Fall in global rankings

France offers universal healthcare largely financed by government through a system of national health insurance, though many people buy topup cover.

When the World Health Organisation conducted its only global healthcare survey in 2000, it rated France’s system the world’s best. But the ageing population, tight budgets and an increase in burnout among doctors have taken a toll.

France ranked only 10th in a global study published last year by the Commonwealth Fund, a private US healthcare foundation. It had been ninth in the fund’s previous report in 2014, the only other time it had been included.

As in neighbours Germany and Spain, and larger countries such as Australia and Canada, France also has an uneven distribution of doctors. Most are attracted by work in cities, where they can make more money.

Some rural areas also lack hospitals, and hospital doctors staged a strike in 2016 in protest at what they considered poor working conditions and shortages.

‘‘We have been alerting authorities for decades and nothing has changed,’’ said Gilles Ollivier, who serves on a regional doctors’ council in Laval.

‘‘Many here live in rural areas where inhabitants, and some of them very old, find themselves in small villages where there are no shops, no post office, no schools and no doctors.’’

Under Macron’s plans, 400 doctors will be deployed to rural areas where coverage is thin. No hospitals will be closed and 4000 medical assistants will be recruited to handle paperwork and make basic checks to free up doctors.

The president also says he will end a system under which the number of graduates allowed to enter the medical profession each year is limited. Doing so, he hopes, will ensure there are more new doctors interested in working in rural areas. about 300km southwest of Paris, is one of the communities where the fate of Macron’s reforms will be played out. It also shows how big a challenge the centrist president faces.

The Mayenne region has 255 registered doctors per 100,000 residents, one of the lowest rates in the country, official data shows. The national average is 437 and Paris has the highest rate with more than 1100 doctors per 100,000.

In Laval, the SMP has helped plug the gaps. Fifteen months after it opened its doors, it handles more than 5500 patients.

Its doctors are regulated as others are under the French system.

‘‘I had been looking for a family doctor for years but every time I was turned down because they said general practices couldn’t take new patients,’’ Fatou Diaby (30) said in the SMP’s waiting room with her two young daughters.

‘‘When I last became pregnant, I had nobody to go to except hospital emergencies,