Bureaucratic stakes of the delivery of free health care to 'the poor': quandaries and social productiveness of the introduction of a system of medical coverage in Morocco
(University of Barcelona)
Paper short abstract:
This paper discusses the establishment of a system of medical coverage for the disenfranchised in Morocco: ethnographic fieldwork in urban public health settings opens up a reflection on the mobilisations and contestations of bureaucracies in the delivery of health care as a service.
Paper long abstract:
Building on fieldwork in Morocco, this contribution aims to discuss the recent introduction of a system of medical coverage for 'the poor' and 'the socially vulnerable' and its extension at the national scale (in 2012): this process has been investigated through ethnographic methods across a variety of public and charitable (State-sponsored) health services in urban contexts. The daily dynamics embedded in the early stages of implementation of this system - or 'regime' - of medical coverage have been explored both from the perspectives of potential 'beneficiaries' and from those of the personnel in charge of its operational aspects. The latter will be the focus of this paper, in which attention will be brought to the flou, the 'bureaucratic voids' or the 'looseness' of bureaucracies ascribed by the actors to the initial phases of delivery of services (health care) within the new system. The goal of delivering health care free of charge - or according to partial exemption of medical fees - to targets identified as deserving is perceived by some as inadequate, hardly achievable or even detrimental to 'vulnerable' populations, precisely because of the reform's 'bureaucratic flaws' and its distance from daily challenges and local resources. Others - among bureaucrats or health professionals - deem this system a (potential) measure to counter inequalities, informal arrangements and transactions at the core of current strategies of access to public health care. Hence, questioning diverse insights, stakes and tensions enables to ground bureaucratic architectures in their everyday social productiveness.
The anthropology of public services and bureaucracies