HEALTH IN MACEDONIA

AIM, Skopje, April 5, 1994

The health picture in Macedonia currently has two sides: on the one hand the citizens of this country are a relatively healthy people, and on the other the situation in all forms of health protection is such state that the representatives of the World Health Organization here ask themselves how long this can last, if things do not take a turn for the better. Namely, Macedonia is certainly affected by the consequences of the developments in and around the Balkans. First of all, by those of the dissolution of Yugoslavia when a whole economic system broke up, which had been built up for decades as an overall whole, making all the republics mutually dependent on one another in this respect. Naturally, the newly formed states could not create, overnight, all the prerequisites for their full independence in all spheres of life.

In the economic sense, like everywhere else, in Macedonia too this was first felt by pensioners , followed by the socially vulnerable categories which last year numbered about 169,000. Officially, this year that number should remain unchanged, although practice speaks to the contrary. For example, according to the data of the Institute for Trade during last month only, 561 trade enterprises with 4,800 employees faced bankruptcy. In the political sense, the embargo imposed by Greece to throw its northern neighbour on its knees, significantly affects the already bleak economic situation, while the sanctions imposed by the international community against FRY also weaken the Macedonian economy. Imports and exports are attended by problems, and have even been rendered impossible in some cases (imports from Serbia or Croatia). Particularly hit are those employed in enterprises the accounts of which have been blocked, as well as those working for private businessmen, who often tend to avoid paying the statutory dues and for that reason and on account of the large supply of labour, employ workers only illegally.

In such a situation the first visible consequences are the fall of the living standard and, as criminologists claim, an increase of all types of criminal acts, from petty theft to organized drug and arms smuggling. The less visible, but therefore probably more lasting consequences will be felt later. They concern the health of the population. It is hard to say which is the greatest problem in the sphere of health care in Macedonia. Perhaps it is the fact that all the population is not covered by even the basic forms of health care.

This primarily refers to those employed in enterprises who have no money to pay for participation, and the unregistered labour. The worker himself can hardly manage, on his salary, (and it is not infrequent that he receives nothing for months) to feed his family, let alone think about other expenditures. For those with enough money such problems don't exist: they will pay the rather expensive services of private medical practitioners. The same problem applies to drugs. The pharmaceutical industry of Macedonia is relatively well developed, but like all other economic branches it is partly dependent on imports from and exports to the former Yugoslav market.

Of course, drugs by different manufacturers can be found in private pharmacies, but those who depend on the resources of the health care fund are in an unenviable position since due to the lack of resources in these funds drugs cannot be found there where they are available to the poorer strata of the population - i.e. in "state"pharmacies. The result is that patients of poorer material standing often go for a month and more without a very important drug (such as insulin, for example).

The uninformed will perhaps be surprised by the fact that there are too many hospitals in Macedonia in proportion to the number of inhabitants. However, when we know that, just like everything else, the Macedonian health system was developed as a part of the overall Yugoslav system, then it becomes clear that these hospitals were envisaged for a large number of patients. A very grave problem is the poor state of repair of the equipment in health institutions. Almost 80% of the apparata is out of order, without any chance of being repaired soon or put into operation. The consequence is that it is frequently impossible to make the correct diagnosis and problems in treatment. Next comes a problem of a moral nature. Due to a small number of functioning apparata, their use is confined to emergencies. Doctors are faced, almost every day, with the dilemma of judging which case is less and which more urgent. In addition, the question arises of who should be treated - only urgent cases, and the more simple ones postponed until they too become so complicated that they can also be considered urgent.

It is not hard to guess what this will mean for the health status of the population if this situation persists. In addition, work is necessary on the eradication of the two diseases characteristic for this area : one is brucellosis, as a consequence of the irregular vaccination of cattle against this disease. It is transmitted by milk products. The other characteristic ailment is Hepatitis A, which is caused by the poor quality and supply of water. Some towns are not connected to the public water supply system, and the number of unplanned settlements is not negligible either. Having this in mind, the World Health Organization estimates that health care in Macedonia is far below the standards set by this Organization, so that much effort is needed to stabilize the health system here.

RAJKA STEFANOVSKA