TIME FOR A NEW HEALTH STRATEGY – A VISION FOR 2025–2035
By Prof. Dragan Danilovski
In recent years, Macedonia’s healthcare system has faced numerous challenges: a pandemic, a chronic shortage of medical professionals, long waiting lists, a fragmented hospital network, and outdated technology. In such a context, every country needs a visionary document—not only to diagnose problems but to outline a clear path to solving them. That is the purpose of a strategy.
In 2021, the “Health Strategy 2021–2030” [1] was adopted. Unfortunately, despite its ambition to cover an entire decade, the strategy failed to meet even the basic prerequisites of being a truly operational instrument for the development of the health system.
What are its key weaknesses?
1. The strategy is filled with declarative commitments (e.g., “improving access to healthcare services”), but it almost completely lacks SMART goals—specific, measurable, achievable, relevant, and time-bound. Without clearly measurable indicators, progress cannot be monitored or assessed.
2. It contains no detailed action plan, timeline, responsible actors, or evaluation indicators for any strategic goal. Instead of serving as a concrete mechanism for reform, the document remains a well-meaning vision with no practical implementation.
3. Though healthcare is a vital public interest, the strategy lacks thorough expert review and excludes open dialogue with universities (a complete marginalization!), professional chambers, and patient associations. As a result, it feels administratively enclosed rather than socially legitimized.
4. Between 2021 and 2024, the world witnessed massive digitalization, explosive development of artificial intelligence in medicine, and new models for financing and employing medical staff (including hybrid hospitals). None of this is reflected in the strategy.
5. Finally, the strategy has not been formally adopted by the Government or Parliament, which means it lacks political and legal authority.
Under these conditions, continuing to apply a strategically flawed framework would mean wasting precious time, resources, and public trust.
We need a new National Health Strategy (2025–2035)—retaining essential values from the previous version, but with:
- a concrete action plan for each strategic goal,
- measurable outcomes,
- a defined institutional oversight mechanism,
- and formal adoption by both the Government and Parliament to give it political and legal weight—as a “constitution” for healthcare.
This new strategy must rest on the following principles:
1. Open public debate—developed with input from professional associations, chambers, universities, patient groups, and civil society.
2. Clear goals, timelines, responsibilities, and monitoring indicators—only then can it become a real tool for change.
3. Integration of digital medicine and AI—Macedonian healthcare must embrace the future, not only in diagnostics but in patient management, resource allocation, and quality control.
4. European compatibility—in an age of shared health challenges (pandemics, rare disease treatments, workforce mobility), Macedonia’s strategy must align with European models of solidarity and coordination.
What could be the future strategic priorities?
Faced with new health, technological, and demographic challenges, the new strategy should consider the following key priorities:
1. Strengthening the healthcare workforce—through incentives, restoring professional autonomy, decentralization, and retaining young professionals in the public sector.
2. Digital transformation of the healthcare system.
3. Improving the quality, accessibility, and continuity of healthcare services.
4. Reforming primary, secondary, and tertiary care—with clear functional distribution, digital integration, and transparent governance.
5. Functional integration of public and private healthcare.
6. Reorganizing tertiary care—by integrating clinics into a unified Clinical Center and transforming it into a university center with academic and operational autonomy.
7. Sustainable and equitable financing—with results-based payment models, transparent budget allocation criteria, and ending the monopoly of the Health Insurance Fund by opening competition among insurers.
8. Institutional accountability and anti-corruption efforts.
9. Proactive public health policies—prevention, health education, mental health, climate resilience.
10. Regional cooperation—joint procurement, workforce mobility, and sharing best practices.
11. Preparedness for climate and ecological risks and global crises—through health strategies adapted to pollution, heatwaves, new vector-borne diseases, and other global threats.
We need a strategy not written behind closed doors, but built on expertise, experience, and public accountability. A document that becomes a tool for action, not a declaration without implementation.
The National Health Strategy 2025–2035 must be the result of broad public dialogue, led by experts and focused on citizens’ needs. Only then can our healthcare system move beyond chronic stagnation toward a modern, fair, and sustainable model.
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[1] https://zdravstvo.gov.mk/wp-content/uploads/2021/12/19.11.-SZ-posledna-Konechna-Natsrt-Strategija-MKD.pdf
Quo vadis, salutem? – Where are you going, healthcare?