"Made in Morocco: How can nation branding revamp the strategic positioning of Morocco in the Medical Tourism Industry" _Thesis-Jorio-Dinia

"Made in Morocco": How can nation branding
revamp the strategic positioning of Morocco in the
Medical Tourism Industry?
By:
Camelia Dinia Dinia & Jihad Jorio
Master of Science in International Strategy & Influence
Thesis’ supervisor:
Pr. Amine Ezzerouali

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Plan:
Acknowledgements: 3
Dedication: 4
Abstract: 5
Introduction: 6
Aim of the subject: 6
Proposed methodology: 7
Key words: 7
Academic Review: 8
I. Medical Tourism: 8
II. Nation branding: 10
Nation Branding Perspectives: 12
Place reputation & Soft Power: 13
Nation and destination branding: 14
Nation branding in what follows: 15
III. Made in Morocco: 15
IV. Strategic Positioning: 17
V. Conceptualization of the thesis: 19
In-depth analysis: 21
I. Rankings & Models: 22
1) Africa Region: 23
Morocco: 23
South Africa 25
Tunisia 27
2) Middle East Region: 28
3) Partnerships in the Middle East & Africa Region: Dubai x Morocco 30
II. Public understanding of the field/ rankings: 32
1. The quantitative questionnaire: 32
1. The panel definition: 32
General understanding of the field of Medical Tourism: 32
Feedback on Medical Tourism experiences: 40
“Made in Morocco”: 43
2. The qualitative questionnaire: 49
- The panel definition: 49
- General understanding of the field of Medical Tourism: 49

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Synthesis: 54
Recommendations: 59
Strengths: 59
Weaknesses: 59
Implications: 60
Benefits: 60
Challenges: 61
11 Golden Rules: 63
Key Reference literature: 65

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Acknowledgements:
We are grateful to our thesis supervisor Professor Amine Ezzerouali for his
responsiveness and for providing the scholastic support needed to complete this
research paper.
We are equally thankful to the academic corps of the Master of Science in
International Strategy and Influence at SKEMA Business School - and in particular: Pr.
Benjamin Lehiany, head of the MSc IS&I -, for it has prepared us to address strategic
problematics at macroeconomic scales.
We hereby declare that this thesis is our original work, submitted in partial
fulfillment of the requirements for the degree of Master of Science in International
Strategy and Influence, at SKEMA Business School.

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Dedication:
This research project is firstly dedicated from one co-author to another for this
thesis could not have been completed without the mutual respect for one another’s
work, dedication and appreciation of this collaboration.
It is also dedicated to our family members, from both Andalusian families: Jorio
and Dinia, for their support and encouragement throughout the duration of the thesis.
On a bigger scale, it is with pride and passion for our native city Rabat, capital
city of Morocco, that we would like to gift this study to the Ministries of Health and
Tourism in Morocco. It would be an honour if the results of our work could urge and
help set an effective strategy to achieve a higher ranking in the field of Medical
Tourism.

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Abstract:
From November 2017 to September 2018, this study examined the performance
appraisal of Morocco in the field of Medical Tourism, a booming market. It challenges
the current position of the nation and the causes for its ranking as 31st out of 41
countries, listed by the Medical Tourism Index. The main objective of the study is to
explore the possibilities of a better ranking through a nation branding strategy.
To do so, the research paper starts by a literature review of the different key words of
the problematic and attempts to contribute to the academic world by setting a new
definition for “Medical Tourism” and “Nation branding”. Moreover, it introduces a new
concept: “Made in Morocco” which corresponds to the nation branding strategy this
study tries to apply to the field of Medical Tourism, in the case of Morocco.
To complete an exhaustive strategic assessment of this business case, a study of the
market was made to position Morocco and improve its status thanks to the best
practices retained from the analysis of the different competitors within the chosen
scope. The latter, “Middle East and Africa”, was determined following the current
“South-South” strategy adopted by the kingdom; such as strengthening its partnerships
and developing new alliances. Also, considering its core competencies, it is only within
this region, that it could potentially surpass its competitors (mainly Tunisia and South
Africa) in the near future.
Additionally, a sample of 120 respondents were researched on and two questionnaires
were used to collect data. This helped set the perceived performance of the nation
within the industry and assess how the panel responds to the concept of “Made in
Morocco”.
The study then synthesizes the findings. This allows it to settle on the question:
whether a nation branding strategy could revamp the strategic positioning of Morocco
in the field. Although it concludes on the fact that is not really achievable in the few
upcoming years, it does hand in recommendations on how to potentially reach a better
position.
Consequently, a hybrid strategy is suggested to develop the Wellness and Healthcare
aspects of Medical Tourism in accordance with the two identified segments,
respectively a niche market strategy for the first and a cost leadership one for the
second. Finally, eleven golden rules are disclosed to ease the settling of an effective
strategy plan for the country in the field of Medical tourism.

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Introduction:
Aim of the subject:
The Field of Medical tourism is considered to be a fast-growing industry. Indeed, the
mapping of the medical travel industry indicates an annual growth of 25% over the next
decade, states Visa and Oxford Economics.
One of the key objectives of this thesis is to give an insight on how and why its rankings,
trends and models are evolving at such a fast pace. This should help identify the
current positioning of Morocco in the field of Medical tourism and define the best
practices to strategically position Morocco within the industry, globally.
In fact, on a regional perspective, Africa Healthcare and Medical Tourism Summit took
place in Morocco in late 2017 and allowed the host country to shine as an “International
medical tourism destination” with a fine health infrastructure and as a crossroads for
medical tourism, especially within the African Continent. The summit aimed to boost
intra-African tourism by using the Moroccan Model, which underlines the concern of
reviewing the Moroccan Medical Tourism case.
Also, Africa being widely and increasingly recognized as the future, the choice of
Morocco became an obvious one for this case study. Actually, the Kingdom aspires to
rank as the capital of tourism in Africa. In this sense, the thesis will explore how to set
a successful nation branding model, in the case of Morocco and applied to the Medical
tourism industry. It shall therefore provide a theoretical support to this ambitious vision
on a regional level and define best practices to back it up on an international scale, for
future reference.
To do so, the thesis will start by an academic review of the findings on the field and in
link with the main concepts that have been identified; such as: medical tourism, nation
branding, “Made in Morocco” and strategic positioning. This first part should lead to a
clear conceptualization of the thesis’ subject and its relevance.

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Proposed methodology:
Compare rankings and models.
Defining best practices.
Qualitative Questionnaires addressed to the different stakeholders & interviews:
❖ Ministry of Health in Morocco
❖ Ministry of Tourism in Morocco,
❖ Experts in Medical tourism: such as, doctors operating in the field of Medical
Tourism
❖ Organizers and speakers at the 3rd edition of «Africa Healthcare & Medical
Tourism Summit», held in December 13th -14th 2017 in Casablanca, Morocco
Key words:
Medical Tourism, Nation branding, Made in Morocco, Strategic Position

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Academic Review:
I. Medical Tourism:
Medical tourism is often split into three main categories. Whereas Sandberg
(2017) distinguishes between international, domestic & employer sponsored medical
tourism, Menvielle William and Menvielle Loick (2013) identify two types of medical
tourism: wellness medical tourism and healthcare medical tourism; to which Roxana &
al. (2013) add medical tourism. However, the French literature (Pian, 2015),
differentiates between "medical tourism" (tourisme médical) & "therapeutic
immigration" (l’immigration thérapeutique) as it dichotomies the origin of the traveler
between a poor country citizen versus a wealth provider. These distinctions will be
tackled in the following as to settle on a firm definition of medical tourism in regard to
the rest of the thesis.
According to the Center for Disease Control (CDC), “Medical tourism refers to
traveling to another country for medical care”. In “Medical tourism: An emerging global
healthcare industry”, Debra S. Sandberg seems to match the CDC’s definition with
what she sets as the first category of medical tourism: International Medical tourism.
The latter refers to medical tourists who are exclusively international- coming or going
to other countries. However, considering medical tourists who may travel within their
own country for care, the author introduces another category: Domestic Medical
Tourism. In addition to this, she includes a third category: Employer Sponsored
Medical Tourism, in which employers take on tasks such as contracting hospitals,
clinics and healthcare providers, regardless of location, aiming for the best value for
money: high-quality/ low prices, depending on the agreements and the partnerships
between the employer and the local agencies and governments.
For Menvielle W. et Al., “medical tourism is characterized by an offer of curative or
therapeutic care, which may include the management of the patient's recovery in a
setting that is often more favorable and more conducive to recovery than in his/her
country of origin”. In that sense, there are two types of medical tourism: Wellness
medical tourism (tourisme du bien-être) and rehabilitation medical tourism (tourisme
de réadaptation). The first one is developed in various countries, such as France,

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Tunisia or Turkey, in regard to the availability of spas, thalassotherapy and
hydrotherapy. The second one is centered on special treatments, such as post-
operative care, and addictions, to smoking, for instance.
Although the terms exist in Roxana et Al.’s categorization of medical tourism, their
definition are distinct from those of Menvielle’s et Al. In their academic paper: “Medical
tourism: Between the content and socio-economic development goals. Development
strategies”, the authors distinguish between wellness medical tourism, healthcare
medical tourism and pure medical tourism. Healthcare medical tourism is what
corresponds more to the general definition of medical tourism by Menvielle; as it covers
two aspects: i. Spa & Others: Spa, Yoga, … ii. Rehabilitation: Physical, therapy. In fact,
Roxana et Al. identify a conceptual wellness tourism which promotes ecotourism, rural
tourism, and natural tourism and so on. They then define a pure medical tourism
category. The purpose of the latter is to cover: plastic surgeries, cancer treatments,
periodical medical tests, ....
Before settling on a definition, it is worth mentioning that the French literature draws
the line between “medical tourism” and “therapeutic immigration”. Pian, 2013, depicts
the first as often associated with a regulated mobility through medical tourism agencies
for instance, more or less supported by the host country. The program includes
excursions as well as appointments at doctors' offices and treatments. Medical tourists
are often seen as wealth providers. Meanwhile, the second - Therapeutic immigration-
is usually linked to a poor population or citizens of a poor state, which involves a
potential risk for public health, in the case of aids, for instance. Therapeutic immigrants
are often accused of abusing a human right and forcing their installment in a foreign
country. This brings about a cost for a host country. The dichotomy appears as it
distinguishes between desired/legitimate and undesired/illegitimate populations which
is coupled with a strict line in regard to the economic status ("solvent"/ solvable - non-
solvable & poor/rich), as well as to a temporal context (The tourist leaves, the
therapeutic immigrant stays).

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Thus, in what follows, the French distinction will be disregarded, in addition to
the location aspect of Sandberg’s categorization and the wellness approach of Roxana
and Al.
Medical tourism shall be defined as traveling for medical care, whether in one’s own
country or abroad, depending on the desired service and the package offered. In fact,
all flows shall be included, the cause behind the journey being the only factor behind
the following grouping:
1. Wellness: The wellbeing of the patient being the reason behind the traveling.
The medical tourist seeks relaxation in Spas, thalassotherapy, and
hydrotherapy... (Menvielle, 2013)
2. Healthcare: post-operative rehabilitation, physical therapy and diet treatments
(eating disorders) ...
3. Treatments and Surgeries: cancer treatment, plastic surgeries, preventive care
such as tests.
In this sense, a medical tourist or an employer sponsored medical tourist (Sandberg,
2017), decides to travel for a specific care reason but agrees to a package whether
locally or internationally, depending on various criteria, such as: type of joint tourist
activities, for instance “ecotourism, rural, natural” (Roxana et al.,2013), price/service,
and/or the destination/nation branding.
II. Nation branding:
Nation branding has many different meanings that are often related to one's
perspective. Before handing in a detailed concept, it is valuable to give a few cited and
attempted definitions.
To begin with, the concept of ‘brand’ was defined by (Dinnie, 2008) as “invariant, i.e. a
cluster of values that enables a nation to make a promise about a unique and
welcomed experience. Successful brands thrive because the people delivering the
brand act in a manner that reflects the promised values. In nation branding, there would
likewise be dominant values that define the behavioral characteristics of a population.
The type of constitution governing the country, religions and social mores would enable
the population to appreciate the boundary points defining the cluster of values.

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Through the social and economic interactions, individuals become more aware of the
nation’s core values”.
Dinnie’s current thought values the cluster as being the core target of nation branding.
The definition given by Dinnie underlines the uniqueness of each country’s values,
constituting de facto “la raison d’être” of nation branding. On the same path, Simon
Anholt has always considered a country as a brand in the broadest sense, since each
country has its one culture, identity, values, religions and traditions. According to him,
the following message is clear: “if a country is serious about enhancing its international
image, it should concentrate on product development and marketing rather than chase
after the chimera of branding”’ (Simon Anholt, Nation Brand 2013)
Fan endorses Simon Anholt thoughts; his idea about nation branding concerns
“applying branding and marketing communications techniques to promote a nation’s
image” (Fan, 2006: 6). In other words, it invokes the use of a set of marketing tools to
implement a suitable strategy for the purpose of promoting a country. Simon Anholt is
known for being the first one who coined the concept of nation branding; in fact, he
refers to nation branding as the will of a country to enhance internationally a nation-
image through promotion and communication strategies with the aim of fulfilling its best
interests.
Gold and Ward share a similar vision and expose it as the understanding “of a process
of employing publicity and marketing to promote selected images of a geographical
location” (Gold & Ward, 1994)
Moreover, Gudjonsson came up with a deeper thought and underlines the
governmental power and will to push anyone interested in nation branding to make the
adequate changes when needed ‘Nation branding occurs when a government or a
private company uses its power to persuade whoever has the ability to change a
nation’s image. Nation branding uses tools of branding to alter or change the behavior,
attitudes, identity or image of a nation in a positive way’ (Gudjonsson, 285). Finally, he
continues with the thinking that promotion and marketing are not only the assigned
pillars that drive a country to a successful country image.
In addition to this, Simon Anholt the most prolific British consultant on the subject
emphasizes the concept of branding a nation by defining three main components that
will help to achieve a well-founded reputation.

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First, “strategy” consists in defining the identity of the nation and its actual position.
Anholt highlights two main areas where the strategy may encounter difficulties during
its development such as reconciling the needs and desires of a wide range of different
national actors into a more or less single direction and finding a strategic goal that is
both inspiring and feasible, since these two requirements are frequently contradictory
(Anholt, Nation Brand, 2013)
Second, “substance” the implementation of the strategy in the form of new economic,
legal, political, social, cultural, and educational activity: the real innovations,
businesses, legislation, reforms, investments, institutions, and policies which will bring
about the desired progress.
Finally, Ansolt gave relevant insights regarding the effectiveness of strategy, which are
related and defined to have an intrinsic communicative power, it is called “symbolic
actions”. These actions are tightly linked with innovations, laws, and regulations, the
aim is to extend the international promotion of the country.
In sum, nation Branding is linked to the creation of an amplified sense of an
organisation corporate culture or the way an organisation or nation build up its
reputation. It endorses the distinction role and model that will constitute an “appealing
country”.
Nation Branding Perspectives:
Based on Kaneva’s Nation Branding: Toward an Agenda for Critical Research paper
work a distinction is required regarding nation branding definition.
- Political perspective tackles the governmental coordination to control a
nation’s image. Actually, Volcic & Andejevic raised the government implication
concerning tourism, investment and foreign relations (Volcic & Andrejevic,
2011). However, Aronczyk has a mitigated thought on the field ‘nation branding,
at worst, as an augmented form of propaganda, or, at best, as an inoffensive
way of building and managing reputation by promoting a country’s culture,

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history and geography, a more progressive form of patriotism than its
chauvinistic or antagonistic counterparts” (Aronczyk, 2009, p. 294).
- Economic perspective: The notion of competitiveness between countries was
raised by Anholt with regard to nation branding, which is ‘a metaphor for how
effectively countries compete with each other for favorable perception, be it with
regard to exports, governance, tourism, investment and immigration, culture
and heritage, or people’ (Anholt, 2007).
- Cultural-critical perspective: As mentioned above, nation branding pays a
particular attention to the social identity, social and public relations. Kaneva
mentioned it as “nation branding tends to focus on its implications for national
identities, social power relations and agenda-setting” (Kaneva, 2011)
Place reputation & Soft Power:
Nation branding relies on an important factor that leverages the nation image, which is
place reputation. Anholt Simon links place reputation to the competitive identity term.
Besides, the author stated that nation branding ‘has more to do with national identity
and the politics and economics of competitiveness than with branding as it is usually
understood in the commercial sector. Today, almost every country wants to manage
its reputation’. (Simon Anholt, 2013)
However, to achieve a concrete nation branding promotion, soft power remains useful
and primordial in many cases. The notion can be defined as a “persuasive approach
to international relations, typically involving the use of economic or cultural influence.”
(Oxford Dictionaries) whereas Joseph Nye draws a causal relationship based on
persuasion, he defines it as follows “soft power – or having the ability to persuade
others by using your culture, values and ideas” (Joseph Nye in Solter, p. 3)
In fine, soft power goes in pair with reputation factor. It can be considered as a tool for
reputation factor as much as a country put forward its culture and values to build up
and increase its reputation.

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Nation and destination branding:
It is important to make a distinction between nation branding and destination branding
concept. As a matter of fact, Kerr justifies this distinction by enhancing the dominant
position granted to tourism.
According to Morgan and Pitchard (2000), the tourism industry’s growth sustainability
lies under immaterial arguments. In fact, they put forward the idea that, in order to
attract more tourists, countries should focus on values and concepts rather than the
price. This idea brings us to the definition that Blain (2005) gave to destination
branding. As a matter of fact, Blain defines destination branding as “the set of
marketing activities that support the creation of a name, symbol, logo, word, mark or
other graphic that readily identifies and differentiates a destination; that consistently
convey the expectation of a memorable travel experience that is uniquely associated
with the destination; that serve to consolidate and reinforce the emotional connection
between the visitor and the destination; and that reduce consumer search costs and
perceived risk”. In other words, destination branding is a group of activities that focus
on creating an emotional bond with potential tourist through the promise of a unique
(and safe) travel experience. It is now clear that destination branding and nation
branding share a common ground. But can destinations be branded like products,
services, or organizations, and if so, to what extent? (Iris Kasapi and Ariana Cela,
Destination Branding, A review of the City Branding Literature 2017)
Kerr (2006) argued that tourism “occupies more common ground with nation branding
than any other aspect of a country’s international publicity”. Even though, the
complexity and diversity of actors explains also the existence of cross-purposes
branding campaigns. According to Simon Anholt, “this diversity of actors can also
prove counterproductive, as with separate sectors emphasizing different national
qualities, multiple branding campaigns sometimes work at cross-purposes”. (Simon
Anholt, Public Diplomacy Blog)
It is also important to highlight the fact that this kind of campaigns can be even more
significant than the destination branding, as it is the case for the Football World Cup or
the Olympic games. These examples show how the nation selection phase epitomizes
the cross-purposes branding. All concerned countries put forward their best arguments

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in order to explain why they should be the one to organize the event; which obviously
means that the branding behind this competition does not depend only on putting
forward tourism.
Nation branding in what follows:
In essence, nation branding can be defined as an answer to the competition
between countries in terms of reputation. It consists in building a reputation in order to
create a distinction based on nation branding perspectives, such as economic, political
and cultural, for instance. (Kaneva, 2011).
Also, the depiction of a nation identity plays a part in amplifying the conveyed and
intended culture image, it is at this point that soft power may come into play.
The in-depth review of nation branding led us to a concise destination branding
definition. Nevertheless, we chose to tackle the nation branding topic as a whole by
addressing, also, the destination branding matter. Morocco is facing different issues
that engage in political, tourism and economic concerns. For that purpose, it would be
interesting to study how Moroccan reputation factor affects the country and what can
be done to leverage it.
III. Made in Morocco:
Historically, the notion of “Made in” emerged during the industrial revolutions.
Great Britain being the industrial leader at the time imposed a law forcing foreign
companies that imitated its products, to specify the country of origin on their products.
Wanting to discriminate against the challenger (Germany), it turned out that the label
“Made in Germany” became a cachet for well-made products and marked its reputation
for delivering good quality products, says the New Yorker.
Nowadays, marking the origin of products is not mandatory within the European Union,
except in the field of agriculture and food which are more regulated for sanitary

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reasons. What about the industry of services? What does the label “made in” mean for
services?
“Made in” is more of an abstract concept. Keywords that could be taken from
the example of Germany are “label” and “reputation”. It is a simplification of what the
origin of the product/service means to people or should inspire them to think of its
attributes; such as “savoir-faire” and “excellence” when it comes to the Made in France
(Challenge, 2012) or “detail-oriented” and “high quality”, as mentioned before in the
case of Germany. So, what does the Made in Morocco represent?
“The Made in Morocco Label is a regulated initiative developed in December 2015 as
a “Think made in Morocco”. The Label here, refers to a Nation Branding strategic
concept. In fact, it is aimed to create a national competitive advantage based on
uniqueness, authenticity, local know-how and Moroccan expertise”- Attempted
translation from (Libération, 2017):
The use of this Label allows Morocco to exert and to operate a « soft power » at the
global level. Indeed, it relies on a territorial marketing approach which is defined as: -
Attempted translation from (Gollain, 2014) « [The territorial marketing is] the collective
effort of valuation and adaptation of territories to competitive markets, to influence, in
their favor, the behavior of the public aimed by a different and attractive offer the
received value of which is durably superior to those of the competitors. This approach
tries to find the best balance between the marketing of the offer of the promoted
destination and the marketing of the demand based on an excellent knowledge of the
customers. Finally, the territorial marketing establishes a toolbox based on methods,
techniques, tools and analyses of practices led worldwide ».
In the Competitive Advantage of Nations, Michael Porter emphasizes that nations and
national character remain of prime importance, even in the age of globalization: “My
theory highlights and reinforces the importance of differences in nations and of
differences in national character. Many contemporary discussions of international
competition stress global homogenization and a diminished role for nations. But, in

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truth, national differences are at the heart of competitive success.” (Porter, The
competitive advantage of Nations, 1990)
In conclusion, in light of labeling a clear nation branding strategy, the concept
“made in Morocco” will be used. It shall refer to the unique attribute that could qualify
products/services provided within or by the Kingdom of Morocco. The territorial
marketing applied to the sector of medical tourism should enable an empowerment of
the nation as a brand and strategically position the country within the industry.
IV. Strategic Positioning:
Strategic positioning can be defined such as the following: (Porter, 1996)
“Strategic positioning attempts to achieve sustainable competition advantage by
preserving what is distinctive about a company. It means performing different activities
from rivals or performing similar activities in different ways.”
According to Porter, the concept emphasizes the valuable and specific
advantages that make a company or, in this case a nation completely unique.
Differences in culture, traditions and nation background as a whole, are considered as
assets, which can allow a nation to compete on the worldwide scene. The matter of
rivalry deals with the success factors that own and possess a country, thereby to
outperform the rivals it is of a prime importance to preserve its competitive and
distinctive advantages. In fact, countries rule as industries when it comes to rivalry and
competition. Hence, a nation has to know its attributes “to identify and understand the
critical factors of competitive success, and identify which industries are attractive and
the company has competitive advantages.” (M. Angelo Hamzo, 1998).
As discussed above, countries as industries have to define their strategy
accordingly with the country’s assets. In other words, the strategic assets- generally,
assets that ensure the country well-being and prosperity, have to be maintained once
determined. Moreover, the country is required to rely on its competitive advantage and
that involves the development of a process based on a reliable communication mix

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plan. By doing so, the plan enables a leverage over more plausible advantages through
the capacity to innovate, for instance.
However, the real challenge behind setting a concrete strategic position is being
aware of the external environment, the organisations’ or industries’ capabilities and
competences and finally the culture and values conveyed through the concerned
stakeholders. (CIMA, 2008)
Still, Porter is addressing a strategic position dilemma related to its upkeep and
sustainability. In fact, according to him, no matter how strong a country’s strategic
positioning can be, the question related to its sustainability will always be at stake. In
other words, even though a country has effective assets to back up its strategic
positioning in a given field, it can still face competition within that same field. To answer
this dilemma, Porter puts forward the importance of what he calls Trade-offs. “Trade-
offs occur when activities are incompatible. Simply put, a trade-off means that more of
one thing necessitates less of another.” (Porter, 1996)
Nowadays, some industries and organisations tend to be “all things to all
customers” which engenders a blurred message leading to confusion. Same thing
happens when an organisation’s activity is over-designed or under-designed, these
actions ruin the desired value.
In sum, the prevalence of trade-offs in competition enable industries to
constantly call into question their competitive advantages within the chosen field. As
stated by Porter, strategic positioning is the point of preserving the difference that
makes one industry sustainable on the long-run in a battlefield. Even if trade-offs may
seem destabilizing, the intention is to become more pragmatic.
The purpose of identifying the adequate strategic positioning is to recommend the best
practices that are suitable to the Moroccan Medical Tourism, by using Porter’s generic
strategies for instance. Also, the analysis of the Moroccan field will give insights about
the plausible trade-offs that ought to be made in order to stay competitive.
Finally, the medical tourism nature chosen and required strategic positioning
will be discussed throughout the thesis’ development section.

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V. Conceptualization of the thesis:
Current literature addresses Medical Tourism on a global perspective, tackling
its typology or its industrial specifies; for instance: Medical tourism: An emerging global
healthcare industry, Sandberg, 2017 and Hallem, Y. and Barth, I. (2015).
Understanding the role of Internet in explaining the medical-tourist behavior: a
conceptual model. Management Prospective Ed. Others base their findings in the field
on a particular country, tackling one key point or another (Health policy, impacts,
drawbacks…) in regards to that geographical scope, such as: Medical tourism in India
and the Health policy of the NDA government: An overview, by Bhaidkar et A. (2017),
Klij et Al.(2016) ’s A state-level analysis of the economic impacts of medical tourism in
Malaysia and Selected problems of medical tourism- Development, benefits,
customers. Case of Poland, by Haberla et Al. (2015).
This thesis aims to bridge the gap between solemnly considering the industry versus
giving an insight on a country’s performance in the field of Medical Tourism. With a
proactive vision, in light of the Master of Science in International Strategy & Influence
‘s teachings, it intends to provide a thorough strategic analysis that could help position
Morocco in the field with best practices, challenging existing theories and rankings,
thanks to the featuring of a Nation Branding approach. Additionally, the relevance of
the subject is highlighted with the development of the medical tourism industry within
the African continent and based on the strong will of the Kingdom to take the lead in
the field; a large influence potential for an application of soft power is to be scrutinized.
Considering the established definition of medical tourism (cf. I. Medical tourism),
a medical tourist chooses to travel locally or internationally to receive a desired type of
care depending on various factors.
On the one hand, these factors, as defined by Zolfagharian M. et Al. in March 2018:
Determinants of medical tourism destination selection process, will be studied in the
development part as to see what could motivate a medical tourist to pick Morocco as
a destination. On the other hand, the analysis will examine how can Morocco adapt its
nation-branding strategy “Made in Morocco” applied to medical tourism, in order to
attract more medical tourists.

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In this perspective, there is a certain potential as to turn the nation-branding:
“Made in Morocco” into a strategic asset that could strengthen the strategic position of
Morocco in the field of Medical Tourism. Hence, the relevance of the thesis subject:
"Made in Morocco": How can nation branding revamp the strategic
positioning of Morocco in the Medical Tourism Industry?

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In-depth analysis:
While there has been much debate in the strategy literature on strategic assets,
competitive capabilities and “firm” performance, this debate has generated little
consensus. (Kilika, 2017). To avoid oversights, the attempted analysis will proceed to
a broad strategic assessment of the situation matching Morocco with the field of
Medical Tourism and the possibility to use a nation branding strategy: the “Made in
Morocco”. In order to conduct a thorough strategic assessment, four aspects will be
considered in this case: studying the competitive and market pressure, defining the
core competencies as well as exploring resource allocation, and analyzing the
“product/firm” performance.
On the battlefield, theoretical strategies and models constitute an undeniable shield to
cope with competition. It is in this sense that the competitive and market pressure will
be targeted first. It will indeed include the study of the leaders and direct competitors’
models within the scope of this thesis: The Middle East & Africa region.
This part will additionally target Morocco itself determining its resource allocation as
well as its core competencies within the field. The latter will be used to define the “Made
in Morocco” as a tagline in reference to the core competencies that could be used to
boost the position of the country in the field of Medical Tourism.
Considering this, “product” performance, in this particular case, will address the
perceived performance of the nation as whole, within the industry, by both the general
public and experts. It will consequently explore the hypothesis of shifting the strategic
position of Morocco through a nation branding strategy by examining the feedbacks
received on the “Made in Morocco” by both the panel for the quantitative and qualitative
questionnaires.

22
I. Rankings & Models:
The global growth and acknowledgment of Medical Tourism has lead the
industry to build and define key indicators. The aim is to be able to measure and to
rank the participative countries according to their attractiveness, health industry
development, safety and the political climate.
The Medical Tourism Index (MTI) is an international measurement tool designed
to assess liable destination indicators
“The MTI is the worldwide reference point on the
attractiveness of countries as medical tourism destinations, rating and analyzing the
state of a country as a medical tourism destination, how it is positioned and should be
positioned to increase the prosperity of its population.” (MTI, 2016)Hence, the MTI has the ability to enable a country to benchmark its strategic
positioning.
In collaboration with the Medical Tourism Association, the International
Healthcare Research Center (IHRC) has developed the Medical Tourism Index (MTI).
This index analyzes complex environments in order to provide a destination ranking
through 3 sub indicators: the destination environment, the medical tourism industry and
the quality of facilities & services.
The MTI is constructed as follows:

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The following destination models’ review will be split into two main regional
focus: Africa & Middle East (MEA) and will, also, take into consideration the MTI
indicators to value Morocco’s attractiveness and define its prosper future.
1) Africa Region:
The African Region has three main actors according to The Medical
Tourism Index, a southern destination and two North African countries; which
are respectively: South Africa, Morocco and Tunisia. The review evoked the
selected destination from different angles such as the environment, the quality
of the services, and the medical sector politics.
Thus, to illustrate Morocco’s position, an in-depth review of its direct competitors
is needed.
Morocco:
With its liberal economy and a USD 107 billion GDP, Morocco’s economy is
ranked 5th in Africa. The two most important sectors in Morocco are tourism and
agriculture. When it comes to tourism, the local government put forward in 2010 its
ambition to be one of the top 20 destinations in the world as it has reached last year
more than 10 million tourists. On the other hand, agriculture is a major employment
driver as it employs 40 to 50 percent of the working population.
The business environment is also very attractive as much as the Kingdom is
considered as a hub in many major fields (finance, tourism, automotive industry…).
This attractiveness can be explained by many factors such as Morocco’s strategic
localization (Gibraltar Detroit, proximity to Europe…) and the political stability that is
ensured by its Constitutional Monarchy.

24
In its article 31, the 2011 Constitution affirms that the State and the public
institutions have the obligation to implement, by all possible means, the necessary
conditions for all citizens to enjoy the right to social welfare, healthcare and health
coverage. As a result, the government implemented, since 2012, many reforms to
support the demographic and epidemiologic transitions.
In Morocco, two healthcare systems were created: The Mandatory Health
Insurance system (AMO “Assurance Maladie Obligatoire”) in 2002 and the Medical Aid
system (RAMED “Régime d’Assistance MEDicale”) in 2012. While the first system
(AMO) is dedicated to the citizens who are either employees, entrepreneurs, pension
fund holders, veterans or students, the second (RAMED) is based on social welfare
and solidarity principles and is dedicated to the very poor. Also, the healthcare sector
is growing, as much as the annual healthcare budget recorded a 20% growth between
2012 and 2014. In fact, the budget increased from EUR 1.08 billion in 2012 to EUR 1.3
billion in 2014.
Nevertheless, the road is long ahead for the sector. In fact, public facilities
throughout the Kingdom are facing major issues that prevent them from providing the
community decent healthcare service. The National Court of Auditors published its
annual report that puts forward the lack of qualified doctors, equipment and medication
in regional care centers. As a matter of fact, 152 healthcare centers were shut down in
2014, mainly due to the lack of staff. Morocco counts 141 hospitals, 400 private clinics
and 2,600 healthcare and dispensary centers. According to X the four main University
Hospitals (Casablanca, Fes, Rabat and Marrakech) recorded, in last 2013, more than
the third (35%) of the national hospitalizations and chirurgical interventions.
According to the Medical Tourism Index, Morocco is globally ranked 31st.
Proceeding through the indicators, Morocco is ranked 26th regarding its Medical
Tourism Industry, 31st in Destination Environment and 33rd on the Facility and Services
Quality factor. As a matter of fact, the Kingdom is a tourism hub that attracts a growing
number an estimation of 10 million tourists each year. “The market segment is
increasingly emerging elsewhere on the continent, including in Gabon, the Gambia,
Ghana, Kenya and Nigeria, it states, adding that Egypt, Mauritius, Morocco, South
Africa and Tunisia already have developed niche markets.” Thereby, Morocco’s current
situation is focusing its tourism strategy on market niche development through, for

25
instance, luxurious hospitality services merchandising “The Moroccan Experience” and
the “Tales of the Arabian nights”. The outcomes of Niche Market strategy are a
conclusive promotion of the Moroccan Experience within the selective sphere and the
creation of the Moroccan Experience image.
Nonetheless, the geopolitical environment context (Arab Spring, tensions in
Occidental Sahara) is very complex and even though the Kingdom has qualified
doctors and nurses, the facilities and the services quality have yet to be improved.
Furthermore, there is an important gap between public hospitals and private
clinics in terms of equipment, depending on the geographical areas. Within the public
sector, there is 1 hospital bed for every 1,000 citizens, only 1 doctor for every 12,000
citizens, 1 healthcare center for every 10,000 citizens and 1 nurse for every 1,000
citizens. Also, 54% of households direct expenditures’ is spent in the healthcare sector,
which represents 400 MAD (around 37 EUR) per capita spent every year on
medication. Both high medical services and medication costs and the lack of medical
facilities (and remoteness) are major issues. Consequently, the access to medical
attention is limited in Morocco.
South Africa
The Southern African country: South Africa was elected as the 26th medical
tourism destination in the African Region; which propels the country to the first position
on the continent. The country owes its ranking to its ability and will to develop medical
advancements and improvements. South Africa offers a plethora of landscapes,
diverse fauna and flora that are enhanced with a rich ecosystem. Its renowned Safari
remains an absolute reference in the African continent. The country takes advantage
of its geographical variety to develop its tourism attraction. In fact, it helped the
Southern country to develop its brand image throughout the world. Breathtaking
landscapes, diverse species and an African Folklore are the country’s international
image; which are wooing hundreds of visitors today. In a competitive tourism area, the
experience is the major factor that determines the success of the destination; that being
pointed out, South Africa relies on its biggest strength known as “Experience”.
Moreover, the Sub-Saharan Africa region is capturing a meaningful number of
tourists since the region is developing its Wellness and Spa offers. In fact, the region
constitutes the fastest growing markets in the Medical Tourism industry -specialized in

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Wellness being, states the Business Daily Africa. Even further, the Medical Tourism
Index is displaying a 62,60 rate, which takes into consideration three different factors
and the medical tourism scoring “30th” is relatively competitive.
First, the southern African country was ranked one of the four African countries
that have an upper-middle-income. The country is considered to be second biggest
economy in Africa and the 33rd biggest one economically by dint of a nominal GDP of
349,419M US Dollars which constitutes nearly the quarter of the global African GDP.
One of the main downsides affecting the population is the high-income inequality, in
other words, the gap was enhanced by the fast-growing economy. Its economical
raking did not impact positively its poverty and unemployment rate. These aspects still
up-to-date considered as developing countries main economic and social
problematics.
Second, the governmental sector seeks to reach a National Health Insurance
system. The Government will is to offer a qualified healthcare service for all, and to
diminish the disparity of care. Suffering from continuous dysfunctions regarding the
required staff, the absence of management, the urgent need of renovating the medical
infrastructures and finally the lack of investments. Meanwhile, the medical environment
is led by the public and private sectors.
“African travelers coming to South Africa for medical treatments do so less for
cost savings and more because of South Africa’s advanced infrastructure and medical
technology, as well as its doctors, whose skills are on par with international standards.”
states the Africa Business Insight in its article. (How we made it in Africa, 2017)
The medical issue gave the Government an opportunity to balance the public
sector medical activity with an improved private version. The latter allowed South Africa
to reach the 25th position regarding the Quality and facilities services. By doing so, the
Government take advantage from this opportunity to open up internationally in order
to appeal new business to use the private sector services. “American patients who pay
about $12,400 for in vitro fertilization, a procedure that helps a woman become
pregnant, can expect to pay a third of that in South Africa.” (How we made it in Africa,
2017) Yet, South Africa is highly vulnerable to its environment variability, in fact,
security was always a major concern and the Government lend a particular
consideration to this issue.

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Tunisia
The second African competitor and the nearest geographically speaking to
Morocco is Tunisia. Despite the stormy years, Tunisia kept a well based position within
the field of Medical Tourism. In fact, a comparison with a North African neighbor is
essential to Morocco’s “Made In” image, as both countries have cultural similarities.
However, many aspects of the Tunisian case make it a unique Maghreb nation such
as a high level of alphabetization, a laic country, a great historical heritage.
Alternatively, Tunisia was ranked as the third African country in Africa and the
36th world widely with an average score of 56,78, in 2016. The Medical Tourism Index
published the detailed ranking as follows: 35th regarding the destination environment,
the 32th concerning the Medical Tourism environment and finally the 34th for its quality
of services and facilities. The Travel Congress Summit in Tunisia announced Tunisia
as the second best positioned medical destination country in Africa right after South
Africa.
Tunisia demonstrated a quick expansion in the medical sector after its
damaging events in 2010. Since then, Tunisia reinforced its security and control,
planed a strategic action plan in order to gain back tourists’ trust. The Increase of the
African client base drove the Ministry to set up a “register to list and identify the foreign
patients handled in Tunisia” said Hammami, head of the Public Health Ministry in
Tunisia, in an interview. “Specifications are in the course of finalization to regulate and
organize the agencies of service for the sanitary evacuation”, announced Hammami.
Moreover, the Ministry communicates through various interviews on the Government
will regarding the tourism improvements, according to the Health Minister “these assets
will be strengthened by the creation of the national agency of promotion of the investors
and also the development of the communications strategy for the export of the services
bounded to health”.
Actually, the Government is determined to run against South Africa, as Salma
Elloumi Rekik the Minister of Tourism and Crafts mentioned “The services quality
remains at the heart of the Tunisian strategy”, she added that the Tunisian sociology

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did change: “Before, Tunisia was known for the mass tourism; today, we welcome
international high-end and tourists stay longer.
Nonetheless, after the “Spring Revolution” Tunisia is, finally, seeing an upturn
in the Economy. The economic situation is in a transitioning position as it tries to get,
first, an economic reform and also get free from the over controlling state liberalized.
As its North African competitor Morocco, they both have in common tourism as one of
their main growth actors, the second main actor in Tunisia being oil.
The first Tunisian target is Europe: the proximity, low prices and diverse culture
constitute successful factors for the tourism area. The relationship between Europe
and Tunisia granted the country the second position in the Thalassotherapy medical
tourism destination, after France.
However, the country still needs to improve its facilities and services quality in
order to create a stable ecosystem regarding their offer. The environment is a key
element to consider when it comes to select a destination, and especially a medical
destination. Plus, it would be strategically wise to use the Government communication
as a first channel to spread the image of the destination, hence to develop the Brand
Image. Finally, Tunisia is aligning its resources from communication to quality services
and facilities enhancement in order to maximize the cost leadership strategy that it is
willing to offer. More specifically, with a less expensive and yet, qualified workforce,
Tunisia uses this competitive advantage to attract European tourists.
That being said, Tunisia receives 6,73 million visitors against 11,7 million in
Morocco. Based on numbers, Morocco is receiving approximately the double of tourists
compared to Tunisia and yet, that did not work in favor of the Moroccan destination
ranking. To which extent Tunisia’s quality services is exceeding Morocco’s?
2) Middle East Region:
Within the Middle East region, this part will focus on the study of the United Arab
Emirates as it scores number 1 destination for medical tourism in the Arab World, which
makes it in direct competition with Morocco. This does not exclude the option for a
certain “coopetition”, notably through “Dubai Alliance”.

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The United Arab Emirates
The study of the United Arab Emirates (U.A.E)’s model is justified by its ranking as first
in terms of destination attractiveness in the Arab world. In fact, with barely a population
of 9,4 million, it receives more than 10 million tourists every year. Its perception as a
safe haven considering the low rate of corruption, the renowned healthy economy and
its image allow it to rank 22nd within the Medical Tourism industry, according to the
Medical Tourism Index, based on a global score of: 67,54. Unlike the serendipity that
comes with the Moroccan case, the UAE, and Dubai in particular, has been working
on its ranking for years. In fact, Dubai is the only sheikdom within the country that does
not rely solemnly on oil.
Also, side from its luxurious facilities, the countless malls and complying with all tourism
requirements which allow it to be ranked 18th as best destination environment, Dubai
has addressed the medical aspect thanks to the establishment of “Dubai Healthcare
City (DHCC): a free trade zone, a medical and wellness community generating an
estimation of 180 000 medical tourists yearly. This estimation will likely increase rapidly
as Dubai Health Authority regulation plans on launching a second free trade zone.
If thoroughly planned, this new free trade zone could potentially help close the gap of
being ranked 10th in terms of quality of services. Indeed, despite its ranking as first in
the Arab world, it still is within the average on the global ranking. Its position could
evolve with a better focus on the patient’s experience, bring close attention to the
cultural fit and the economic aspect of a medical stay in Dubai.
On this last point, the U.A.E was noticed for having kept “double-increases in medical
costs” over the last couple of years, but it is predicted that by the closing of 2018, the
country will have slowed down its price increase. However, the intervention of Dubai
and Abu Dhabi, and health authorities (DHA and HAAD), be it through the application
of a mandatory medical insurance policy, the close monitoring in areas of wastage
(such as: fraud and abuse) or the management of healthcare facilities, induces a
certain inflation within the market. This is also due to the presence of international
actors in the market that bring innovative practices and raise the stakes against
competitors; especially when it comes to the wellness type of Medical tourism with the

30
use of advanced smart technologies that not many other countries could afford to
develop and/or acquire; such as: “wearables, telemedicine and patient portals).”
Additionally, the country is well aware of the great strategic position it holds at the
moment within the Middle East & North Africa region and does not fail to point it out
and even promote it. The website “Visit Dubai” includes a page about the “Rise of
Medical Tourism in Dubai” providing detailed information on the industry and the
sheikhdoms’ endeavors, projected investments, communication on Medical Tourism
related events as well as plans for innovation; for instance “In April 2016, the emirate
launched the world’s first comprehensive electronic medical tourism portal, Dubai
Health Experience (dxh.ae), offering access to a comprehensive menu of health and
related services including wellness, cosmetic and dental, ‘packages’, plus
ophthalmology, orthopedics, physiotherapy and other specialized medical tests”. This
page is available in at least four languages: Arabic, French, English and Chinese. The
country shows a strong will to be a major actor in this global industry. In fact, the
upcoming section will address one of the initiatives the United Arab Emirates have
launched on the field, through an alliance with Morocco.
3) Partnerships in the Middle East & Africa Region: Dubai x
Morocco
The U.A.E has a gargantuan investment hub in Morocco for real estate projects,
touristic projects and so on. In regard to the Healthcare City in Marrakech the
Moroccan-Emirati real estate developer Tasweek invested approximately 100 million
dollars to build a hospital, a luxurious hotel and medical apartments. The project is in
practice a 12.000 m2 Health Village that includes a luxurious rehabilitation center of a
capacity of 150 beds, 16 operating blocks endowed with the class 4 ISO 5 - high sterile
environment. (l’Economiste, 2017)
Moreover, Healthcare City Marrakech is a specific case as it is the contribution of both
medical professionals and real estate developers. The City developed a beauty-care
area with high performant technologies dealing for instance with ageing. Moreover, to
deal with the lack of Medical staff and high qualified practitioners, Tasweek called on

31
71 Moroccan doctors and professors to join the teams -most of them were trained
abroad and wanted to settle down in Morocco. (l’Economiste, 2017)
Furthermore, Fouad El Mountassir the General Manager of the Hospitals Morocco
Emirati Investment North/ South, underlined that “The staff will be constantly trained,
and that it will be added to the fees” (l’Economiste, 2017). The City restores faith in the
Medical competencies and the infrastructures capabilities to receive patients.
However, the project is led by a foreign developer and run by the private medical &
tourism sector. Is the Moroccan public medical sector willing to invest into the
Healthcare system?

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II. Public understanding of the field/ rankings:
In order to capture the general comprehension of Medical Tourism and the position of
Morocco within the field, two questionnaires were developed: a quantitative
questionnaire and a qualitative questionnaire. They collectively generated 120
responses, respectively 107 for the first one and 13 for the latter.
1. The quantitative questionnaire:
Addressed mainly to family, friends and acquaintances, it was also published on
diverse Facebook groups of travelers and executives (mainly Moroccans), the
quantitative questionnaire consisted of 4 sections:
1. The panel definition:
The targeted population was:
- Gender balanced (50-50 men-women ratio),
- Mostly young: aged 18-25 (51,9 %), 26-35 (25,5%), 36-55 (19,8%), the 2,8%
remaining aged 56 years old and above.
- About 50% of the panel is fully employed, 45% are students while 5% are job
seekers.
- A melting pot: Indeed, the diversity of the panel is worth mentioning as the
population accounts for 18 nationalities from all 5 continents: 67% being
understandably Moroccans, considering their relevance to the “Made in
Morocco” factor, 11,3% French, 8.4% equally split between: Indian - Gabon and
Spain. The remaining 13% included citizens of Cameroon, New Zealand,
Greece, Lebanon, Algeria, China, Canada, the United States of America,
Guinea, Norway, the Netherlands, Turkey and more. This insured a broad global
vision of the subject.
General understanding of the field of Medical Tourism:
It appears that there is no common understanding of what Medical Tourism is. Given
the choice between three definitions, here is how people identified to each:

33
The field medical tourism is yet to be fully comprehended by the general public. In this
case, it is generally associated with medical services mainly and tourism as an option.
The focus is indeed on the price. Very few people related to wellness aspect of medical
tourism. This shows that there is a lack of communication on the field and that
sensitization campaigns should be organised in the near future to highlight the different
types of Medical Tourism, their respective targets and their benefits.
When asked about the ideal destination for medical tourism, here follows the ranking
by countries then by region:

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The top 5 ranking countries are the following:
Preferred country Sum by Occurrence Frequency
France 20
Morocco 14
Turkey 12
USA 11
Tunisia 6
The choice of France coming as first is understandable considering that it is ranked
7th globally according to the Medical Tourism Index. Additionally, this could be justified
thanks to the constitution of the panel (11% is French), not to mention the strong
historical links between France and Morocco (67% of the panel, many of whom reside
in France).
In fact, many people have cited the geographic proximity, the language barriers as
determinant factors for choosing one destination instead of another. However, this
could work both ways as Morocco does in fact receive countless French, and European
tourists. There could be an important market share to capture, if the nation modelled
France’s best practices, as it often does in other fields in order to attract more
European medical tourists. Actually, an important number of Moroccan doctors take

35
on graduate studies in France and are very well qualified. This being said and
highlighting the low cost of services that medical travelers generally benefit from in
Morocco, this could be a competitive package for medical tourists all over the world
and a winning strategy for Morocco.
Additionally, the nation could aspire to gain more visibility on the market if it were to
restore its natives’ faith in the healthcare system and trust in the quality of medical
infrastructure as many choose to go abroad instead of being treated in Morocco and
do not see it as a favorable destination for medical tourists, even on a global scale, as
it will be seen later on, as the thesis advances.
Here follows a more detailed chart by region and country with a few arguments
advanced to justify the choice of destination:
Ideal destination by region Sum by Occurrence
Frequency
Asia 19
Asia 3
Acupuncture - traditional/ natural treatments 3
China 3
Wonderful and serious quality and service 3
Developed country in Asia 1
Cost effective and easily reachable 1
India 2
Variety of wellness medical tourism offers and availability of luxurious hotels 1
Yoga & meditation 1
Japan 4
thermal water and good environment 4
South East Asia 1
Beautiful countries with well advanced traditional medicine 1
South Korea 3
Beauty 2
Esthetics 1
Thailand 2
successful surgery of a friend 2
Eastern Europe 10
Bulgaria 1

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Thermal water 1
Croatia 1
(vide) 1
Czechia 2
dental care and cheap 2
Eastern Europe 2
attractive prices, political stability, same service as in France 2
Hungary 3
cheap, close and has a lot of Norwegian medical students there 1
dental care and cheap 1
Prices x Tourist' trail package offered by clinics there 1
Romania 1
dental treatment 1
Latin America 11
Brazil 2
Beauty 1
Hair implants 1
Cuba 3
accessible "All-included" packages 3
Ecuador 1
(vide) 1
Latin America 2
Cheap and close 2
Mexico 2
similar standards of quality to the US but at greatly reduced prices 2
Venezuela 1
Plastic surgeries 1
Middle East 18
Dubai 1
(vide) 1
Jordan 1
(vide) 1
Lebanon 4
Lebanon: Looking at the ratio of population to doctors, it is relatively low,
way cheaper than Western countries. Most doctors graduated from
reputable international establishments. Banks even provide loans for plastic
surgery!
1

37
Plastic surgeries 2
When it comes to esthetic surgeries, Lebanon is the best country because
such services are widely used and are common, so the results are of high
success rates.
1
Turkey 12
2 in 1 beautiful country 8
Hair implant 1
Hair implants 1
Prices x Tourist' trail package offered by clinics there 1
warmness & cheapness 1
North Africa 24
Maghreb 2
Attractive prices & good quality 2
Morocco 14
Agadir 1
Marrakech mainly because of the good medical competencies, the cheaper
costs, the wonderful climate for recoveries and the fact that is one of the
best touristic destinations in the world!
1
Merzouga 1
Ophthalmology, cheap, less waiting time 1
Plastic surgeries 1
Proximity to France & Good Price: quality ratio, alliances with European
countries, reliable (spa & plastic surgeries)
1
Seaside 7
Tranquility and healthcare in Marrakech and Agadir 1
North Africa 2
2
Tunisia 6
Plastic surgeries 2
Proximity 3
1
North America 15
Canada 4
Healthcare system as good as France but better infrastructure 1
Interesting country to discover with well advanced medicine 3
USA 11
Great infrastructure for both tourism and healthcare industries 4

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Interesting country to discover with well advanced medicine 3
The cost of treatment is high but so is its quality 4
Scandinavia 4
Scandinavia 2
Health insurance 1
Spa treatments 1
Sweden 2
(vide) 2
South-West Europe 38
Austria 1
(vide) 1
France 20
Great quality: price ratio when it comes to healthcare 2
Healthcare benefits and its quality 3
Proximity & reputation 3
Trust and safety 8
Vichy (thermal water) 4
Germany 4
Reputation 2
universal healthcare system 2
Greece 1
(vide) 1
Luxembourg 1
Luxembourg with the world's highest annual index of prosperity in the world.
Life expectancy is 82 years. They arrive at the top of the ranking because
they have the best doctor and offer the best medical care
1
Southern Europe 2
(vide) 2
Spain 4
cultural and economic links with good hospitals and qualitative healthcare 3
Nephrology 1
Switzerland 4
High quality of some plastic surgery 4
UK 1
(vide) 1
Sub Saharan Africa 2

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South Africa 1
(vide) 1
Sub Saharan Africa 1
(vide) 1
Total général 141
Here follows a schematization of preferred destination for Medical Tourism by region:
The mention of the Middle East & Africa region 31% shows that there is a big market
share to capture if positioned within the region. However, to be positioned within the
field, it shall not be forgotten that people have showed a different understanding of
medical tourism. The latter should be considered when positioning the country. Indeed,
if there are three types of medical tourism, why can’t there be at least more than one
positioning to adapt to the market and its clientele needs?
The study suggested criteria to base off the choice of destinations: Medical
Staff, Tourist trail package, Unavailability of the desired treatment locally, Security and
Geopolitical stability, Reputation, Price/Quality Ratio.

40
It appears that people give the most importance to the medical staff. They then
consider the reputation followed by the security and geopolitical stability aspects. In
fourth position comes the Price: Quality ratio. Last comes the tourist trail package, right
after the unavailability of the desired treatment locally.
This is confirmed through the different comments: why they would pick a destination
over another. For instance, Switzerland was chosen more than once because of its
renowned quality service, Brazil and South Korea for their high success rate in terms
of plastic surgeries. More information is available on the personal preferences in the
chart above.
Feedback on Medical Tourism experiences:
18% of our panel has previously experienced medical tourism personally, or indirectly
through relatives and friends. Here follows information on where and why the medical
tourism experience took place, a feedback on its occurrence and the desire for
renewal.
Here is a schematization of where the travel experience took place:
In fact, 17 out of the 19 people who have experienced directly, or indirectly medical
tourism have given the following details on the location and the reason behind it.
Location of previous medical tourism experience Sum by Number of travelers
Asia 3
China 2

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Dentistry 2
India 1
Dental & wellness all-inclusive 1
MENA 13
France 5
Ocular damage treatment, tympanoplasty, Gynecology 5
Lebanon 1
Aunt's Breast cancer and friends' stays for plastic surgeries too. 1
Morocco 2
Ebola x2 2
Spain 2
Goiter diagnosis 2
Switzerland 1
Good reputation for some procedures 1
Tunisia 1
Tourism 1
Turkey 1
Hair implantation 1
North America 1
Canada 1
Birth delivery 1
Total general 17
The fact that more than 75% of the experiences took place in the Middle East & North
Africa (MENA) region for several reasons: from esthetics to the treatment of viruses
and fatal diseases, hints that it is a great market to exploit and focus on when
positioning Morocco; especially in the category “treatments & surgeries” of Medical
Tourism.
The panel was then asked to rate the experience in terms of: Quality of the
medical service, the tourist trail, Price/Quality ratio and infrastructure.
Overall, more than 83% of people who have experienced medical tourism, directly or
indirectly, have found their experience at least satisfying or more: 15% found the
experience excellent, especially in terms of infrastructure; 27% rated the stay as very
good and were particularly keen on the quality of the medical service; 41% thought it

42
was a satisfying experience and had a special appreciation for the quality/price ratio.
The tourist trail on the other hand was the one to receive the highest amount of
negative reviews. 26% of the panel found it less than satisfying, worse: mediocre.
It appears this aspect (tourist trail) must be better addressed in the future.
Furthermore, when asked whether or not they, or their relatives, would be willing to
renew the medical tourism experience, more than 90% of the panel were positive.
While a few suggested trying a stay in another country, some went on and praised the
actual experience they had: They spoke highly of the quality of the service, others
focused on the end-result being successfully achieved, whereas others gave further
insight on specific countries such as Lebanon and China:
“Lebanon is not “sharing-economy” friendly. For a developing country, it has a
wrong grasp of the developed world. Everyone drives his own car alone. There
is no public transportation, or at least to a smaller/badly reputable extent.
However, tourism-wise, as a citizen I could be biased, hence why I will talk about
my foreigner friends’ feedbacks: Nightlife better than Ibiza, architecture better
than Paris, food better than any other cuisine, perfect weather, no camels, no
desert as the cliché stereotypes mention.”
“I could never truly describe the service in China. The level of expertise was so
high there that it cannot be compared to other places or put into words; be it
regarding the service, the staff, the given trust, the smiles, the fast responses
and most surely, the efficiency.”
All in all, people who have experienced medical tourism are most likely to renew the
experience and give positive feedback on it, highlighting mostly the quality of the
service and the tourism infrastructure. Whether or not these traits are part of the
package offered by Morocco, the question now is:
Are people willing to experience medical tourism in Morocco?

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“Made in Morocco”:
Despite having 67% of the panel being of Moroccan origins, out of 107 responses to
the question: “Would you be willing to experience medical tourism in Morocco? And in
case you are Moroccan, would you rather get treated in your home country or
experience medical tourism elsewhere?” barely 44% replied with a clear yes and
agreed to being treated in Morocco, being it their home country or not.
In the following, the “clear no” responses will be analyzed first, then the “hesitating”
replies next before addressing the clear “yes”’ comments which should help define the
“Made in Morocco”. The promotion of nation-brand (“Made in Morocco”) will be
addressed after that, in order to view the perspectives of a strategic positioning. Finally,
this part will be concluded by a deeper analysis on why and the consequences of
having such a small ratio of yes-responses, especially considering the majority of the
panel being of Moroccan origins.
First of all, 35% of the panel responded with a clear no to the question. These
people supported their statement saying that the medical core’s reputation is not the
best, except maybe for a certain type of medical tourism activities related mainly to
plastic surgeries. They added that they lacked trust in the local infrastructure that they
feared scams and that the applied prices are quite costly and not that different from
those applied in France, for instance where the quality is said to be better. They also
mentioned the lack of professionalism, the “cupidity” of doctors, the “extremely
mercantile” medical industry in Morocco, the best treatment being offered within the
private sector, as well as the inefficiency of health insurance there. Hereby follow two
personal insights taken from the panel responses:
“I am from Moroccan origins. But I would never go there for medical purposes.
Tourism is a thing and medical care is another one. These 2 terms are definitely
paradoxical. Medical is a matter of life issue while tourism is a matter of pleasure
time. Morocco is still a developing country, so I cannot trust medical services for
the moment. There must be excellent doctors, but they must be expensive too.
So, staying in France where I live is more convenient.” - said a person from
Moroccan origins.

44
“No, the language barrier would be too large, insurance would be a problem,
and several countries nearby offer cheap treatment” - said a person from
Norwegian origins.
Secondly, there was a certain 13% of the panel who said that agreed partially
to the idea of experiencing medical tourism in Morocco. Here are a few of their
feedbacks:
“I’d be open to it, but never considered it, mainly because I didn’t know it was a
popular destination for medical tourism” - said a person of Canadian origins
“In general, rather in my home country, saves time and travel expenses too.
However, it would depend on the medical issue and the availability in the home
country. About Morocco, not familiar with medical tourism there and have not
heard about it within my connections that anyone has been there for medical
reasons.” - said one replier from the Netherlands
“I don’t know, it depends on the requirement and facilities provided by Morocco”
- replied one with Indian roots.
“Honestly, if my case was serious, I’d rather go to more renowned and
specialized countries. However, for secondary cases, I would definitely go, not
only for the treatment, but to live the “La Mamounia” experience. “- said a person
of Lebanese origins
Note: The “Mamounia” is a luxurious palace located in the city of Marrakech. It has received the reward of
the World’s Best Palace in 2017.
This shows that there is an important lack of information on the services provided by
Morocco in the field of medical tourism, and that it could capture an important part of
the market (13% eventually) if it had a better reputation and advertisement.
Also, it must be highlighted that often, people had more troubles capturing the essence
in pure medical services rather than that of the tourism industry; especially when it
comes to luxurious activities. Indeed, for people coming from more developed
countries, Morocco is generally associated with the wellness type medical tourism.

45
Yet, having had two cases, just within the panel, of treatments in Morocco for purely
medical reasons (Ebola) brings about questions on whether the strategic positioning
should differ when it comes to targeting the Sub Saharan African region.
Thirdly, aside from the fact of being at home for many, others evoked the
following arguments to support their choice to respond with a 100% certain yes: high
competence of the local doctors, availability of healthcare, political stability, cost
attractiveness (especially compared to France), dreamy travel destinations within the
country (e.g: Merzouga, in the South of Morocco), “the welcoming culture and beauty
of the country”.
Such comments allowed a smooth transition as to how many people would agree to
what makes Morocco’s Industries & Services unique and how they would describe “the
made in Morocco” in 3 words. The mapping of their wordings is shown in what follows:

46
In fact, people view the “Made in Morocco” as mainly Heritage (35 mentions:
Authenticity, handicrafts, traditions, history and more), a positive concept (26
mentions: safety, reliability, beauty...) as well as Exoticism (22 mentions: original and
unique). However, in third position, with an equal number of mentions 22, it was also
made to be a negative concept: lacking trust and needing more efforts to be
developed.
The study suggested 6 criteria and asked the panel which ones should be focused on
when promoting the brand “Made in Morocco”: The weather, the hospitality, the
affordability of services, the culture, the quality of packages, and security plus
geopolitical stability. The ranking came as follows, from the most important criterion to
the least important:
1. The quality of services
2. Security and geopolitical stability
3. The affordability of services
4. The culture
5. The hospitality of Moroccans
6. The weather
In that sense, the panel was asked if they could see Morocco as number 1 destination
in the MENA region in the field of Medical Tourism: 46% percent said yes, for sure;
28% said a definite no whereas a remaining 17% said perhaps, the final 9% being non-
useful feedbacks. All in all, the responses mostly mentioned Tunisia as number 1 rival
of Morocco. Therefore, it was a question of whether people believe it is possible to
have a better ranking than that of Tunisia, in the future.
As a matter of fact, Tunisia’s changed its mass tourism strategy into a strategy
centered on offering quality services. To do so, the North African country invested in
luxury infrastructures, in revamping medical facilities and in raising Ministries
awareness on the importance of communication.
Tunisia outstrips Morocco on successfully undertaking and building an effective
action plan. First, the country re-established a fortified security control in order to gain
tourists’ trust - following the attacks. Second, the Tourism Ministry explicitly
communicated on the Government will to take the lead in North Africa and to finance
the required infrastructure and facilities. Finally, Tunisia defined a clear strategy path

47
and so far, the country is outperforming the expectations. This is clearly not the case
for Morocco and the general public tends to have a clear perception on the subject
which could just justify the pessimism sensed considering the amount of negative
responses.
Additionally, all those that were hesitant made sure to mention that if Morocco
were to ever become destination number 1 in the MEA region, it would be only be
possible with better infrastructure. Here follows a more elaborate insight from one of
the repliers to the study:
“I have mixed feelings about this: Morocco has the potential (proximity to
Europe, competitive prices for medical acts, government willingness to develop
the sector) but faces some structural weaknesses (uneven quality, corruption,
reputation to build and consolidate)”.
Last but not least, considering the initial statement [Despite having 67% of the
panel being of Moroccan origins, out of 107 responses to the question: “Would you be
willing to experience medical tourism in Morocco? And in case you are Moroccan,
would you rather get treated in your home country or experience medical tourism
elsewhere?”, barely 44% replied with a clear yes and agreed to being treated in
Morocco, being it their home country or not.], the estimation of the number of
Moroccans overall who replied with a clear yes to the question had to be set:
1. Setting the hypothesis that the two events “Replying with yes” [Event A] and
“Being Moroccan” [Event B] are two completely independent event, the
probability of “Replying with yes and being Moroccan” [P(𝐴 ∩ 𝐵)] equals the
probability of “Replying with yes” [P(A)] multiplied by the probability of “Being
moroccan” [P(B)].
Therefore: 𝑃(𝐴 ∩ 𝐵) = 𝑃(𝐴) 𝑥 𝑃(𝐵) = 0,44 𝑥 0,67 = 29,48%
2. Relying on the extraction of data, the other estimation method relied on filtering
through nationalities and setting Moroccan as a basis before filtering through
the answers so as to check who amongst Moroccans replied with a clear yes.

48
It turned out that amongst 77 replies from people with Moroccan origins (66%
of a panel of 107 people in total), only 33 said they would be willing to be
experience medical tourism in their home country: Morocco.
That is a ratio of 30.84 % (33: 107)
The numbers are quite astonishing! There is a slight margin of 1,36 % between a
factual response rate and a hypothetical one that suggested that replying to whether a
person Lambda would agree to being treated in morocco, and that same person
Lambda being Moroccan are two independent matters. The same logic can be applied
to the responses regarding whether Morocco could be the number 1 destination in the
Middle East and the African region and both the results and the margin would be quite
similar. Indeed, the “objectivity” of the answers is quite alarming as it shows the
mistrust of nationals to their own medical facilities and tourism activities.
This brings about a bigger issue: If 69% of Moroccans don’t trust the medical x tourism
industries, how can international be attracted to it? More than half the country has a
negative opinion to whether they would personally be treated there; let alone
recommend it. And yet, those same nationals are the real spokespersons to the quality
of the services, the infrastructure estate, and the trust in the health system… In the
recommendations part of the thesis, it should be pinpointed that nation-branding shall
start from within, with satisfied citizens before targeting foreigners.

49
2. The qualitative questionnaire:
Addressed mainly to Moroccan Medical Associations and groups, Travel Agencies,
Health and Tourism Ministries and journalists. The questionnaire was sent by email to
an expert who relayed the questionnaire internally. The results of this questionnaire
will highlight the areas that need attention.
- The panel definition:
The targeted population was mainly linked to the Health and Tourism areas. The 13
responses are split precisely into: 84,6% in the medical professions (esthetics,
dentists, surgeons and so on). 7,7% member of Health Tourism, and 7,7% journalists.
- General understanding of the field of Medical Tourism:
The topic was introduced by a general acknowledgements question concerning the
field: “What does the “Medical Tourism” concept evoke to you?
On the one hand, the majority of the panel 84,6% selected from the three-
available definition the one that defines Medical Tourism as having access to hybrid
services including touristic and medical care. The percentage reveals people’s
awareness and knowledge about the concept. In fact, the hybrid solution is the most
straightforward answer.
On the other hand, the idea of getting more affordable medical care in a foreign
country, specifically surgeries represent only 15, 6% of the panel. The competitive
pricing factor of relevance to the concept did not keep the attention of the questioned
people.
However, the spa and wellness suggestions went unnoticed; the selection’s absence
may underline a shortfall of the national communication in relation to the availability of
Wellness offers within the country.
Thus, the concept evokes mainly a hybrid services access intensified by an
economical offer abroad. In sum, the overall picture is aligned with the basic outlines
of concept features.
- To have access to hybrid services: touristic and medical care. (84,6%)

50
- To get more affordable medical care in a foreign country: surgeries, and so on
(15,6%)
- To have access to spas and Thalassic treatments (0%)
As a means of getting professionals’ thoughts on the medical tourism, the panel
was asked to answer to the following question: What is the field of expertise of
Morocco in terms of Medical Tourism?
The gathered answers reveal that 76,9% of the panel focuses the Moroccan Medical
Tourism expertise on the Esthetics specialization. In parallel, one source cited a
concrete project in which Emiratis have invested. Indeed, the Emirati Real Estate
Tasweek spent 40 million dollars with the aim of providing luxurious care to 5 000
patients per year. The ochre city Marrakech was chosen since it is considered as the
Healthcare City.
Again, the Wellness section did not get the panel’s attention as well as the
surgery and cancerology expertise. This implies a clear lack of the Government
implication to promote its own wellness and Spa services. Withal, could the Wellness
and Spa section be targeting the niche market?
The aim of asking the panel to address the most advanced countries in terms of
medical tourism “According to you, what are the “at the cutting edge” countries
in terms of medical tourism?” was to list the most perceived countries positively in
the tourism industry. The most significant and specific responses were in favor of the
Middle East and Africa, 23,1% perceives this region as developed. Continuously, 7,7%
on the panel were more specific by raising Tunisia as the North African country with
advanced medical treatments. The biggest part which means 65,1% people of the
panel is aware of the expertise of some countries on the subject. The favored answer
was related to the existing relationship between expertise and medical tourism. In
short, countries developing the medical tourism branch have each a specific expertise,
hence core competencies constituting significant key success factors.
On the other hand, the Eastern countries such as Thailand, Indonesia, Taiwan
and Korea were also mentioned at 7,7%.
From a strategic perspective, the MEA countries could be used as targeted countries
to assess partnerships and alliances; along with Tunisia. For instance, one can be
specialized in transplantation surgeries and others in providing dentistry services for

51
an unbeatable value for money. The expertise positioning constitutes the first step in
establishing a strategy.
To the succeeding question: “What are the main reasons?” the panel had an open
field to fill in. The findings demonstrated the high importance of competitive prices and
a reliable value for money as the most redundant answers. The second major part
relies on the sector’s competencies and infrastructures, these two factors are key to
offer a qualified service; especially when the medical act is concise.
When asked to position Morocco in comparison with other African countries, the panel
to the following question showed an optimistic approach regarding the perception of
Morocco as a destination. In fact, 58,3% choose Morocco as belonging to the Top 5
African countries followed by 8,4% of the panel who consider Morocco as a Top 10
African destinations. Last but not least, 33,3% appointed Morocco as an out-of-
competition within the field.
These findings might seem paradoxical and contradictory in comparison with the stated
feedbacks. Is the optimistic position an ounce of patriotism and faith? Are other African
countries suffering a real lack of medical development?
Continuously, those who ranked Morocco among the Top 5 countries had to
detail the criteria on which they based their ranking. The percentage of the reputation
of the workforce got from half of the panel consideration. Successively, the geopolitical
factors rank second with 25% of people’s concerns. Arab countries and North African
experienced complex situations recently; which makes their situation very sensitive to
the political variations.
To this question “According to you, how can Morocco reach the leader
position destination on the African Continent?” two main factors stand out with
approximately 50% for the first one and 8,3% for the second. The biggest issue brought
up the medical and tourism infrastructure development; second, a qualitative
communication on the existent offers or emerging. The second element underlined the
need to develop a better reputation of the professional care, hence, to build a strong
image of the medical body.

52
These elements reflect the urgent need of Moroccan hospital institutions. In fact,
there is a lack of hospitals and hospital facilities that are able to provide the necessary
care. Also, the Government has failed in sustaining the medical staff to better off its
image. Due to relentless hours of work because of workforce deficit, the probability to
offer a qualitative service declines.
The responses to the existence of a Governmental budget “Is there an
allocated medical tourism budget? (Subventions, State aides, Private sector)”
suggests that there is no governmental implication regarding the matter. It appears the
Moroccan Government has not communicated on the topic and/or the State has not
defined a strategy yet. However, this industry is mainly led by the private sector to
encourage the investments. Also, is the Government able to invest in medical
infrastructure and therefore develop the medical tourism sector?
In this particular question “At which growth rate (per year) would you
estimate the development of this type of tourism?” the results are heterogeneous,
38,5% of the panel predicts an annual growth of 5%. The type of perceived growth
chosen is relatively slow, unlike the other part of the panel (38,5%) estimates a
maximal annual growth of 5%. 15,4% of the panel were more optimistic and voted for
20% of the annual growth.
Furthermore, the panel was challenged to list three Moroccan Tourism key success
factors which can pull a better development of the medical tourism. Aside from the fact
that mainly recalled competitive prices and good value for money others underlined
the significance to revamp the infrastructure.
A few suggested training programs to get improved medical acts. It goes without
saying that the medical act and the infrastructure are the predominant pillars to a
valuable service offer. The need of establishing a strategic communication plan was
also noted.
The question “In two words, what does Made In Morocco inspire you?”
brings about a substantial topic of perception. The Brand Image or National Image is
tightly linked with perception. Thereby, the panel raised positive and negative
connotations; the positive ones come under the services’ affordability and good value
for money. Also, it inspires positive evolution, exoticism and cultural authenticity. The

53
positive answers underlined security, trust and reliability. On the other side, the
negative feedback tickled counterfeiting and unreliability.
In sum, the Made In Morocco is well perceived by the professionals and it is inclined
to evolve positively. However, the weaknesses require a particular attention to limit
Morocco’s negative promotion, more precisely to convert national objectors into
potential prescriptors.
Last but not least, when asked about their Medical Tourism Project
acknowledgment forecasted for 2025, none of them seemed informed about the
matter. These elements raise the shortfall of the Governmental contribution in
promoting the strategy.

54
Synthesis:
Before addressing the “how” in the original problematic: "Made in Morocco":
How can nation branding revamp the strategic positioning of Morocco in the
Medical Tourism Industry? it is high time its mere possibility was targeted based on
the previous in-depth analysis. Through a cross-reference of the academic review with
the reality of the successful and/or rivals of Morocco in the field of medical tourism, in
addition the perception of the subject by the general public as well as by experts, the
following part is a response to the question: “Can nation branding revamp the
strategic positioning of Morocco in the Medical Tourism Industry?”
To begin with, the various distinctions in theory in regard to the different types
of Medical Tourism was also very well noted by a confusion when it came to a general
comprehension of the field by the public.
As a reminder, this thesis chooses to contribute to the academic community by defining
Medical Tourism as “Traveling for medical care, whether in one’s own country or
abroad, depending on the desired service and the package offered. In fact, all flows
shall be included, the cause behind the journey being the only factor behind the
following grouping:
1. Wellness: The wellbeing of the patient being the reason behind the traveling.
The medical tourist seeks relaxation in Spas, thalassotherapy, and
hydrotherapy... (Menvielle, 2013)
2. Healthcare: post-operative rehabilitation, physical therapy and diet treatments
(eating disorders) ...
3. Treatments and Surgeries: cancer treatment, plastic surgeries, preventive care
such as tests.”
The general public comprehends less likely Medical Tourism as a mix of these 3 types
(23,4%) compared to it being simply defined as a package: medical treatment and
touristic stay (35,6%) without distinctions based on the type of stay or type of treatment.
In order to completely adapt to the customer needs more, the next choices of
definitions are to be addressed: “Receiving cheaper medical treatment in a foreign
country; be it surgeries or other (33%)” and “Wellness treatments: spa, thalassotherapy
sessions...5%”. This highlights a dichotomy in the market and suggests an adapted
strategy for each segment:

55
- A niche market strategy in regard to the wellness treatment. The models
studied above, such as South Africa and Emirates, highlight the interest of
establishing a concrete strategy to capture valuable market shares.
In fact, the niche market strategy relies on delivering “Experience” oriented
services, and on promoting a “Wellbeing” philosophy.
For instance, Marrakech is the most privileged destination that capitalizes most
of the niche market. The Moroccan luxury hub managed to diversify its touristic
segments to open the market to profitable opportunities just as Medical Tourism
“Wellness and Spa”. For instance, a source cited “La Mamounia Experience” as
a reference to the wellness experience offered by the most famous Palace in
Marrakech. Many Moroccan Palaces and five stars hotels suggest for instance
Moroccan Hammam Experience, Mud Treatment, Oriental Massage packages
and so on.
- A cost leadership strategy to attract more seekers of the most advantageous
value for money services for any type of medical treatment and therefore
capture more market shares.
The target for each of these segments shall be defined based on the next cross-
references.
Then comes the problematic of trying to apply a branding strategy to a nation
rather than to a product, a firm or an industry. As a reminder, nation branding tackles
three key perspectives, political, economic and cultural-critical. The political
perspective puts forward a “way of building and managing reputation by promoting a
country’s culture, history and geography” (Aronczyk, 2009, p. 294). This being
pinpointed, there are yet improvements to be made in Morocco be it national and
international. In addition to that, the economic perspective highlights the need to build
up a favorable Moroccan perception to effectively compete with other countries be it
regarding tourism, culture and investment (Anholt, 2007). These literature reviews
underline wisely the main focal point on which Morocco has to orientate its strategic
perspectives to conceive and to improve its nation image.
Yet, formulating the nation branding strategy as a “Made in” concept is not a
one of a kind. Indeed, the “Made in Germany” has been around for more than a century

56
now, since the industrial revolutions, with an estimation to the 1890s. And yet, it still
evokes the same positive insights: Good Quality. However, applying the same idea to
Morocco has appeared to be a delicate matter as it lacks history and one spontaneous
tagline to be associated with it. Nonetheless, a few interesting suggestions were made
by the panel; such as “Soleil - Simple & Sympa” (Sun - Simplicity - Friendly). Such
taglines, could, if promoted well, help the spread a certain image of the nation, the
industry and its services.
Therefore, it is an ambitious idea to intend to brand the country, especially in regard to
“Medical tourism” but it is not impossible. The general response to the concept was
mainly positive, seeing it as a concept that brings about heritage, history, and positive
ideas be it about the culture, the hospitality of the people, the niceness of the weather,
the exoticism.... But, it also did, to a certain extent, induce negative thought; mainly
about the lack of trust in the system, the lack of the Government investment, the fragile
infrastructure and the questionable quality of services at points.
Additionally, the delicacy of the matter is drawn from the fact that people often
insisted that they questioned the medical aspect of the branding as well as the
positioning, rather than the touristic side of it. This goes to show that more efforts shall
be deployed by the Ministry of Health and the local government in general, so as to
restore faith in the healthcare system as well as medical infrastructure. This does not
exclude a certain cooperation between the different ministries impacted by the matter:
Ministry of Foreign Affairs and Ministry of Tourism.
In fact, one of the most challenging aspect of the qualitative questionnaire was finding
the right people to ask. Each ministry suggested asking the other for basic knowledge
on the field and at best, sent data extracted from the online tourism medical exposition
website “quoting the salon of Medical Tourism and its annual conference (Started in
2017) as their main source of information on the subject. No service in either ministries
has been created in order to watch over this fast-growing sector that is worth billions.
It might come as a surprise considering the above, but it was mentioned during a
couple of interviews that the Ministry of Health has a 5 year vision plan that includes
medical tourism. Here is an extract of the mention:
“Pillar 3: Improve Governance and Optimize Resource Allocation and Utilization
Axis 22: Promote partnerships and consultation.

57
104. Encourage medical tourism in consultation with the relevant departments
and support investment in the private health sector in accordance with the
health map” ( Ministère de la Santé, Santé 2025)
However, when asked how the ministry plans to encourage such industry and what
partnerships they were planning on enhancing, the responders said that it was still an
idea in process and that it still had five years to mature, the plan being set for 2023.
Overall, there is a certain desire to address to field of Medical Tourism, but this will has
yet to be put into a detailed strategic plan as to how to achieve a better performance
in the field. In the meantime, the unhurried Moroccan position within the field
constitutes a clear advantage for Tunisia as the latter is currently ranked second and
Morocco third in the Africa region. The Tunisian Government overtakes Morocco in its
effective communication through Tourism Ministry interviews, professionals’
conferences and articles published in the national newspapers. These elements
allowed Tunisia to strengthen world widely its image and to make a name for itself in
the Medical Tourism field.
Last but not least, it is also important to highlight the questionability of the
infrastructure and quality of services that was raised by Moroccans themselves. The
fact that 67% of the panel was of Moroccan origins and yet, having barely 30% of them
respond favorably to questions such as “Would you be willing to experience medical
tourism in Morocco? And in case you are Moroccan, would you rather get treated in
your home country or experience medical tourism elsewhere?” and “In your opinion,
can Morocco become the number 1 destination in the MENA region in the field of
Medical Tourism?” shows a lack of trust in the services offered by Morocco as well as
its future in the field. The negative connotation that were mentioned when defining “the
Made in Morocco” suggest that it might not be the most welcomed strategy for
rebuilding the reputation of Morocco, especially in the domain of Medicine. Indeed, the
separation between the industries was often cited. In that sense, many feedbacks
insisted that it could be more relevant to address internal healthcare issues rather than
intending to attract foreigners and therefore questioned the relevance of strategizing
the position of Morocco in the field of Medical Tourism.

"Made in Morocco: How can nation branding revamp the strategic positioning of Morocco in the Medical Tourism Industry" _Thesis-Jorio-Dinia

"Made in Morocco: How can nation branding revamp the strategic positioning of Morocco in the Medical Tourism Industry" _Thesis-Jorio-Dinia

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