138470 1/24/2008 13:00 08RABAT72 Embassy Rabat CONFIDENTIAL VZCZCXRO0280 RR RUEHTRO DE RUEHRB #0072/01 0241300 ZNY CCCCC ZZH R 241300Z JAN 08 FM AMEMBASSY RABAT TO RUEHC/SECSTATE WASHDC 8050 INFO RUEHAS/AMEMBASSY ALGIERS 4644 RUEHNK/AMEMBASSY NOUAKCHOTT 3645 RUEHTC/AMEMBASSY THE HAGUE 0880 RUEHTRO/AMEMBASSY TRIPOLI 0251 RUEHTU/AMEMBASSY TUNIS 9479 RUEHCL/AMCONSUL CASABLANCA 3841 C O N F I D E N T I A L SECTION 01 OF 02 RABAT 000072
STATE FOR NEA/MAG AND INL/C/CP AID/W FOR GH
E.O. 12958: DECL: 01/23/2018 TAGS: PINS, SOCI, ELAB, MO SUBJECT: MOROCCO: HEALTH MINISTER DESCRIBES A CRISIS OF CORRUPTION, NOT CAPABILITY
Classified By: Ambassador Thomas T. Riley for reasons 1.4 (b) and (d)
1. (C) In the course of a courtesy call on Morocco's new Health Minister, Yasmina Baddou, she told the Ambassador that corruption, not capabilities or resources, was the primary reason for Morocco's substandard level of health care provision. She said that fighting graft was her top priority, followed by improving efficiency and professionalizing hospital and health care administration. The largest obstacle to reform continues to be a heavily unionized workforce resistant to change and perceived erosions of privileges and influence. End Summary.
Background and Biographic Note
2. (SBU) On January 16, the Ambassador paid a courtesy call on Yasmina Baddou, Minister of Health in the new El Fassi Government. A lawyer, prominent women's rights activist, and member of the Istiqlal (Independence) Party, Baddou served the previous government in the sub-cabinet role as Secretary of State for Families, Solidarity and Social Development. The Ambassador and Baddou have a strong and long-standing professional relationship. She is generally supportive of the USG and openly appreciative of the warm bilateral relationship between the U.S. and Morocco. Her husband is the brother of Foreign Minister Taieb Fassi-Fihri and is the current head of the Water Development Agency.
Corruption Threatens Morocco's Health
3. (C) Baddou said that corruption within the health sector was the primary reason for the poor state of Morocco's health care infrastructure. Morocco has enough skilled doctors and staff, but supply-chain graft and theft siphon off a significant portion of her Ministry's funds and undermine patient care. As an example, she said that it is now accepted that patients must pay a bribe of approximately 150 Moroccan Dirhams (approximately USD 20) to obtain blankets or basic service in virtually every hospital. In some hospitals, patients must pay additional unofficial "fees" to be admitted or receive testing and drugs.
4. (C) As an example of the fatal consequences of systemic inefficiency and corruption, she pointed to a recent media article which placed Morocco's maternal mortality rate at 227 per 100,000 live births, versus 17 in France and 13 in Great Britain. Further, statistics indicated that the infant mortality rate is 40 infants per 1,000 live births in Morocco, as opposed to 33 in Egypt, 24 in Tunisia, and 19 in Libya. She said she was ashamed of these facts and wanted to ensure that, under her watch, the ratios change for the better.
Systemic Improvements Require Bureaucratic Cultural Change
5. (SBU) Strikers were encamped outside the Ministry of Health (MOH) when the Ambassador arrived for his visit, forcing him to enter through the basement. When asked, Baddou said that the protesters were nurses who had completed their studies and were demanding jobs within the MOH. Baddou added that she had ample jobs to offer, but applicants were required to take a national standards test (which the majority of them would pass). However, the group outside the Ministry refused to take any type of examination and insisted on being hired directly. Baddou complained that this view of government jobs as a birth-right, coupled with the almost total unionization of her 50,000 direct employees, hampered her ability to effect change quickly. She emphasized that the MOH needed a corps of professional health care managers, similar to U.S. hospital administrators, in order to allow doctors to focus on medicine, saying that physicians often did not know the first thing about running an enterprise.
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Baddou also expressed great interest in exploring the -- THE NAME ISSUE
REF: A. SKOPJE 48 B. SKOPJE 21 C. SKOPJE 32
Classified By: P/E CHIEF SHUBLER, REASONS 1.4 (B) & (D).
1. (C) The January 21 talks in Ohrid on the name issue between Skopje and Athens resulted in no new substantive developments, although UN Special Negotiator Nimetz characterized the discussions as positive (ref A). The Macedonian side offered a new list of CBMs as a goodwill gesture and is awaiting an official Greek response. Nimetz later told President Crvenkovski he had been asked by a high-level USG official to come up with a new proposal on the name to be presented to the two sides, either during their next bilateral in Athens in February, or shortly thereafter. Crvenkovski told Nimetz such a proposal would have to be based on Nimetz's October 2005 proposals, or a variant thereof. We continue to believe that the best, if not only, chance for resolving the name issue is to get both sides to agree, (possibly on the basis of agreement on a name formula as a basis for discussion and resolution) before the NATO summit in Bucharest in April, to resolve the name issue in the period between Macedonia receiving a membership invitation and Greek ratification of the invitation. End summary.
MACEDONIAN CBM PROPOSAL
2. (SBU) The President's Chief of Staff, Natasa Savova, briefed P/E Chief January 22 on the meeting between the Macedonian and Greek name issue negotiators mediated by UN Special Negotiator Nimetz in Ohrid on January 21. Nimetz had briefed President Crvenkovski and Savova on the Ohrid talks the morning of January 22.
3. (C) Savova said the GOM negotiator, Ambassador Nikola Dimitrov, had presented the Greek side with an expanded list of CBMs (ref A), which Greek negotiator Vassilakis had said "would be considered" by Athens. Vassilakis had warned, however, that the two sides needed to focus on resolving the name issue, and that CBMs could be discussed after that occurred. Apart from the discussion of the CBMs, there had been no substantive progress in the name talks, Savova added.
NAME SOLUTION BEFORE BUCHAREST?
4. (C) According to Savova, Nimetz told Crvenkovski that he recently had been asked by a high-level State Department official to prepare a new proposal on the name before the NATO Summit in Bucharest this April. The Macedonians expected the proposal would be unveiled at the next Greece-Macedonia meeting in Athens in February, or shortly thereafter. Savova said the Macedonian side was concerned that the GOM would come under pressure to resolve the name issue at the same time as it was being pressed to recognize an independent Kosovo. She suggested the political optics of such pressure would have a negative impact on public opinion here, and could further bolster the government's resistance to being forced into agreement on a name solution before the Bucharest Summit.
5. (C) Responding to Nimetz, the President had said that, if/if the Macedonian side were to receive a new proposal, it had to be based on Nimetz's October 2005 proposal (ref B), or a variant thereof. Savova said she suspected PM Gruevski would not/not share the President's position on this, which the two leaders had not yet discussed, since Gruevski had rejected any discussion of the 2005 proposal in cabinet meetings on the name. Crvenkovski had asked Nimetz to craft any new proposal so that the Macedonian side would not be forced to reject it, and said the GOM could not accept any proposal that would "detract from Macedonia's identity."
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6. (C) We continue to believe, as outlined in ref C, that the most realistic and viable path to a positive outcome for Macedonia's NATO bid, if Greece is intent on vetoing, is to get both Skopje and Athens to agree before the Bucharest summit that they will resolve the name issue after/after Macedonia receives a membership invitation, but before ratification of that invitation by Greece. If Nimetz does present a new proposal in February or March, its chances of success, though very slim, will be best -- from Skopje's perspective -- if it does not push the GOM to agree to a final name solution before April, which we are certain PM Gruevski would reject as political suicide. MILOVANOVIC