• On arrival in Rabat, the team discovered that Morocco had not participated in the bulk purchasing system for a period of two years and that the country left the CMAC three years earlier. In addition Algeria did not participate in the last cycle of bulk purchasing. This may explain why people met during the first few days did not have any detailed comprehension of the system. It took the mission three days to discover that the CMAC is still involved in bulk purchasing for the three remaining countries of the UMA. Inspite of the reduction in the number of countries from five to three, the bulk purchasing system survived and maintained its operations.

• This part of the mission should have taken place in Tunisia instead of Morocco, since this is where the rotating secretariat of the CMAC was in 1998. But even though the team regretted not having been able to experience a procedure in actual progress, the Morocco visit provided a lot of useful information.

• Meetings at the quality control laboratory revealed that the bulk purchasing system brought in important additional work during the early years of the system. Different systems and levels of quality control existed in the UMA countries. Morocco had the most demanding and the most efficient system. Morocco has therefore contributed to increase the general level of quality control within the UMA countries.

• Due to its system of registration of products in the country and its very strict policy on authorising new pharmaceutical products on the market, Morocco has never extensively participated in the volume of the bulk purchases. The country has never purchased or imported more than 5% of its drug needs through bulk purchasing. The Moroccan pharmaceutical industry is however remarkably represented at all levels of decision-making in the pharmaceutical sector.

• The manufacturers of generics in Morocco have a more favourable opinion of bulk purchasing than their colleagues manufacturing branded products. They have discovered an export market that surpasses by far their local sales and consider the bulk purchasing system more as an opportunity than as a threat.

• The suppliers of the LIMA countries were not always well prepared for the type of regional competition inherent to a bulk purchasing system. This was apparent in the area of production capacity and in the area of price-concessions, necessary in order to obtain awards from bulk tenders.

• A number of persons met were positive about the process of bulk purchasing and its potential positive effects on accessibility to drugs for a larger public.

• The General Secretary of the LIMA, Mr. Amamou, confirmed the intention of the LIMA to continue the CMAC system and to re-install it for the whole of the LIMA countries. There remains a serious interest in the system of bulk purchasing at the political level because of the savings that may be realized and the impact of these savings resulting in a more efficient use of the resources available for health.

• The process of bulk purchasing by CMAC has been carefully prepared, stage by stage. The tasks and responsibilities have been well defined and documented.

• After the evaluation of prices before and after bulk purchasing, done by the Ministry of Health, price differences (savings) of factor 1 up to 5 have been realized due to the introduction of generics and the competition between a large number of interested suppliers.