evenly throughout
       the rest of the country, making it difficult for
       marketers to focus on one particular area.

Date                                                  12                                      © Finpro
Maghreb Life Sciences

Market: Morocco
Health Care System
Hospitals
Medical Devices & E-health
Health Care Sector Division



                           6%            15 %




                         79 %




               Private          Public          Non-profit




Date                                14                       © Finpro
Hospital Framework in Morocco


                   Health Care System
          Private                Public                  Non-profit
         270 hospitals        16 healthcare regions    National Social Security Fund
                                                                  (CNSS)
          5 000 beds               69 districts         > private sector employees
                                                           13 CNSS polyclinics
                               2626 Basic Health                1800 beds
         Located mainly in
       Casablanca (50%) and     Facilities (ESSB)
              Rabat               133 hospitals        The National Fund for Social
                                   26 000 beds         Security organisms (CNOPS)
                                                        > public sector employees
                                (19 CHU, 101 SEGMA,
                                     14 Regie)
                                7 military hospitals
                                 (open to public)


             15%                       79%                        6%
Date                                    15                                        © Finpro
Public Hospital System

Health is one of                         National university hospitals
    the most
  centralized
fields in public
     sector                              Regional hospitals



                                         Provincial hospitals

                                         Polyclinics

                                         Diagnostic Centers

                                         Healthcare Center (local)



Date                               16                                 © Finpro
Health Insurance System
            Assurance Maladie Obligatoire (AMO)
            Agence Nationale de l‟Assurance Maladie (ANAM)
            Oblibatory for all employees
            Launch 2005- (2010)2013
            www.assurancemaladie.ma


                                 AMO / ANAM
       • Caisse Nationale des       • Caisse Nationale de        • Régime d'Assistance
         Organismes de                Sécuritè Sociale             Médicale
         Prévoyance Sociale         • Private employees          • Low-income population
       • Public employees           • Facultative > obligatory   • Launch 2008-2011
       • www.cnops.org.ma             (2005)                     • 8,5 million Moroccans
                                    • www.cnss.ma                  eligible




       CNOPS                         CNSS                        RAMED

Date                                             17                                        © Finpro
Medical staff 2007

       •   Public physicians 6500     > 50%
                                     at CHUs
       •   Private physicians 8300
           Total 14800
                                      ~ 50% in
             – Generic 8600          the 2 main
                                       urban
             – Specialists 6200        areas



       •   8452 pharmacies




Date                                       18     © Finpro
Some Hospital Figures

       •   Hospital organisation regulation introduced in 2007, but still there are
           gaps in the management and organisation. Problems arise e.g. in lack
           of human resources, the management, lack of information systems.

       •   Surgical activities at public hospitals:
                240 000 surgeries in 2006
                503 operating theatres
                1,3 operations/day/theatre

       •   Hospital occupancy rate 54% (stable)

       •   Average length of stay 4,6 days

       •   Survey by Transparency Maroc: 80% thinks coppruption is very
           common, 23% have had contacts with corruption payments
           http://www.transparencymaroc.ma/


Date                                 © Finpro                                  19
Health care sector development and main drivers

         ICT infrastructure ready
          for mobile and broad                               Health insurance
              band solutions        Santé Vision             coverage:
                                                             17% > 34% > 50%
                                       2020
                                      Since 2006
                                                   Health insurance
                  MoH Health                            reform
                  Action Plan                       (AMO, RAMED)
                  2008-2012                          Since 2005



                                    Health Care           Social and
        REDRESS                      system in           demographic
          Since 2005                   strong           changes in the
                                    development            country
                                       phase
       Regionalisation of
       basic healthcare

Date                                    20                             © Finpro
The 4 University Hospital Groups (CHU)
         6th CHU                5th CHU
       planned for          under constuction
  North Tanger/ Tetouan   in Oujda, ready 2012                            opened in
                                                                            2009
                                                            2 hospitals
                                                            1050 beds
                                                            (best practice)




                                                              10 hospitals
                                                              2500 beds


                                                              2nd CHU in
                                                             Casablanca ?



                                                            4 hospitals
                                                            1600 beds
                                              3 hospitals
                                              900 beds


Date                                     21                           © Finpro
CHU Casablanca

       Public hospital
       Since 1930‟s
       CHU Casablanca includes 4 units:
                  1.   Hôpital Ibn Rochd
                  2.   Hôpital du 20 Août 1953
                  3.   Hôpital d'Enfants
                  4.   Centre de Consultation et de Traitement Dentaire

       •     1600 beds
       •     98 000 hospitalisations/year
       •     35 000 surgeries/year
       •     320 million MAD annual investment budget

       Hospital IT
                     •   Optic fibre network
                     •   IBM Lotus notes
                     •   Patient card with bar code
                     •   Radiology system RIS PACS by Siemens + Odelga

       Telemedicine used for pediatric ward for attending school lessons while in hospital
       The First Moroccan tissue bank under construction
       Difficult access to care in the rural areas > patient flows to big hospitals

       www.chuibnrochd.ma




Date                                                22                                       © Finpro
CHU Rabat

       •   Public hospital in Rabat
       •   10 hospitals
       •   2500 beds
       •   Staff 2000
       •   600 000 € investment budget
       •   New hospital building under construction

       •   3 years of heavy investments (2008-2010) e.g.:
                Central operating theatre (25 million MAD)
                Central laboratory (equipment + IT)
                Spect-CT
                Radiology IT
                Hospital IT network, optic cables since 2006-2008
                Electronic patient records
                Electronic medicine management for hospital pharmacy

       •   Needs
              Information systems
              Biomedical engineering (e.g. maintenance costs are a problem)
              Organisation and management (Efficiency, treatment chain management)

       •   www.chisrabat.ma




Date                                           23                                     © Finpro
Clinique Badr

       •   Small private clinic in Casablanca
       •   45 beds
       •   6 operating blocks
       •   Imaging unit

       • Patient records only on paper

       • www.cliniquebadr.ma




Date                              24            © Finpro
Hospital Cheikh Zaïd



                                                                                                      virtual
       Private university hospital in Rabat               New hospital to Casablanca                   tour
       • Non-profit foundation                            •  72 million € investment
       • Investor Cheikl Zaid from United Arab            •  Under construction since 2008
         Emirates
       • Built in 1998, part of CHU since 2006            •  Estimated to be completed by late 2011
       • 150 beds                                         •  53 000 m2
       • Centre of excellence with up-to-date             •  280 beds and 12 operating theatres
         technology                                       •  Multidisciplinary medicine
       • New hospital building under construction         •  Teaching hospital
         (budget 200 billion MAD)
       • Cornea transplants                               •  Engineering by Jacobs (US)
       • Treatment costs 5 times less than in
         Europe > medical tourism
       • 15% foreign patients
       • Annual equipment budget around 2-3
         million €
       • Investing in radioprotection systems
       • www.hcz.ma
Date                                                © Finpro                                              25
Hospital Technology

       •   A Yearly Medical Expo is organized in Casablanca during January
       •   The 2011 edition had several foreign exhibitors, the biggest
           countries being China, France, Portugal and Spain.
       •   The main product categories covered:
            1. Medical and paramerical material
            2. Consumables (medicine and
               parapharmacies)
            3. Dental material and consumables
            4. Pharmaceutical laboratories
            5. Medical sector information technology
            6. Wellness and spa

       •   The market is still relatively small, but the growth rate is
           significantly higher than in the European mature markets.



Date                                © Finpro                                 26
Medical Devices
                 •   Medical device market in Morocco 117 million € (2009)
                 •   Annual growth rate 16,8%
                 •   2014 estimate around 170M€
                 •   90% imported and 10% local production
                 •   85% public sector 15% private sector

                 • The hospital investment during 2003-2007 period by the MoH
                   were massive and several hospital were build and over 100
                   hospitals upgraded.
                 • The current trend is to update the technology level at the
                   hospital in order to provide a good standard quality all over
                   the country.
                 • Value chain: 250 distributors, 100 agents/wholesalers,
                   around 30 major players

                                                                    Private
                                                                     15%




                                                           Public
                                                            85%




Date                            27                                            © Finpro
Medical Technology Imports




Date                   28           © Finpro
ICT Penetration Figures




Date                    29       © Finpro
E-Health in Morocco

A national plan for the development of
ICT in health, which sets targets for health        ICT skills programmes in the ongoing
sector connectivity, was implemented in             training of health-care professionals were
2004.                                               introduced in 1989.

The preparation and development of a                ICT skills courses as a part of university
„master plan‟ for computer technology and           curricula for health sciences students and
information within the Ministry of Health           health sciences courses through
was done in 1992 and revised in 2004.               eLearning for health professionals in
                                                    training and practice are planned to
                                                    commence by 2008.

   Research South of Morocco in
   2008(1):
   • almost 95% specialist
      physicians have positive                         Regulations to protect the
      attitude towards ICT                             privacy and security of
   • Priorities:                                       individual patient data
        1) human factor (76%)
                                                       where eHealth is used was
        2) ICT (64%)
        3) Tasks (55%)                                 planned to be introduced by
        4) Context (38%)                               2008.

Date                                           30                                       © Finpro
Potential use of e-health in Morocco
       •   Education of healthcare professionals is lacking behind and the Government has allocated
           financila resources for education. E-health solutions for continuing education could partially help
           ti achieve the objectives set by the Goverment.

       •   Administrative and organisation management needs new tools to be efficient

       •   Teleconsultations, telecare and telemonitoring have opportunities in the rural healthcare, where
           specialized pyhisians are lacking

       •   Moroccan National Agency for Public
           Health is under construction. It has
           been designed
           according to
           the Finnish THL
           model. Good
           connection
           between Finland
           and Morocco.
           Opportunity for
           public e-health
           solutions from
           Finland.



Date                                               31                                                © Finpro
Health Care Expenditure


       • Health care expenditure in Morocco in 2009:
         39 billion MAD

       • Annual growth rate 8,24%

       • Health care expenditure is 5,37% of the GDP




Date                            32                     © Finpro
Healthcare Purchasing

       •   Some strategic functions reserved to the central administration are
           gradually being delegated to the regional level, such as the health
           care supplies planning

       •   each Region Health administration develops its health care supplies
           diagram, called SROSi

       •   An autonomous state sponsored public establishment called
           “National Agency of the Health Insurance (ANAM)” is the first
           organization to regulate health insurance system. It‟s mission is to
           supervise the obligatory health insurance system and to manage
           RAMED resources allocation process

       •   Substance decision making by French speaking medical doctors 
           product demos and references in French




Date                                © Finpro                                      33
Consumer expenditure in health
       •   While total real consumer expenditure rose by 3.4% in real terms over
           2006-2007.The single fastest-growing category was health goods
           and medical services, which rose by 4.5% in real terms between
           2006 and 2007, and indicates that more Moroccans are able to afford
           essential medical goods or private healthcare.




Date                                34                                   © Finpro
Cronic Diseases


       • Cronic diseases are increasing rapidly in Morocco

       • Many cronic disease tratments are now eligible for full
         reimbursement under the NHS, after the CNSS removed the
         need for patient co-payment of up to 30% in July 2008.




Date                            35                           © Finpro
Maghreb Life Sciences

Market: Morocco
Pharmaceutical Market
Pharmaceutical Market
       •   Second largest pharma market in Africa, after South Africa
       •   Pharmaceutical consumption in Morocco 31 €/capita/year.
           Estimate for 2013 national expenditure is around 1,3 billion €.
       •   70% of the medicines sold in Morocco are expected to move to the generics
           within next 3 years.
       •   Domestic manufacturing caters for approximately 70-80% of the local demand.
       •   Nearly all APIs are imported (over 250 million USD per year),
           high dependance on foreign prices

       •   36 pharmaceutical companies with manufacturing facilities in Morocco , both local and foreign
           companies. They employ 8000 people and produce 282 milliion units (2010). The total markets size is 7,9
           billion MAD.
                 The biggest Moroccan pharma Company is Laprophan, with a turnover of around 100 million
                    USD. European GMP certification since 2009.
                 Sothema, another local company, is partnering with Eli Lilly and MSD. First company to establish
                    foreign subisidiary in Senegal (West Afrique Pharma)
                 The biggest pharma company in Morocco is the French multinational Sanofi-Aventis. Others
                    foreign players are GSK and Pfizer.
                 Very few research laboratories
       •   There are 50 pharmaceutical wholesalers in the Morocccan market

       •   After the OMA reform pharmaceutical sales has been growing steadily (e.g. +10% 1Q/2007)
       •   A recent law has abolished the requirement that pharmaceutical companies be majority-owned by a
           pharmacist. > opening of the market
       •   Moroccan Pharmaceutical Industry Association www.amip.ma
       •   Major sector fair Officine Expo every March in Marrakech www.officinexpo.com


Date                                                            37                                                   © Finpro
Customs statistics

       Health care sectors imports statistics analysis?
       • Moroccan statistics from Source Office des Changes
       • to be elaborated

       Finland-Morocco statistics
       • Exports Finland > Morocco 2010
          75 million € (0,1% of total exports)
          source: tulli.fi
       • Finland exports 2010
          Electromedical and x-ray equipment (SITC 774)
          363 million €
          growth +14 %
       • Medical devices exports 2010
          Finland > Morocco
          SITC 774: 154 000 € (463 000 € ?)


Date                             38                           © Finpro
Medical Device Trade

                                    Medical Device Exports 2005-2010 (€)
                                             Finland > Morocco
                                                                           154451
                   160000
                                                          144000

                   140000                                            +56
                                                 118157              %
                   120000
                                                                   98792
                   100000                92118


                    80000


                    60000    51815


                    40000


                    20000


                         0
                             2005        2006    2007     2008     2009    2010


  Source: www.tulli.fi
Date                                              39                                © Finpro
Detailed Exports 2010

                        Finnish Medical Device Exports to Morocco 2010

         Electro-diagnostic apparatus used in medical science                       40533



   Apparatus based on the use of X-rays or of alpha, beta or
                                                                                                                        113918
                    gamma radiations


           Therapeutic instruments and appliances; breathing
                                                                         14003
                              appliances


        Syringes, needles, catheters, cannulae and the like;
                                                                                              57565
       ophthalmic and other instruments and appliances n.e.c.


         Instruments and appliances used in dental treatment                         42938


                                                                0        20000   40000      60000     80000   100000   120000
                                                                                            Euro




Date                                                                40                                                   © Finpro
Medical Device and Consumables Trade
                               Exports from Finland to Morocco
EUR




             300000


             250000


             200000                                              154451
                                                                          Irradiation,
                                                                          electromedical and
             150000                                                       electrotherapeutic
                                                                          equipment (C266)


             100000                            98792
                               144000                                     Medical and dental
                                                                          instruments and
                                                                 114506   supplies (C325)
             50000
                                               47400
                                11471
                    0
        Source: www.tulli.fi   2008            2009              2010
      Date                                        41                                © Finpro
Moroccan Medical Device Imports 2009
                                                                                                         Million €
                                                       0   2   4   6        8   10   12   14   16   18            20
                     electrodiagnostic equipment
                 infrared & ultraviolet equipment
                                      consumables
                                 dental equipment
                         ophtalmology equipment
                 other electromedical equipment
mechanical therapy equipment for massage etc.
     oxygen and other gas therapy equipment
                          respiratory esquipment
                            orthopedic equipment
                                  dental protheses
        joint and eye protheses, cardiac valves
                                       hearing aids
                 pace makers and other devices
                                              x-rays
                           other radiation devices
                           medical teaching tools
                        material testing machines
                                     thermometers
              electric and electronic instruments
                                    level indicators
                         pressure control devices                                               Total
                             other control devices
                           parts and components
                                                                                               140 M€
                          gas or smoke detectors
                                    cromatographs
                                     spectrometres
                       other optic ray instruments
                     other analytical instruments
                                       microtomes
    Source: Office des Changes                                         42                               © Finpro
Maghreb Life Sciences

Market: Morocco
Dental care
Dental Care Overview

General info                                                                  Current Challenges

•      The number of dentists is low and not exactly known,                     • Mouth and dental inflamations are a serious and
       though a registering with the ONMD will be                                 widespread public health problem. Regular
       mandatory starting in 2011. In 2008 the estimated                          information campaigns are intended to promote
       number was around 3.300 in the private sector and                          public awareness of the problem and prevention
       250 in the public sector (Universities of                                  measures, but the new Social Security system will
       Casablanca and Rabat, military doctors...).                                not cover dental care until 2013.
•      Privately-owned dental centers are usually better
       equiped than their public counterparts.                                  • The country is up to 90% dependent on foreign
                                                                                  imports for the equipment. In 2008, the main
                                                                                  providers (ad valorem) were Germany, the US,
                                                                                  France, China and Italy.
Government Action Plan 2008
                                                                                • The insurances covering the patients are not
       In 2008, the governement launched a                                        considered satisfactory by the dentists themselves
       comprehensive 3-year action Plan aimed at                                  (a “Mutuelle”, or Mutual Insurance, called
       modernizing and better regulating the dental                               Mugephar PS and a policy issued by the
       profession, with a view to stand up to the                                 Insurance Company SANAD).
       international standards. This included a review of the
       code of ethics (crackdown on illegal practices), a
                                                                                • The local training is poor: most Moroccan dentists
       strengthening of the regulatory body (l‟Ordre
                                                                                  have been trained abroad (In the US, France or
       National des Médecins Dentistes, ONMD),
                                                                                  Brazil), and many of them narrowly specialize in
       incentives for the upgrade of the equipments and
                                                                                  dental implants.
       better training of the professionnals. It also targets in
       lowering the trade barriers concerning the dental
       supplies.


Date                                                               © Finpro                                                    44
Number of Licensed Dentists in Morocco as of 10/2007


                                   1.    Chaouia – Ouardigha: 21
                                   2.    Doukkala-Abda: 96
                                   3.    Fès – Boulemane: 171
                                   4.    Gharb Chrarda - Béni-Hssen: 117
                                   5.    Grand – Casablanca: 1293
                                   6.    Guelmim - Es-Semara: 13
                                   7.    Laâyoune - Boujdour - Sakia-El-Hamra: 21
                                   8.    Marrakech - Tensift - Al-Haouz: 176
                                   9.    Meknès – Tafilalét : 143
                                   10.   Oriental: 185
                                   11.   Oued Ed-Dahab –Lagouira: 2
                                   12.   Rabat -Salé-Zemmour – Zaër: 774
                                   13.   wilaya de la région du Souss-Massa-Drâa: 63
                                   14.   Tadla – Azilal: 72
                                   15.   Tanger – Tétouan: 194
                                   16.   Taza - Al Hoceima – Taounate: 33

                                   Total: 3374 *

                                   Moroccan: 2013
                                   Foreign: 1361




                                                               *Ordre National de Médecins dentiste

Date                          45                                                             © Finpro
Maghreb Life Sciences

Market: Morocco
Health tourism
Tourism


            Ecotourism                   Golf
                                       tourism



                            TRENDS


       Wellness
       tourism
                                      Luxury
                                     tourism

                          Health
                         tourism



Date                          47                 © Finpro
Health Tourism Overview

       •   Tourism and hospitality are by far the largest export cluster in Morocco,
           being valued at US$3.9 billion in 2005 (ISC); furthermore, tourism is one of
           the five priority development sectors for the Government.

       •   Two successive development plans have been launched, “Vision 2010”
           (just finished) and “Vision 2020” (now starting), under the high
           sponsorship of his Majesty the King Mohammed VI, with a view to
           develop Morocco as a significant destination for international and
           industrial tourism (target: 20th in the world). New and important
           infrastructures will be developed through an important volume of public
           funding.

       •   Health and wellness tourism will strongly benefit from the Plans. The
           number of hotel/resort spas is predicted to grow by a 6% CAGR to reach
           467 outlets by 2014. Many of the new spas will be located in the luxury
           hotels being built in the six coastal resorts included in Vision 2020.

       •   Additionally, there are several specific tourism niches with strong potential
           but not yet developed, ie rural, desert, and cruise.



Date                                   48                                       © Finpro
Vision 2010: Plan Azur




                                          Vision 2010 included Plan Azur, which prioritized six spa
                                          sites, associated to specific high-growth products (such
                                          as health tourism)

                                       These resorts are: Saidia, near the Algerian border (opened
                                       2009); Port Lixus, near Larache and Tangier; Mazagan, near
                                       El Jadida; Taghazout, near Agadir (2013); Mogador, near
                                       Essaouira; Plage Blanche, near Guelmim (2012). (see chart
                                       page 4)

               In total, Plan Azur will add approximately 80,000 beds to the country‟s
               accommodation capacity at an investment cost of up to €9Bn (including
               infrastructures). The expected number of tourists generated by Vision 2010 will reach
               10 M (70% from abroad).

               The new resorts will create strong investments needs in infrastructures (airports and
               roads, salt-to-drinkable water plants, energy plants) and new dwellings (it is
               estimated that every 10.000 beds need an accompanying new town for 80.000
               people).
Date                                49                                                               © Finpro
Vision 2020

       •   The tourism sector objective is to further increase by 100% the
           size of the tourism sector, and to be in the top 20 destinations in
           the world by 2020.

       •   The strategy is to develop high value-added specific market
           segments, such as business-and-wellness, sports-and-culture,
           and the like; to improve the infrastructures in order to allow
           Morocco to host important world events; to increase the image of
           the country as a destination for health tourism; and to hone the
           image of quality and sustainability of the tourism industry.

       •   Public funding will be channeled through a State agency, the
           FMDT

       •   Eight new destinations are scheduled to be developed under
           Vision 2020
       •   http://www.maroc.ma/PortailInst/Fr/MenuGauche/Les+grands+chantiers/Tourisme/Stratégie+et+vision+2020.htm




Date                                            © Finpro                                                       50
Health Tourism

       •   Morocco enjoys a good image as far as health tourism and SPA
           offering is concerned. There are a number of tour operators
           specialising in the arrangement of medical treatment alongside a
           Moroccan holiday, with consumers typically coming from Europe,
           Canada and the US.

       •   However, the industry is still in its infancy, as the country is estimated
           to deploy at present no more than 10% of its actual potential.

       •   Popular treatment areas include cosmetic surgery, dentistry,
           ophthalmology, weight loss and orthopedics. The cost of many of
           these procedures is much lower in Moroccan hospitals and clinics
           than in Europe and the US; as an example, the fees in cosmetic
           surgery are estimated to be 30% lower than in Europe

       •   The quality is good; for example, the high competency of the plastic
           surgeons is acknowledged worldwide. Most of them have been
           trained in France, Brazil or the US.



Date                                   51                                     © Finpro
Health Tourism

       •   The main specialized cliniques in aesthetic plastic surgery ,
           ophtalmology and orthopedics are situated in Rabat, Casablanca,
           Marrakech and Tanger

       •   The main acts of surgery are related to face, thigh and arm
           liftings, liposuctions, rhinoplasty, blepharoplasty,
           abdominoplasty, breast cosmetic improvement (reductions or
           upsizing), and some dental care.

       •   The Moroccan cosmetic surgery industry is being supported by
           foreign investors, willing to develop those specialties.

       •   The owners of Moulay Yacoub, Groupe CDE, have enhanced their
           offering to customers. In addition to treatments centred around hot
           natural spring water, the resort also provides beauty, massage
           and well-being treatments.


Date                              © Finpro                                52
Foreign Direct Investment (some examples)

       The Governement signed in 2009
       within Vision3 (a strategic alliance
       between Gulf Finance House,
       Ithmaar Bank and Abu Dhabi) a
       Project aimed at developing a
       $1.8bn mixed-use health resort
       over a massive 270 hectare area in
       the Province of Essaouira.


                                                The French Group Life‟Valley is
                                                building a medical residence, an
                                                university campus and a functional
                                                rehabilitation center on a 40 ha site.




Date                                      © Finpro                                       53
Health Tourism Project




Date                    54      © Finpro
A private clinic case:
              Malo Clinic Casablanca

       •   Malo Clinic Casablanca and Malo SPA
           in Casablanca, Dar Bouazza, will be opened in 2011
           www.maloclinics.com

       •   Malo Clinic is jointly promoted by a Moroccan Doctor and the
           Portuguese Group Malo Clinica, which have invested 200 MDH
           (€18M).

       •   The premises are in a 2000 sqm luxury building located on a 6800
           sqm plot.

       •   The sponsors have the ambition to build a reputation in all Africa
           and near East, as a center for medical tourism, well-being, disease
           prevention and treatment, and staff training.

Date                                      55                                  © Finpro
Maghreb Life Sciences

Market: Morocco
Retail Market
Retail Market in Morocco
       • Moroccan lifystyles and shopping
         patterns are changing

       • Global Retail Development Index 2011:
         Morocco 17th

       • Sector growth 5% per year

       • Modern future:                                   Facts & Figures
         Rawaj Vision 2020                                Retail outlets     850 000
         + medium and large retail outlets
         + independent stores                             Sector employs     1 million
         + trade networks and franchising
         + 450 000 new jobs                               Sector turnover    8,5 billion €/year
       • Malls are trying to find success                 Small shops        400 000 – 5 million
         formulas                                         (souks, markets,
            Mega Mall opened 5 years ago in              shops)
             Rabat is one of the most succesful
                                                          Supermarket        Acima (31) / ONA, (Auchan)
            Morocco Mall in Casablanca is
             planned to be openned in 2011, the           chains             Label‟Vie (19) / Carrefour
             biggest in North Africa with 70.000                             Hanouty (100+) / franchising
             m2 of retail space. Retailers include
             Galerie Lafayette, FNAC, etc.                Hypermarket        Marjane (21)
                                                          chains             Aswak Assalam (8) / Casino
                                                                             Metro (7)
Date                                                 © Finpro                                               57
Global Retail Development Index
               Morocco: Retail sales bolstered. Morocco drops from 15th to 17th place this year.
               The retail sector represents 13 percent of the country's GDP and is expected to grow 5
               percent annually in coming years. A strong performing tourism sector and a shift toward
               more modern retail channels has bolstered retail sales. Key drawbacks in Morocco
               (population 31.9 million) include low consumer spending per capita compared to
               Tunisia, complexities in the distribution models and the need for local knowledge.




Date                             58                                                          © Finpro
Maghreb Life Sciences

Market: Morocco
Business Opportunities for
Finnish Companies
LS Opportunities in Morocco

                                                                         Organisation &
         Hospital                             Dental                      management
       Information                         supplies and                      (efficiency,
        Systems!                                                          treatment chain
                                             devices                       management)
                                                                                              + cancer
               Rural areas have                                                              treatments
                                                     Liberalization of
           limited access to health                                                         >technology
                                                     private hospital
            services and specialist                                                             needs
                                                       ownership in
              physisians are not
                                                          2011
                  everywhere                                                      Vaste availability of
               TELEMEDICINE                                                      medical plants, but
                                                            Radio-
                                                                                   no research and
                                                           protection
                                                                                   production know-
                                                          systems for
          A national program Appcircum                                                  how of
                                                            hospital
          amounting EUR 2.5mn, will aim to                                          nutraceuticals
                                                           personnel
          improve co-ordination among
          medical services and to carry out
          more kidney transplants and to           Cronic                    Tissue banks
          improve dialysis treatments. Over
          6000 kidney failure patient, without    Diseases                       under
          transplant.                            Management                  construction
                                                                               Software
                                                                                 needs
Date                                                 60                                                   © Finpro
Telemedicine Opportunity
                                                                                          SAMU Obstetrics for rural
                                                                                          areas
                                                 Now 100%                                 ”services d'assistance médicale
     > mobile equipment                        GSM coverage                               d'urgence”
     > field units                              in the whole                              • Midwives network + GSM
                                                   country                                technology
     > Distance medical
     support                                                                              2015 UN Millennium Dev. Goal
                              Lack of
                            specialized                             Maternity care        to reduce maternity mortality
                            physicians                              in rural areas        and urgency obstetrics




                      National            Telemedicine
2010:                  Medical
                      Caravan
                                           developping in                                      Public
90 caravans                                                             Expected funds
                   Programme and             Moroccan                    allocation for        procurement
112 000 visits       Committee
                                            rural areas                 the MoH action         by tenders
                        2011-                                           plan 2012-2016
12 000 surgeries


                                                                 1st Rural
                                                                Healtlhcare
                                                               Conference in
                                            Rural Health          Rabat
                                           Plan by Ministry     19.4.2011
                                           of Health 2011




                                                      61                                                     © Finpro
Morocco LS Sector SWOT

                            Strengths                                     Weaknesses


             • Stable political situation and economy        • Lacking organisation
             • Government action plan for health care        • Private hospitals short of funds
             • Positive business environment for foreign     • Language skills? French vs. English
              companies and products
             • Europe strong as a trade partner (>20%)




                          Opportunities                                      Threats

             • Telemedicine solutions for rural areas
               (medium-term)                                 • Maghreb revolution expanding
             • Technology for cancer treatments              • Chinese competition is growing in
             • Field hospital solutions                        healthcare supllies
             • Trade customs for Europe to be
               abolished



24/10/2011                                        © Finpro                                           62

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Maghreb life sciences Morocco final report Finpro

  • 1. Maghreb Life Sciences Market Study Morocco Jenni Mäkipää, Senior Consultant October 2011
  • 2. Contents 1. Morocco in brief 2. Market characteristics: Economy & Trade 3. Ecosystem & main players 4. Development Policy 5. Doing Business in Morocco 6. Health Care System 7. Hospital framework and case studies 8. Hospital Technology 9. E-Health 10. Health Care Expenditure 11. Pharmaceutical Market 12. Dental Care 13. Health Tourism 14. Retail Market 15. Business Opportunities 16. Morocco LS SWOT 2 © Finpro
  • 3. Kingdom of Morocco Population 31,5 million (50% less than 25) Area 710 850 km2 (excl. W. Sahara) Capital Rabat (largest city Casablanca) Languages Arabic (French, Berber) Currency Moroccan Dirham (1€ ≈ 11MAD) GDP €65 446 million (per capita €2 076) Minimum salary 0,90 € per hour Largest cities: Casablanca (3 m inhabitants), Marrakech (2), Fes (1), Tangier (0,9), Rabat (0,8), Meknes (0,8) Government Constitutional monarchy Sources: Haut-Commissariat au Plan, Chiffres Clés 2009; HCP Recensement 2004. 3 © Finpro
  • 4. Economic indicators Evolution of GDP/Capita in € 2009 2008 2500 Unemployment 9,1% 9,6% 2000 1500 GDP growth 4,9% 5,6% 1000 Growth of primary sector 29% 16,6% 500 Growth of 0 secondary sector - 4,7% 3,6% Growth of tertiary sector 3,9% 4,1% Moroccan GDP per sector FDI & private loans 2 367 M€ 3 137 M€ Primary 16 % Transfers from migrants 4 465 M€ 4 717 M€ Income from Tertiary tourism 4 696 M€ 4 938 M€ 55 % Secondary 29 % Healthcare 5,4% of GDP Sources: HCP, Direction de la statistique 2009; Office des Changes. 4 © Finpro
  • 5. Trade • Growing trade deficit – Imports 2,5 times larger than exports • 60% of Moroccan exports from – Raw and processed phosphates (acids & fertilizers) – Cloth and footwear – Food products (mostly fresh and processed fish, fruits and vegetables) • 46% of Moroccan imports are capital goods and energy – Rising share of capital goods (from 22 to 25%) and consumer goods (from 16 to 20%) Main exports (in MMAD) Evolution of Moroccan trade 180 000 350 000,00 160 000 300 000,00 Phosphate 140 000 Value in MMAD 250 000,00 products 51 394 200 000,00 120 000 Cloth & Footwear Exports 100 000 18 810 150 000,00 27 877 Food Imports 80 000 26 536 100 000,00 60 000 26 164 Electrical 50 000,00 23 961 14 328 machinery 0,00 40 000 12 316 Others 20 000 35 976 30 343 0 Sources: Office des Changes. 2008 2009 5 © Finpro
  • 6. Trading partners • In 2009 EU countries received 65,6% of Moroccan exports and supplied 56,4% of its imports – France and Spain are the main trading partners • 24,5% of Moroccan exports and 15,7% of imports for France; 21,2% of exports and 12,1% of imports for Spain – China is now its 3rd largest supplier, ahead of USA, with respectively 7,8% and 7,1% of Moroccan imports • Finland represented 0,65% of Moroccan exports and 0,53% of its imports – Finnish exports to Morocco were 78 M€ and imports 19 M€ • Wood & paper (50%) and electric devices (21%) were the main exports • Clothes (37%) and phosphates (33%) were the main imported products Morocco Main Clients Morocco Main Suppliers Europe Asia America Africa Others Europe Asia America Africa Others 7% 5% 7% 13 % 14 % 22 % 60 % 70 % Sources: oc.gov.ma; Tulli. 6 © Finpro
  • 7. Trade Practice & Regulations Duration Import Procedures US$ Cost (days) Documents 10 300 preparation 2008 Customs clearance A new risk-based inspections 2 250 and technical control system was introduced, causing the time to export to Ports and terminal decrease by 2 days, and 2 350 handling import by 4 days. Inland transportation 2009 3 100 and handling Document requirements for importing and exporting were Totals 17 1000 simplified, reducing the time to import by 1 day. Source: World Bank; doingbusiness.org Date © Finpro 7
  • 8. Fast Railway Connections • TGV Tanger – Casablanca • The first high speed train in the African continent • 200 km / 2h10 • 20 billion MAD investment • Dec 2010 Tanger station opened • The works to be completed by 2015 Date 8 © Finpro
  • 9. Key Moroccan Companies 1 2 3 Groupe ONA Samir Maroc Telecom turnover 2009: 2 637M€ turnover 2009: 2 055 M€ turnover 2009: 3 393 M€ Oil refining and distribution Former state-owned Holding company with a company owned by the monopoly, now a subsidiary portfolio of 20 firms in Saudi Corral Group of the French group Vivendi • distribution (Marjane, Acima, Optorg) • food industry (Lesieur Cristal, Cosumar) • mining (Managem) • telecom (Wana) LS LS • finance (Attijariwafa Bank) In Jun 2010 ONA and SNI Laprophan Eramedic turnover 2010: 86 M€ turnover 2010: 5-10 M€ (?) merged. Exit from stock exchanges. International The biggest Moroccan Hospital technology importer subsidiaries mainly in Africa. pharmaceutical company and distributor specialized in located in Casablanca. Staff operating theaters. Part of over 600. Own research Cofimag Group, an investment facilities and modern logistics. holding company active in new technologies. Sources: Corporate websites; les500.com. 9 © Finpro
  • 10. Development Policy The King has set 2 main objectives: – developing the economy around the sectors where Morocco has some competitive advantages – reducing Morocco‟s energy dependence 5 years Health Action Plan 2008-2012 King Momammed VI – Main objectives to expand infrastructure and reduce costs – 181 priority actions divided into 4 strategy axis: 1. Strategic repositioning of the health sector players 2. Developing healthcare offering with quality care, easy access and covering populations needs by quantity and geographically 3. National plans for preventions and healthcare 4. Safety in healthcare Tourism Vision 2020 / Plan Azur – 100% growth in 10 years – the top 20 destinations in the world by 2020 – 8 new tourism destinations financed Sources: emergence.gov.ma; Ministère de l‟Energie, des Mines, de l‟Eau, et de l‟Environnment, mem.gov.ma. © Finpro 10
  • 11. Doing business in Morocco • Exporting to Morocco – Today tariffs are applied on many imported products – EU trade agreement to be ratified in 2012 > EU imports easier with less customs • Investing in Morocco – Morocco is highly accommodative to foreign investors – Creation in 2009 of the Moroccan Investment Development Agency (AMDI), under the Ministry of Industry, Trade and New Technologies – Designed to inform and assist foreign investors throughout the different phases of their project • Corruption – In 2009 Morocco ranked 89th out of 180 in the Corruption Perception Index scoring 3,3*, below the world‟s average (4) and median (3,35) – Morocco has set up a commission and voted several laws to fight corruption – www.transparencymaroc.ma • Travel & safety issues – No visa required to enter the country – No particular risk and political situation relatively calm – The Maghreb revolution has not had major effects in Maroc thanks to the Kings prompt decision to shift power from himself to the parliament and the government. Constitutional Refererendum 1.7.2011 (98% voted yes) Sources: AMDI; Transparency International; business- anti-corruption.com *The country ranking 1st is the least corrupt., New Zealand in 2009, scoring 9,4. © Finpro 11
  • 12. Household Expenditure Casablanca is the business capital • Median household disposable income was 5445 • Wealthiest region USD/year in 2007 • Medical services concentrated here • Income growth rate average 2,3% (2001-2007). Rabat is the administrative capital • The highest average household disposable incomes are found in the greater Casablanca area, where expenditure average was 10 589 USD in 2006. • The same region is also the single most important in terms of total spending, accounting for slightly more than a fifth of nationwide household expenditure in 2006 – more than double the contribution made by the second- most important region, the area around the administrative capital Rabat. • The remaining proportions of household spending are spread relatively evenly throughout the rest of the country, making it difficult for marketers to focus on one particular area. Date 12 © Finpro
  • 13. Maghreb Life Sciences Market: Morocco Health Care System Hospitals Medical Devices & E-health
  • 14. Health Care Sector Division 6% 15 % 79 % Private Public Non-profit Date 14 © Finpro
  • 15. Hospital Framework in Morocco Health Care System Private Public Non-profit 270 hospitals 16 healthcare regions National Social Security Fund (CNSS) 5 000 beds 69 districts > private sector employees 13 CNSS polyclinics 2626 Basic Health 1800 beds Located mainly in Casablanca (50%) and Facilities (ESSB) Rabat 133 hospitals The National Fund for Social 26 000 beds Security organisms (CNOPS) > public sector employees (19 CHU, 101 SEGMA, 14 Regie) 7 military hospitals (open to public) 15% 79% 6% Date 15 © Finpro
  • 16. Public Hospital System Health is one of  National university hospitals the most centralized fields in public sector  Regional hospitals  Provincial hospitals  Polyclinics  Diagnostic Centers  Healthcare Center (local) Date 16 © Finpro
  • 17. Health Insurance System Assurance Maladie Obligatoire (AMO) Agence Nationale de l‟Assurance Maladie (ANAM) Oblibatory for all employees Launch 2005- (2010)2013 www.assurancemaladie.ma AMO / ANAM • Caisse Nationale des • Caisse Nationale de • Régime d'Assistance Organismes de Sécuritè Sociale Médicale Prévoyance Sociale • Private employees • Low-income population • Public employees • Facultative > obligatory • Launch 2008-2011 • www.cnops.org.ma (2005) • 8,5 million Moroccans • www.cnss.ma eligible CNOPS CNSS RAMED Date 17 © Finpro
  • 18. Medical staff 2007 • Public physicians 6500 > 50% at CHUs • Private physicians 8300 Total 14800 ~ 50% in – Generic 8600 the 2 main urban – Specialists 6200 areas • 8452 pharmacies Date 18 © Finpro
  • 19. Some Hospital Figures • Hospital organisation regulation introduced in 2007, but still there are gaps in the management and organisation. Problems arise e.g. in lack of human resources, the management, lack of information systems. • Surgical activities at public hospitals: 240 000 surgeries in 2006 503 operating theatres 1,3 operations/day/theatre • Hospital occupancy rate 54% (stable) • Average length of stay 4,6 days • Survey by Transparency Maroc: 80% thinks coppruption is very common, 23% have had contacts with corruption payments http://www.transparencymaroc.ma/ Date © Finpro 19
  • 20. Health care sector development and main drivers ICT infrastructure ready for mobile and broad Health insurance band solutions Santé Vision coverage: 17% > 34% > 50% 2020 Since 2006 Health insurance MoH Health reform Action Plan (AMO, RAMED) 2008-2012 Since 2005 Health Care Social and REDRESS system in demographic Since 2005 strong changes in the development country phase Regionalisation of basic healthcare Date 20 © Finpro
  • 21. The 4 University Hospital Groups (CHU) 6th CHU 5th CHU planned for under constuction North Tanger/ Tetouan in Oujda, ready 2012 opened in 2009 2 hospitals 1050 beds (best practice) 10 hospitals 2500 beds 2nd CHU in Casablanca ? 4 hospitals 1600 beds 3 hospitals 900 beds Date 21 © Finpro
  • 22. CHU Casablanca Public hospital Since 1930‟s CHU Casablanca includes 4 units: 1. Hôpital Ibn Rochd 2. Hôpital du 20 Août 1953 3. Hôpital d'Enfants 4. Centre de Consultation et de Traitement Dentaire • 1600 beds • 98 000 hospitalisations/year • 35 000 surgeries/year • 320 million MAD annual investment budget Hospital IT • Optic fibre network • IBM Lotus notes • Patient card with bar code • Radiology system RIS PACS by Siemens + Odelga Telemedicine used for pediatric ward for attending school lessons while in hospital The First Moroccan tissue bank under construction Difficult access to care in the rural areas > patient flows to big hospitals www.chuibnrochd.ma Date 22 © Finpro
  • 23. CHU Rabat • Public hospital in Rabat • 10 hospitals • 2500 beds • Staff 2000 • 600 000 € investment budget • New hospital building under construction • 3 years of heavy investments (2008-2010) e.g.:  Central operating theatre (25 million MAD)  Central laboratory (equipment + IT)  Spect-CT  Radiology IT  Hospital IT network, optic cables since 2006-2008  Electronic patient records  Electronic medicine management for hospital pharmacy • Needs  Information systems  Biomedical engineering (e.g. maintenance costs are a problem)  Organisation and management (Efficiency, treatment chain management) • www.chisrabat.ma Date 23 © Finpro
  • 24. Clinique Badr • Small private clinic in Casablanca • 45 beds • 6 operating blocks • Imaging unit • Patient records only on paper • www.cliniquebadr.ma Date 24 © Finpro
  • 25. Hospital Cheikh Zaïd virtual Private university hospital in Rabat New hospital to Casablanca tour • Non-profit foundation • 72 million € investment • Investor Cheikl Zaid from United Arab • Under construction since 2008 Emirates • Built in 1998, part of CHU since 2006 • Estimated to be completed by late 2011 • 150 beds • 53 000 m2 • Centre of excellence with up-to-date • 280 beds and 12 operating theatres technology • Multidisciplinary medicine • New hospital building under construction • Teaching hospital (budget 200 billion MAD) • Cornea transplants • Engineering by Jacobs (US) • Treatment costs 5 times less than in Europe > medical tourism • 15% foreign patients • Annual equipment budget around 2-3 million € • Investing in radioprotection systems • www.hcz.ma Date © Finpro 25
  • 26. Hospital Technology • A Yearly Medical Expo is organized in Casablanca during January • The 2011 edition had several foreign exhibitors, the biggest countries being China, France, Portugal and Spain. • The main product categories covered: 1. Medical and paramerical material 2. Consumables (medicine and parapharmacies) 3. Dental material and consumables 4. Pharmaceutical laboratories 5. Medical sector information technology 6. Wellness and spa • The market is still relatively small, but the growth rate is significantly higher than in the European mature markets. Date © Finpro 26
  • 27. Medical Devices • Medical device market in Morocco 117 million € (2009) • Annual growth rate 16,8% • 2014 estimate around 170M€ • 90% imported and 10% local production • 85% public sector 15% private sector • The hospital investment during 2003-2007 period by the MoH were massive and several hospital were build and over 100 hospitals upgraded. • The current trend is to update the technology level at the hospital in order to provide a good standard quality all over the country. • Value chain: 250 distributors, 100 agents/wholesalers, around 30 major players Private 15% Public 85% Date 27 © Finpro
  • 30. E-Health in Morocco A national plan for the development of ICT in health, which sets targets for health ICT skills programmes in the ongoing sector connectivity, was implemented in training of health-care professionals were 2004. introduced in 1989. The preparation and development of a ICT skills courses as a part of university „master plan‟ for computer technology and curricula for health sciences students and information within the Ministry of Health health sciences courses through was done in 1992 and revised in 2004. eLearning for health professionals in training and practice are planned to commence by 2008. Research South of Morocco in 2008(1): • almost 95% specialist physicians have positive Regulations to protect the attitude towards ICT privacy and security of • Priorities: individual patient data 1) human factor (76%) where eHealth is used was 2) ICT (64%) 3) Tasks (55%) planned to be introduced by 4) Context (38%) 2008. Date 30 © Finpro
  • 31. Potential use of e-health in Morocco • Education of healthcare professionals is lacking behind and the Government has allocated financila resources for education. E-health solutions for continuing education could partially help ti achieve the objectives set by the Goverment. • Administrative and organisation management needs new tools to be efficient • Teleconsultations, telecare and telemonitoring have opportunities in the rural healthcare, where specialized pyhisians are lacking • Moroccan National Agency for Public Health is under construction. It has been designed according to the Finnish THL model. Good connection between Finland and Morocco. Opportunity for public e-health solutions from Finland. Date 31 © Finpro
  • 32. Health Care Expenditure • Health care expenditure in Morocco in 2009: 39 billion MAD • Annual growth rate 8,24% • Health care expenditure is 5,37% of the GDP Date 32 © Finpro
  • 33. Healthcare Purchasing • Some strategic functions reserved to the central administration are gradually being delegated to the regional level, such as the health care supplies planning • each Region Health administration develops its health care supplies diagram, called SROSi • An autonomous state sponsored public establishment called “National Agency of the Health Insurance (ANAM)” is the first organization to regulate health insurance system. It‟s mission is to supervise the obligatory health insurance system and to manage RAMED resources allocation process • Substance decision making by French speaking medical doctors  product demos and references in French Date © Finpro 33
  • 34. Consumer expenditure in health • While total real consumer expenditure rose by 3.4% in real terms over 2006-2007.The single fastest-growing category was health goods and medical services, which rose by 4.5% in real terms between 2006 and 2007, and indicates that more Moroccans are able to afford essential medical goods or private healthcare. Date 34 © Finpro
  • 35. Cronic Diseases • Cronic diseases are increasing rapidly in Morocco • Many cronic disease tratments are now eligible for full reimbursement under the NHS, after the CNSS removed the need for patient co-payment of up to 30% in July 2008. Date 35 © Finpro
  • 36. Maghreb Life Sciences Market: Morocco Pharmaceutical Market
  • 37. Pharmaceutical Market • Second largest pharma market in Africa, after South Africa • Pharmaceutical consumption in Morocco 31 €/capita/year. Estimate for 2013 national expenditure is around 1,3 billion €. • 70% of the medicines sold in Morocco are expected to move to the generics within next 3 years. • Domestic manufacturing caters for approximately 70-80% of the local demand. • Nearly all APIs are imported (over 250 million USD per year), high dependance on foreign prices • 36 pharmaceutical companies with manufacturing facilities in Morocco , both local and foreign companies. They employ 8000 people and produce 282 milliion units (2010). The total markets size is 7,9 billion MAD.  The biggest Moroccan pharma Company is Laprophan, with a turnover of around 100 million USD. European GMP certification since 2009.  Sothema, another local company, is partnering with Eli Lilly and MSD. First company to establish foreign subisidiary in Senegal (West Afrique Pharma)  The biggest pharma company in Morocco is the French multinational Sanofi-Aventis. Others foreign players are GSK and Pfizer.  Very few research laboratories • There are 50 pharmaceutical wholesalers in the Morocccan market • After the OMA reform pharmaceutical sales has been growing steadily (e.g. +10% 1Q/2007) • A recent law has abolished the requirement that pharmaceutical companies be majority-owned by a pharmacist. > opening of the market • Moroccan Pharmaceutical Industry Association www.amip.ma • Major sector fair Officine Expo every March in Marrakech www.officinexpo.com Date 37 © Finpro
  • 38. Customs statistics Health care sectors imports statistics analysis? • Moroccan statistics from Source Office des Changes • to be elaborated Finland-Morocco statistics • Exports Finland > Morocco 2010 75 million € (0,1% of total exports) source: tulli.fi • Finland exports 2010 Electromedical and x-ray equipment (SITC 774) 363 million € growth +14 % • Medical devices exports 2010 Finland > Morocco SITC 774: 154 000 € (463 000 € ?) Date 38 © Finpro
  • 39. Medical Device Trade Medical Device Exports 2005-2010 (€) Finland > Morocco 154451 160000 144000 140000 +56 118157 % 120000 98792 100000 92118 80000 60000 51815 40000 20000 0 2005 2006 2007 2008 2009 2010 Source: www.tulli.fi Date 39 © Finpro
  • 40. Detailed Exports 2010 Finnish Medical Device Exports to Morocco 2010 Electro-diagnostic apparatus used in medical science 40533 Apparatus based on the use of X-rays or of alpha, beta or 113918 gamma radiations Therapeutic instruments and appliances; breathing 14003 appliances Syringes, needles, catheters, cannulae and the like; 57565 ophthalmic and other instruments and appliances n.e.c. Instruments and appliances used in dental treatment 42938 0 20000 40000 60000 80000 100000 120000 Euro Date 40 © Finpro
  • 41. Medical Device and Consumables Trade Exports from Finland to Morocco EUR 300000 250000 200000 154451 Irradiation, electromedical and 150000 electrotherapeutic equipment (C266) 100000 98792 144000 Medical and dental instruments and 114506 supplies (C325) 50000 47400 11471 0 Source: www.tulli.fi 2008 2009 2010 Date 41 © Finpro
  • 42. Moroccan Medical Device Imports 2009 Million € 0 2 4 6 8 10 12 14 16 18 20 electrodiagnostic equipment infrared & ultraviolet equipment consumables dental equipment ophtalmology equipment other electromedical equipment mechanical therapy equipment for massage etc. oxygen and other gas therapy equipment respiratory esquipment orthopedic equipment dental protheses joint and eye protheses, cardiac valves hearing aids pace makers and other devices x-rays other radiation devices medical teaching tools material testing machines thermometers electric and electronic instruments level indicators pressure control devices Total other control devices parts and components 140 M€ gas or smoke detectors cromatographs spectrometres other optic ray instruments other analytical instruments microtomes Source: Office des Changes 42 © Finpro
  • 43. Maghreb Life Sciences Market: Morocco Dental care
  • 44. Dental Care Overview General info Current Challenges • The number of dentists is low and not exactly known, • Mouth and dental inflamations are a serious and though a registering with the ONMD will be widespread public health problem. Regular mandatory starting in 2011. In 2008 the estimated information campaigns are intended to promote number was around 3.300 in the private sector and public awareness of the problem and prevention 250 in the public sector (Universities of measures, but the new Social Security system will Casablanca and Rabat, military doctors...). not cover dental care until 2013. • Privately-owned dental centers are usually better equiped than their public counterparts. • The country is up to 90% dependent on foreign imports for the equipment. In 2008, the main providers (ad valorem) were Germany, the US, France, China and Italy. Government Action Plan 2008 • The insurances covering the patients are not In 2008, the governement launched a considered satisfactory by the dentists themselves comprehensive 3-year action Plan aimed at (a “Mutuelle”, or Mutual Insurance, called modernizing and better regulating the dental Mugephar PS and a policy issued by the profession, with a view to stand up to the Insurance Company SANAD). international standards. This included a review of the code of ethics (crackdown on illegal practices), a • The local training is poor: most Moroccan dentists strengthening of the regulatory body (l‟Ordre have been trained abroad (In the US, France or National des Médecins Dentistes, ONMD), Brazil), and many of them narrowly specialize in incentives for the upgrade of the equipments and dental implants. better training of the professionnals. It also targets in lowering the trade barriers concerning the dental supplies. Date © Finpro 44
  • 45. Number of Licensed Dentists in Morocco as of 10/2007 1. Chaouia – Ouardigha: 21 2. Doukkala-Abda: 96 3. Fès – Boulemane: 171 4. Gharb Chrarda - Béni-Hssen: 117 5. Grand – Casablanca: 1293 6. Guelmim - Es-Semara: 13 7. Laâyoune - Boujdour - Sakia-El-Hamra: 21 8. Marrakech - Tensift - Al-Haouz: 176 9. Meknès – Tafilalét : 143 10. Oriental: 185 11. Oued Ed-Dahab –Lagouira: 2 12. Rabat -Salé-Zemmour – Zaër: 774 13. wilaya de la région du Souss-Massa-Drâa: 63 14. Tadla – Azilal: 72 15. Tanger – Tétouan: 194 16. Taza - Al Hoceima – Taounate: 33 Total: 3374 * Moroccan: 2013 Foreign: 1361 *Ordre National de Médecins dentiste Date 45 © Finpro
  • 46. Maghreb Life Sciences Market: Morocco Health tourism
  • 47. Tourism Ecotourism Golf tourism TRENDS Wellness tourism Luxury tourism Health tourism Date 47 © Finpro
  • 48. Health Tourism Overview • Tourism and hospitality are by far the largest export cluster in Morocco, being valued at US$3.9 billion in 2005 (ISC); furthermore, tourism is one of the five priority development sectors for the Government. • Two successive development plans have been launched, “Vision 2010” (just finished) and “Vision 2020” (now starting), under the high sponsorship of his Majesty the King Mohammed VI, with a view to develop Morocco as a significant destination for international and industrial tourism (target: 20th in the world). New and important infrastructures will be developed through an important volume of public funding. • Health and wellness tourism will strongly benefit from the Plans. The number of hotel/resort spas is predicted to grow by a 6% CAGR to reach 467 outlets by 2014. Many of the new spas will be located in the luxury hotels being built in the six coastal resorts included in Vision 2020. • Additionally, there are several specific tourism niches with strong potential but not yet developed, ie rural, desert, and cruise. Date 48 © Finpro
  • 49. Vision 2010: Plan Azur Vision 2010 included Plan Azur, which prioritized six spa sites, associated to specific high-growth products (such as health tourism) These resorts are: Saidia, near the Algerian border (opened 2009); Port Lixus, near Larache and Tangier; Mazagan, near El Jadida; Taghazout, near Agadir (2013); Mogador, near Essaouira; Plage Blanche, near Guelmim (2012). (see chart page 4) In total, Plan Azur will add approximately 80,000 beds to the country‟s accommodation capacity at an investment cost of up to €9Bn (including infrastructures). The expected number of tourists generated by Vision 2010 will reach 10 M (70% from abroad). The new resorts will create strong investments needs in infrastructures (airports and roads, salt-to-drinkable water plants, energy plants) and new dwellings (it is estimated that every 10.000 beds need an accompanying new town for 80.000 people). Date 49 © Finpro
  • 50. Vision 2020 • The tourism sector objective is to further increase by 100% the size of the tourism sector, and to be in the top 20 destinations in the world by 2020. • The strategy is to develop high value-added specific market segments, such as business-and-wellness, sports-and-culture, and the like; to improve the infrastructures in order to allow Morocco to host important world events; to increase the image of the country as a destination for health tourism; and to hone the image of quality and sustainability of the tourism industry. • Public funding will be channeled through a State agency, the FMDT • Eight new destinations are scheduled to be developed under Vision 2020 • http://www.maroc.ma/PortailInst/Fr/MenuGauche/Les+grands+chantiers/Tourisme/Stratégie+et+vision+2020.htm Date © Finpro 50
  • 51. Health Tourism • Morocco enjoys a good image as far as health tourism and SPA offering is concerned. There are a number of tour operators specialising in the arrangement of medical treatment alongside a Moroccan holiday, with consumers typically coming from Europe, Canada and the US. • However, the industry is still in its infancy, as the country is estimated to deploy at present no more than 10% of its actual potential. • Popular treatment areas include cosmetic surgery, dentistry, ophthalmology, weight loss and orthopedics. The cost of many of these procedures is much lower in Moroccan hospitals and clinics than in Europe and the US; as an example, the fees in cosmetic surgery are estimated to be 30% lower than in Europe • The quality is good; for example, the high competency of the plastic surgeons is acknowledged worldwide. Most of them have been trained in France, Brazil or the US. Date 51 © Finpro
  • 52. Health Tourism • The main specialized cliniques in aesthetic plastic surgery , ophtalmology and orthopedics are situated in Rabat, Casablanca, Marrakech and Tanger • The main acts of surgery are related to face, thigh and arm liftings, liposuctions, rhinoplasty, blepharoplasty, abdominoplasty, breast cosmetic improvement (reductions or upsizing), and some dental care. • The Moroccan cosmetic surgery industry is being supported by foreign investors, willing to develop those specialties. • The owners of Moulay Yacoub, Groupe CDE, have enhanced their offering to customers. In addition to treatments centred around hot natural spring water, the resort also provides beauty, massage and well-being treatments. Date © Finpro 52
  • 53. Foreign Direct Investment (some examples) The Governement signed in 2009 within Vision3 (a strategic alliance between Gulf Finance House, Ithmaar Bank and Abu Dhabi) a Project aimed at developing a $1.8bn mixed-use health resort over a massive 270 hectare area in the Province of Essaouira. The French Group Life‟Valley is building a medical residence, an university campus and a functional rehabilitation center on a 40 ha site. Date © Finpro 53
  • 55. A private clinic case: Malo Clinic Casablanca • Malo Clinic Casablanca and Malo SPA in Casablanca, Dar Bouazza, will be opened in 2011 www.maloclinics.com • Malo Clinic is jointly promoted by a Moroccan Doctor and the Portuguese Group Malo Clinica, which have invested 200 MDH (€18M). • The premises are in a 2000 sqm luxury building located on a 6800 sqm plot. • The sponsors have the ambition to build a reputation in all Africa and near East, as a center for medical tourism, well-being, disease prevention and treatment, and staff training. Date 55 © Finpro
  • 56. Maghreb Life Sciences Market: Morocco Retail Market
  • 57. Retail Market in Morocco • Moroccan lifystyles and shopping patterns are changing • Global Retail Development Index 2011: Morocco 17th • Sector growth 5% per year • Modern future: Facts & Figures Rawaj Vision 2020 Retail outlets 850 000 + medium and large retail outlets + independent stores Sector employs 1 million + trade networks and franchising + 450 000 new jobs Sector turnover 8,5 billion €/year • Malls are trying to find success Small shops 400 000 – 5 million formulas (souks, markets,  Mega Mall opened 5 years ago in shops) Rabat is one of the most succesful Supermarket Acima (31) / ONA, (Auchan)  Morocco Mall in Casablanca is planned to be openned in 2011, the chains Label‟Vie (19) / Carrefour biggest in North Africa with 70.000 Hanouty (100+) / franchising m2 of retail space. Retailers include Galerie Lafayette, FNAC, etc. Hypermarket Marjane (21) chains Aswak Assalam (8) / Casino Metro (7) Date © Finpro 57
  • 58. Global Retail Development Index Morocco: Retail sales bolstered. Morocco drops from 15th to 17th place this year. The retail sector represents 13 percent of the country's GDP and is expected to grow 5 percent annually in coming years. A strong performing tourism sector and a shift toward more modern retail channels has bolstered retail sales. Key drawbacks in Morocco (population 31.9 million) include low consumer spending per capita compared to Tunisia, complexities in the distribution models and the need for local knowledge. Date 58 © Finpro
  • 59. Maghreb Life Sciences Market: Morocco Business Opportunities for Finnish Companies
  • 60. LS Opportunities in Morocco Organisation & Hospital Dental management Information supplies and (efficiency, Systems! treatment chain devices management) + cancer Rural areas have treatments Liberalization of limited access to health >technology private hospital services and specialist needs ownership in physisians are not 2011 everywhere Vaste availability of  TELEMEDICINE medical plants, but Radio- no research and protection production know- systems for A national program Appcircum how of hospital amounting EUR 2.5mn, will aim to nutraceuticals personnel improve co-ordination among medical services and to carry out more kidney transplants and to Cronic Tissue banks improve dialysis treatments. Over 6000 kidney failure patient, without Diseases under transplant. Management construction  Software needs Date 60 © Finpro
  • 61. Telemedicine Opportunity SAMU Obstetrics for rural areas Now 100% ”services d'assistance médicale > mobile equipment GSM coverage d'urgence” > field units in the whole • Midwives network + GSM country technology > Distance medical support 2015 UN Millennium Dev. Goal Lack of specialized Maternity care to reduce maternity mortality physicians in rural areas and urgency obstetrics National Telemedicine 2010: Medical Caravan developping in Public 90 caravans Expected funds Programme and Moroccan allocation for procurement 112 000 visits Committee rural areas the MoH action by tenders 2011- plan 2012-2016 12 000 surgeries 1st Rural Healtlhcare Conference in Rural Health Rabat Plan by Ministry 19.4.2011 of Health 2011 61 © Finpro
  • 62. Morocco LS Sector SWOT Strengths Weaknesses • Stable political situation and economy • Lacking organisation • Government action plan for health care • Private hospitals short of funds • Positive business environment for foreign • Language skills? French vs. English companies and products • Europe strong as a trade partner (>20%) Opportunities Threats • Telemedicine solutions for rural areas (medium-term) • Maghreb revolution expanding • Technology for cancer treatments • Chinese competition is growing in • Field hospital solutions healthcare supllies • Trade customs for Europe to be abolished 24/10/2011 © Finpro 62