Solidarity Economy and Universal Health Coverage in Morocco: Constraints, Opportunities, and the Role of Community Cooperatives

Abstract

This paper investigates how social and solidarity entrepreneurship (SSE) relates to health coverage in Morocco, a question almost entirely absent from the country’s academic literature. Drawing exclusively on publicly available secondary data from the World Bank World Development Indicators, the WHO Global Health Expenditure Database, ODCO cooperative statistics, and the national family health surveys (ENPSF), the study documents three parallel trends over 2000–2023. Morocco’s maternal mortality ratio (MMR) fell from 244 to approximately 72 per 100,000 live births; skilled birth attendance (SBA) rose from 62.6 per cent in 2003 to 87.8 per cent in 2018; and household out-of-pocket health payments declined from a peak of 59.3 per cent of total health spending in 2005 to around 51 per cent in 2022. Over the same period, the cooperative sector grew from fewer than 3,000 entities in 1998 to 58,566 in 2023. The paper does not claim causality, available public data does not permit that but argues that four structural constraints block SSE actors from contributing more fully to universal health coverage: financing exclusion, regulatory fragmentation, provider network invisibility, and inter-institutional coordination failure. Each is documented through CESE diagnostic reports and grounded in information asymmetry, transaction cost, and social embeddedness theory. Four research hypotheses are proposed for future empirical testing, and five policy reforms are advanced: integration of health cooperatives into AMO Tadamon, a dedicated AMES health financing window, a hybrid legal status in the 2025 SSE Law, inclusion in the Carte Sanitaire, and a national health-SSE data observatory.