Skopje, 30 January 2025 (MIA) - World Health Organization's (WHO) mission in a latest overview of the hospital sector in North Macedonia has observed among other a chronic shortage of healthcare workers, particularly in specialized areas, many hospitals in the country lacking necessary infrastructure to provide modern health services, outdated equipment, as well as no staff to use equipment where it is available. WHO consultant Jana Marin presented the key insights and recommendations of experts at an event held in Skopje on Thursday. 

In terms of hospital governance and management, it has been found that governance is often under political influence. Political appointments of directors were very often accompanied by a lack of a clearly defined framework of accountability.

"The Mission included five international experts led by the WHO Office for Europe, who were here with the main objective of assessing the challenges faced by hospitals, as well as assessing the opportunities for improving the hospital sector and aligning it with European and international standards. Other objectives of the mission were to develop a unified vision for the hospital sector in Macedonia, identify the very important needs for capacity building and technical assistance, as well as to promote integration of services according to new models of care, where the patient will be at the centre of the health system. The methodology used included meetings with directors of hospitals and institutions, key stakeholders in the system, field visits to hospitals and clinics, consultations with international experts and finally a workshop was held for dialogue with the Ministry of Health on the creation of health policies," Marin said. 

The first general observation was that there is a very large number of hospitals in the country and the hospital sector is fragmented.

"We have about 70 hospitals per 1.8 million population. A large part of them are underutilized, and in a large part of them health services overlap irrationally," Marin pointed out.

One of the recommendations of the experts is to integrate university clinics in a single coordinated system for better and optimal use of resources.

"Here I would like to point out that the recommendation is integrating clinics, and not just an administrative merger into one legal entity," she underlined.

WHO representative and Head of the Office in Skopje, Akeem Ali, said Thursday's national consultation on reform of the hospital sector in the country is a very important gathering. According to him, it is a milestone on the journey towards better, efficient and effective healthcare in North Macedonia.  

According to Health Minister Arben Taravari, reform of the hospital sector in the country is a strategic priority and a moral obligation to citizens.

"Our vision is a healthcare system that is more equitable, efficient and accountable. Today's consultation is an important step in this process, serving as a platform for collaboration and transparency. The WHO and the European Union have given us a clear vision for modernization and transformation of the hospital sector. Current policies recognize the need to shift health priorities towards health promotion and disease prevention. Analyses show that population ageing and lifestyle changes require optimization of resources," said Taravari.  

He noted that according to a 2023 Health Insurance Fund report, the majority of public spending is directed towards secondary and tertiary care.

"Half of the hospital beds are in Skopje, creating an uneven distribution and challenges for regions with limited access. There are significant differences in the use of hospital beds, with only a few specialities achieving optimal use of 80 to 85 percent, while most see a use of 30 to 50 percent. This points to a need for rationalization and better functional distribution," the Health Minister said. 

He noted that the future of hospitals would be shaped by modernising infrastructure, reforming financing and integrating services. According to him, Europe was already implementing integrated models that linked primary, secondary and tertiary healthcare. 

"The quality and safety of healthcare services depend on appropriate regulation, standards and indicators for continuous improvement. Attracting and retaining qualified healthcare workers is key to delivering high-quality services. The reform will contribute to the implementation of the national healthcare strategy 2021-2030 and the UN Sustainable Development Goals. This transformation requires courage, commitment and cooperation of all stakeholders in order to ensure quality healthcare services for citizens," said Taravari. 

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