WHO and the Ministry of Health of North Macedonia published a report that assessed barriers to care in North Macedonia, focusing in rural areas and small urban settlements.
In the overview of the report, WHO stated:
This study, conducted in North Macedonia, explored the barriers to effective health service coverage and identified ways to enhance health equity and access to quality health services. With a focus on rural populations and people in small urban settlements, the study employed a mixed-methods approach, including surveys, key informant interviews, and focus group discussions. The findings revealed significant challenges, such as insufficient health workers, particularly in disadvantaged regions, inadequate availability of medicines and medical devices, and underprovision of modern medical technologies. Accessibility issues included geographic and transport barriers, affecting particularly the rural populace, the elderly, and those with chronic conditions. Financial barriers were also notable, with high out-of-pocket expenses and a lack of health insurance coverage among certain demographics. Trust in healthcare professionals was generally high, yet issues such as discrimination, lack of privacy, and gender norms affected health service access. The study proposes solutions like cross-system governance, reforming primary health care to address spatial and social inequalities, ensuring financial protection, developing a robust health workforce, and integrating health equity into the National Development Strategy. These approaches aim to close health service coverage gaps and enhance overall health outcomes.