Access to infertility care services towards Universal Health Coverage is a right and not an option

Abstract

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

Mapping maternal and infant health in Morocco: A global scoping review of themes, gaps, and the "unseen" in the published health research literature, 2000–2022

“…Expensive laboratory tests, bloodwork, and ultrasounds sometimes lacking in public care were described as easily available in private care [ 63 , 99 , 100 ]. Private MIH healthcare is growing rapidly in parallel to the public system, raising questions of equity, resources, and regulation [ 13 , 101 , 102 ]. NGOs were also not studied directly, though NGOs provide care to rural, low-income, and other vulnerable populations (HIV+ women, single mothers, asylum-seeking women, disabled children) in Morocco.…”

Exploring the challenges of public health nurses in the management of infertility in Northern Ghana: a qualitative descriptive study

“…Open access in the instances of referrals, primary care providers must offer counselling and professional support to the couple. 8 After receiving specialist reproductive health support, primary care providers, including PHNs, may still need to follow-up on the couple to ensure continuity of care. In resource-limited settings such as Ghana, PHNs may also need to offer psychosocial support to couples undergoing fertility treatment considering the often challenging environment and unique issues they need to navigate.…”

“…In developing settings, the likelihood of a couple presenting with fertility concerns (that is, the desire to conceive but with difficulty) in the primary care setting is high 7. These public health nurses (PHNs) whose role is to provide basic healthcare services including the assessment, diagnosis and referral of clients must decide when to undertake these referrals for specialist reproductive health services 8. PHNs with advanced training may also be expected to commence initial treatment of infertility in primary care settings before undertaking referrals 9.…”

“…PHNs with advanced training may also be expected to commence initial treatment of infertility in primary care settings before undertaking referrals 9. Even in the instances of referrals, primary care providers must offer counselling and professional support to the couple 8. After receiving specialist reproductive health support, primary care providers, including PHNs, may still need to follow-up on the couple to ensure continuity of care.…”

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study

“…Yet, several LMICs have indeed engaged with fertility care in their national health policies [7][8][9]. This is the case, among other, for Uganda, Ethiopia, Iran, Morocco, and Thailand [10][11][12][13]. Morocco and Thailand, for example, both strengthened their national reproductive health policies and infertility services, and fertility care was incorporated as an 'essential' intervention in the Thai National Reproductive Health Strategy in 2020 [14].…”