Following the publication, on Monday 18 June 2012, of an article entitled "Between representativeness and despotism: Skills flouted at the Rabat Children's Hospital", we received from the management of the Ibn Sina CHU clarifications signed by Dr Mohammed Cherkaoui, head of the communication and media relations department, the full text of which is as follows:

"Why is the reorganisation of the Rabat Children's Hospital necessary? At the time of its creation, this establishment was the only paediatric hospital in the Kingdom and had to meet a demand for care that was centred on infectious pathologies and malnutrition with a distribution of beds by specialty adapted to the child health challenges of that time. Since then, the organisation has not evolved outside of the creation of certain services such as paediatric oncology. The evolution that the country has experienced in terms of demographics, epidemiology, and the supply of care has therefore not been accompanied by the hospital and has generated over the years increasingly significant and critical dysfunctions. Some services such as intensive care and pulmonology are regularly short of beds with cases of hospitalisation on mattresses placed on the floor during periods of high activity, while surgical services use less than 50% of the beds at their disposal. This observation was made on the activity indicators of the last 6 years and thus constitutes a structural datum due to the fact that non-urgent surgical pathologies of the child are relatively rare and that the supply of care is today significant between the 4 CHUs, the regional hospitals, and the private sector which has developed strongly. It should be noted that the indicators used are universally accepted and are those used by the health system of all countries including Morocco to evaluate hospital activities.

Furthermore, paediatric services take care of both complex tertiary pathologies and common paediatric pathology, thus making it difficult to take care of children falling under tertiary specialties even though this is the hospital's primary mission. The demand for paediatric hospital care is very high and the supply of care from regional and provincial hospitals in the north-west is very insufficient, requiring an upward revision of the number of general and specialised paediatric beds.

During the analysis of the situation of the hospitals and their performance, the Board of Directors of the CHIS noted, during its February 2012 session, these dysfunctions and adopted a resolution requesting the Management of the Hospital Centre to develop a new organisational scheme aimed at correcting the situation and adapting the hospital supply to the observed needs of the population. A reflection commission, whose members represent the project's stakeholders (five members from the children's hospital, three from the Faculty of Medicine, and three from the CHIS Management), was constituted and developed a global reorganisation scheme meeting the requirements of the moment and future expectations: respect for the Establishment Project, response to the needs of the population, individualisation of tertiary paediatric specialties, constitution of a pathway dedicated to paediatric emergencies with a paediatric emergency service (like the already existing paediatric surgical emergency service).

The proposed reorganisation has the advantage of requiring very little investment, because it reuses existing and underutilised means in a concern for rationalisation and efficiency and will allow for responding, at a lower cost, to the current and future needs of the paediatric population of the CHIS catchment area while preserving the organisation of hospital internships for medical students and paediatric residents. This scheme was presented for discussion to the hospital's professionals during a plenary consultation meeting.

The next step was the discussion of the project by the establishment's consultative medical commission expanded to more than 12 resource persons. This reorganisation aspires to adapt the capacities of certain specialties to the real needs of the population (Pulmonology and general emergency paediatrics) and to create an isolation service that responds to new epidemiological challenges (emerging infectious diseases), and a new intensive and continuous care service to solve the problem of the insufficiency of resuscitation beds. This reorganisation, while respecting affinities by discipline and type of activity, tertiary, secondary, programmed, and urgent, provides for the grouping of specialties into 5 hubs: surgery, medicine, haematology, emergencies and intensive care, and ambulatory care.

In summary, the reorganisation of the HER services is a project that is justified by the observation of the degradation of the hospital's performance indicators linked to an inadequacy between the fixed supply of care and a demand for care in significant evolution.

This project will therefore allow for a redeployment of resources by calling on the principle of solidarity, in order to ensure an optimisation and rationalisation of means at the service of patients. It represents a translation of the ambitions of the professionals expressed in the HER PEH by the individualisation of tertiary specialties while redefining the emergency circuit which constitutes the priority need of patients. Finally, this reorganisation will be the subject of a pilot experiment for a new style of management, because one of the flagship projects of the CHIS, "management by activity hubs", is provided for in the CHIS 2010-2020 development plan.

This reorganisation project thus constitutes a real cultural revolution among professionals, accustomed to judging their means in terms of beds and not in terms of diagnostic and care means, and explains the resistance of certain doctors who put their interests before those of the patients and feel aggrieved by the new organisational scheme. Finally, like any structure reorganisation project, the validation process of this HER reorganisation project will first pass through the Management Council scheduled for 29 June 2012 before being submitted to the Board of Directors, which is sovereign for everything concerning the structuring of the Hospital Centre's hospitals, thus respecting the principles of good governance in all stages from diagnosis by self-evaluation of performance, to validation by the strategic level, passing through the formulation and criticism of the project on a basis of participation of the stakeholders".