Territorial health groups in Morocco: towards decentralized and equitable health system governance

Purpose This paper examines the implementation of Territorial Health Groups (THGs) under Morocco's healthcare reform via Framework Laws 06–22 and 08–22. The study assesses how THGs can improve access, quality and efficiency of healthcare services, identify governance challenges and explore conditions for effective and sustainable territorial health governance. Design/methodology/approach The study adopts a qualitative, exploratory approach with three objectives: (1) to examine public management theories as the theoretical foundation for THG governance; (2) to analyze the regulatory framework, including institutional arrangements, management instruments and digital tools and (3) to review international health-sector decentralization reforms in France, Spain, Canada, Indonesia and Algeria, adapted to Morocco's socio-economic and institutional context. Data were drawn from legal texts, ministerial reports, academic literature and comparative case studies. Findings THGs can enhance territorial equity, strengthen managerial autonomy and support participatory, data-driven governance. Their effectiveness depends on addressing structural challenges, including uneven human resource distribution, limited digital infrastructure and unclear accountability mechanisms. The study proposes a THG governance model with performance indicators, highlights implementation risks and success conditions and provides clear, actionable recommendations, summarizing the key findings to advance Morocco's THG system. International experiences emphasize the importance of national coordination, interregional equalization mechanisms, integrated care pathways and phased implementation. Research limitations/implications Limited THG data restrict the analysis to secondary sources; future research should include interviews and regional case studies. Practical implications Recommendations include a phased rollout, equitable resource allocation and stakeholder engagement. Originality/value The study integrates theory, regulation and international evidence to provide a theoretically grounded governance framework that supports evidence-informed, equitable and sustainable decentralization of Morocco's health system.