On this page

1. Governance

2. Cross-sectorial cooperation

Governance

The key institutions responsible for the establishment, governance, and operation of the health care system in the Republic of North Macedonia include the Parliament, the Government, the Ministry of Health, the Ministry of Finance, the Health Insurance Fund, the Institute of Public Health, the State Sanitary and Health Inspectorate, and the Agency for Medicines and Medical Devices. Among them, the Ministry of Health and the Health Insurance Fund (HIF) represent the two central pillars of the system.

The Ministry of Health oversees health policy development, the organization of the health care system, and the enforcement of health legislation. All policies are developed through regulated consultation processes and coordination with other relevant ministries and agencies. The Health Insurance Fund, established by the Law on Health Insurance, is tasked with implementing mandatory health insurance and acts as a public institution serving the general interest. It is responsible for purchasing health services from both public and private providers on behalf of insured citizens. The Fund’s relationships with health providers across the primary, secondary, and tertiary levels are governed through performance-based contracts, negotiated and signed for predefined periods.

The Ministry of Health’s responsibilities cover a broad range of areas, including:

• health care and insurance of the population;

• prevention of pollution of air, water, soil, and animal products;

• organization and development of health care;

• monitoring the population’s health status;

• protection against infectious diseases and environmental health risks such as radiation, noise, and pollution;

• regulation of hygiene-epidemiological conditions and facilities for general use;

• oversight of medicines, medical devices, poisons, and narcotic drugs;

• and supervision of entities under its jurisdiction, as determined by law.

The Institute of Public Health of the Republic of North Macedonia plays a central role in preventive health care. Its work focuses on monitoring, researching, and analyzing the population’s health status, studying the causes and spread of communicable and non-communicable diseases of social and medical importance, assessing environmental impacts on health, and proposing measures for health protection and promotion.

At the regional level, ten Centers of Public Health perform similar functions to the Institute, except in the areas of research, education, and policy advising. Their activities focus primarily on disease prevention and health promotion, implemented through programs financed by the state budget via the Ministry of Health.

The State Sanitary and Health Inspectorateensures regulatory compliance in health care, protection from communicable diseases, health insurance implementation, safeguarding patients’ rights, and mental health legislation enforcement.

Cross-sectorial cooperation

The Ministry of Health holds the leading role in coordinating intersectoral cooperation with other government bodies, particularly within committees dealing with policies that impact youth and public health. In July 2013, the Committee for Health and Environment was established, chaired by the Prime Minister and co-chaired by the Minister of Health, to enhance collaboration and policy coherence through intersectoral consultations and public hearings.

Participatory approaches have been introduced in strategic health planning, though they are not yet fully institutionalized. One of the first examples of such collaboration was the Committee for Advancement of the Health System, established in 2009. This process, led by the Ministry of Health, resulted in the development of the Green Book in Health — a roadmap for health sector reforms addressing management, administration, financing, pharmaceutical care, and patient rights. The Green Book was developed through broad consultations and consensus among stakeholders, including public institutions, professional associations, academia, civil society, and the private sector.

Despite these positive examples, a comprehensive whole-of-society approach — engaging multiple stakeholders in health policy design and implementation — remains more an exception than a standard practice. Nevertheless, this approach is increasingly recognized as essential for ensuring fairness in policy development and improving outcomes. Several ongoing initiatives promoting intersectoral cooperation are supported by international partners such as the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, including discussions on the institutionalization of a National Health Account to enable the Ministry of Health to systematically track funding flows across different health areas.