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Macedonia - Health Sector Transition Project (English)

The Health Sector Transition Project for Macedonia had a satisfactory outcome with likely sustainability, modest institutional development impact, and satisfactory performances by both the Bank and Borrower. Following a slow implementation, and very limited disbursements during the initial project years, the project was simplified and restructured. Lessons learned include the following: A realistic assessment of the environment for project implementation is crucial. Large investments in equipment and in training worked better when services address major health issues where significant gaps existed in terms of staff skills and technical level of facilities. Complex policy changes or investments in complex technical systems barely worked, with difficulties in implementation and a modest impact. The implementation of changes has to be facilitated by properly timed and designed public information activities. Changes of policy and regulatory environment in areas where vested interests are significant does not work due to collusion among players against changes, and a high potential for corruption. More involvement of local experts and end users would better match the characteristics of the goods and services provided to the specific needs and conditions, and would also require an adequate planning of resources for local consulting services. The procurement of equipment and consumables from UNICEF was not a good experience. Time and effort were spent in the procurement of goods because there were numerous packages for International Competitive Bidding (ICB), international shopping (IS), and national shopping (NS). Better procurement planning and packaging at the project preparation phase would improve economy and efficiency in the procurement process. Both the Bank and the Borrower paid insufficient attention to the setup, maintenance, and systematic use of a monitoring and evaluation framework.


  • Document Date


  • Document Type

    Implementation Completion and Results Report

  • Report Number


  • Volume No


  • Total Volume(s)


  • Country

    North Macedonia,

  • Region

    Europe and Central Asia,

  • Disclosure Date


  • Doc Name

    Macedonia - Health Sector Transition Project

  • Keywords

    Financial Management and Information System;average length of stay;primary care;maternal and child;medical equipment and supplies;Rational Use of Drugs;primary health care services;maternal and child health;vaccine need;financial management information system;financial management and control;quality at entry;public information campaign;procurement of drugs;principal performance ratings;primary care physician;active case detection;primary care doctor;national drug policy;hepatitis b vaccine;evidence based practice;primary care personnel;passive case detection;ratings of bank;distribution of drug;high risk group;cervical cancer screening;reproductive health service;health service provider;prevention of tuberculosis;external technical assistance;ischemic heart disease;exchange rate;Exchange Rates;burden of disease;primary care sector;cost accounting system;improvements in management;High Blood Pressure;adverse drug reaction;quality control laboratory;distribution of pharmaceuticals;bank supervision missions;administration of contract;public health perspective;health system management;institutional development impact;project time frame;quality assurance standard;procurement and distribution;procurement pharmaceutical;financial information system;competitive bidding procedure;methods of payment;national health insurance;health financing reform;issue of access;primary care services;international good practice;health sector institutions;life long learning;human resource issues;health care management;public sector provider;law and regulation;volume of procurement;perinatal mortality rate;family medicine practice;number of candidates;lack of evidence;outputs by components;development of hospital;social health insurance;institutional strengthening;perinatal health services;areas of health;health financing system;public opinion survey;social marketing technique;health care institutions;cost of training;health reform;patient choice;Essential Drugs;prevention program;Fiscal Sustainability;health finance;professional association;payment system;Health Economics;borrower performance;health facility;basic benefit;pharmaceutical procurement;capitation payment;interest group;Perinatal Care;healthcare provider;payment arrangement;tb control;adjustment operation;project plan;medical center;provider payment;public provider;capitation contract;pharmaceutical supply;information center;international tender;reference price;international procurement;local capacity;hospital administrator;foreign consultant;payment mechanism;local expert;budget resource;drug legislation;drug list;pediatric clinic;promotional material;dramatic reduction;Continuing Education;reimbursement system;pilot program;general practitioner;neonatal death;civil works;laboratory equipment;credit funds;hospital management;pharmaceutical policy;investment operation;aids incidence;general hospitals;policy option;policy study;health network;women's health;tuberculosis prevention;sexually-transmitted disease;health expenditure;healthcare management;fee policy;Vocational Training;pay hospital;management skill;data transfer;high ratio;chronically ill;macedonian denar;Disease Prevention;joint financing;diagnostic system;electronic linkage;expert recommendation;advocacy campaign;medical directors;facility management;application software;Employment Services;educational curriculum;price reduction;assessment method;long-term training;evaluation committee;procurement staff;education systems;national implementation;cash benefit;intensive training;local training;clinical training;allocative efficiency;organizational change;competitive procurement;tertiary hospitals;physical environment;pharmaceutical sector;public accountability;procurement practice;adjustment lending;international tendering;coherent strategy;legislative change;local law;media campaign;global budget;educational technology;technical expertise;emergency procurement;finance reform;Infectious Disease;teaching module;assets management



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Macedonia - Health Sector Transition Project (English). Washington, DC: World Bank