On 7 June 2022, WHO and the Ministry of Health of North Macedonia convened a range of stakeholders, including local and national authorities, international agencies, and civil society organizations, to initiate a study to assess the barriers and enabling factors that impact access to primary health care in the country. 

In the context of global efforts to move towards universal coverage in health systems, ensuring equitable access to quality health services remains a challenge. Though access to primary health care is a fundamental human right and central to the performance of health-care systems, many people face economic, geographic or other barriers to accessing the range of available services. 

“This will be the first comprehensive research carried out to identify the bottlenecks and facilitating factors in accessing primary health-care services in the country,” said Dr Anne Johansen, WHO Special Representative in North Macedonia and ad interim Head of the WHO Country Office. “Understanding the barriers being experienced by rural populations and by different genders in North Macedonia will be key for providing evidence-based solutions to progressively expand access to health services and contribute to strengthening health equity and gender equality in the country.” 

Strengthening access to primary health care for all

In North Macedonia and globally, extreme poverty is higher in rural areas. People living in rural areas can be more exposed to ill health because of greater income insecurity, poor living conditions, weaker social and human capital, unemployment, and poor working conditions, as well as inequitable access to quality health services across the continuum of care. 

Looking at education, the proportion of women and men living with long-standing limiting illness is greater among those with lower education than those with higher education. Women with low levels of education are most affected.

Ms Tatjana Buzeti, Policy Officer at the WHO European Office for Investment for Health and Development in Venice, Italy, explained, “Identifying the barriers and needs of the population experiencing different vulnerabilities due to socioeconomic deprivation, discrimination, gender, place of residency (rural–urban divide), and access to health services will serve to better design health services that leave no one behind. The results can also be used by other sectors to address underlying determinants of health and jointly advocate for investments within the National Development Strategy to close the gaps in health and development.” 

This research will enable greater use of evidence in policy decisions and in the ongoing primary health care reform process in the country. 

The initiative is a good example of the 3 levels of WHO working together to support the country. Activities are being spearheaded by the WHO Country Office in North Macedonia with technical support from WHO/Europe, and coordinated by the WHO European Office for Investment for Health and Development alongside the Gender Equity and Rights team at WHO headquarters. 

WHO will continue its efforts to make health for all a reality by enabling everyone to access high-quality health services.