COVID-19 and Public-Private Partnerships

Strategic Issues for the Resilience of the Moroccan Health System

Summary

This article critically examines the role of public-private partnerships (PPPs) in reinforcing the resilience of Morocco’s health system during the COVID-19 crisis. Drawing on collaborative governance theory and systemic resilience frameworks, the study combines document analysis, a systematic literature review, and interviews with institutional and civil society stakeholders. Findings show that PPPs enabled rapid mobilization of private resources, boosting national intensive care capacity by over 35% and facilitating temporary service continuity. However, these gains were unevenly distributed, with urban centers benefiting more than rural regions, where access to healthcare deteriorated. Additionally, 77% of reviewed PPP agreements lacked social pricing clauses, exacerbating inequalities and excluding vulnerable populations from essential services. The research highlights a governance paradox: while PPPs proved effective as emergency tools, they fell short in embedding principles of equity, territorial inclusion, and long-term sustainability. Excessive centralization, weak regulatory frameworks, and the absence of robust monitoring mechanisms limited the transformative potential of these partnerships. The article recommends reorienting PPPs toward inclusive governance models through regional observatories, mandatory social clauses, interoperable information systems, and equitable financing strategies. By addressing these structural gaps, PPPs could evolve from crisis management instruments into strategic levers for equitable health reform. This analysis contributes to ongoing debates on public sector reform, particularly in Global South contexts, by advocating for a balance between efficiency, resilience, and social justice in healthcare delivery.