During my tenure at the High Atlas Foundation (HAF), I observed what I have come to refer to as the invisible infrastructure that subtly permeates rural Morocco. While public health issues do not always manifest overtly, they are present in cooperative meetings, farm visits, and in the distance separating these communities from essential health services. Although health may not be the primary focus in discussions, it is invariably intertwined with the narratives of these communities. Traditionally, we have viewed agriculture and public health as distinct domains; however, they are far more interconnected than we often recognize.
In the village of Anamer-n-Oucheg, local women expressed that their most significant health challenges stemmed from poor sanitation and irritation caused by dust. Interestingly, their descriptions of health issues included references to rashes resembling bruises. This was not merely a linguistic misunderstanding but rather a reflection of the limited health literacy that has been fostered in the village; there was little reason for anyone to explain the distinction between the two. The situation was exacerbated by the presence of wastewater from households flowing through crops, leading to repeated illnesses among children who played nearby. Furthermore, the lack of appropriate facilities at school for girls to manage menstruation highlighted the urgent need for better health services. Although the nearest clinic could provide vaccinations and birth control, any additional healthcare necessitated a journey of two hours, a considerable distance for many families. However, it is important to note that the village is home to a women’s cooperative, akin to many others in Morocco, which is self-sustaining, organized, and actively working to support the community.
The High Atlas Foundation has already acknowledged this intricate connection through its initiatives aimed at providing clean drinking water, thereby enhancing access to safe water and sanitation in rural areas. My experiences in Morocco left me contemplating the potential benefits of extending this philosophy even further—by integrating water, agriculture, procurement, and health education within communities that are already performing commendable work.
It became increasingly evident to me how seldom public health education intersects with broader agricultural and financial planning. Sanitation and clean water are often relegated to the focus of one NGO, while income and agricultural production are managed by another, leaving health literacy as an entirely separate endeavor. Yet, the issues of rashes mistakenly identified as bruises and wastewater contaminating farmland are not isolated problems; they are symptoms of a larger systemic failure. Women who are already nurturing their communities through cooperatives can serve as trusted advocates for health education if these initiatives are designed collaboratively rather than in isolation.
Consider the context of childbirth in this setting: a 2021 study focusing on two villages in the Anti-Atlas Mountains revealed that women felt most secure delivering their babies at home with the assistance of midwives, known locally as kablas. These traditional birth attendants, who have no formal training, learn their craft through observation and practice. Throughout the interviews conducted by researchers, kablas were mentioned repeatedly, not once as a source of complaint. One woman even compared her home birth experience to a hospital birth, noting that hospital staff lacked the patience to encourage her to keep pushing. In contrast, while the regional hospital—located two hundred kilometers away—was described as well-staffed and adequately supplied, it remains inaccessible for many due to the high transportation costs that most families cannot reliably afford. Thus, in areas where formal healthcare systems are not adequately supported, women turn to the informal care systems that have historically been dependable, albeit under-credentialed yet trusted.
This disconnect is also evident in the agricultural sector, where the structural separation between agriculture and health services is pronounced. However, the institutions required to bridge this gap already exist. Morocco’s National Initiative for Human Development (INDH) has long explored community-based approaches before scaling them through government ministries. Furthermore, with over 27,000 cooperatives in Morocco—two-thirds of which are agricultural—there exists an established network capable of providing services beyond mere production. Morocco has already showcased this model effectively: partnerships between ministries, nonprofits, and local organizations have significantly increased preschool enrollment from approximately a third of eligible children to more than 90 percent. This same framework could be utilized to link agricultural cooperatives with educational and health institutions.
What would it take to address this systemic disconnect? This concept is discussed in Dr. Ben-Meir’s decentralization literature, which introduces the idea of delegation. This approach fosters a culture where decision-making and daily responsibilities are transferred to communities and their organizations while the government plays a role in establishing standards and funding. It is crucial to differentiate this from privatization, which completely divests services to private enterprises—a path that Morocco's regionalization efforts have notably avoided. Establishing a procurement rule that connects cooperatives to schools and hospitals could operate under the same principles, targeting a much smaller scale.
However, the current system for school canteens—which provides meals to children in the same villages where these cooperatives operate—relies on a centralized tendering process that favors large intermediary companies and high-volume farms. Research indicates that this often leads to Morocco importing lower-priced ingredients for schools while local, diversified farms are overlooked. The capacity to provide locally sourced meals for schoolchildren already exists; what is lacking is a procurement rule that directs funding to these local farms.
There is, however, hope on the horizon. A pilot project is already in motion to shift food sourcing for schools toward local agroecological farms. Brazil's home-grown school feeding law serves as an international model, mandating that a minimum share of procurement comes from family farmers, with prices established in advance and without competitive bidding required for that portion. This type of mechanism could easily be integrated into Morocco's existing cooperative structure without necessitating additional government expenditure; it merely requires a redirection of existing purchasing practices.
Nonetheless, advocating for centralized procurement can be challenging when central planners often possess more information and are better equipped to assess long-term national interests than a fragmented network of local contracts. Conversely, the risks associated with decentralizing authority without providing adequate financing are well-documented, leaving local institutions struggling for resources and potentially shifting power dynamics from one elite group to another. This concern is particularly relevant here, as cooperatives are not immune to the same inequalities that marginalize women in other contexts. Although nearly a third of cooperative members are women, a significantly smaller proportion actually hold leadership positions within these organizations. Home-grown feeding models in other regions have also faced difficulties with inconsistent supply chains and the coordination required to match numerous small farms to numerous schools. However, these challenges should not deter us from pursuing this initiative. Instead, they underscore the importance of constructing these rules with the same rigor as the systems they aim to replace, if not more.
The objective isn’t to suggest that kablas should be responsible for every birth, nor to imply that women with serious complications should not access hospitals equipped with surgical facilities. The essential takeaway is that development does not always necessitate the introduction of new solutions. Sometimes, it involves recognizing and supporting the existing resources that already sustain communities. The Rowad Tanmia Cooperative in Anamer is not waiting to be discovered; it is waiting for a connection—to the nearby school, to the clinic that is two hours away, and to a funding stream that already exists but currently bypasses them.
As reported by moroccoworldnews.com.
