Health for all – by force!

Health for all – by force!
Watching the latest appearances of Ministry of Health officials, I could not help but remember and draw a parallel with similar statements by regime megaphones from another time. It was the time when the EU finally removed travel visas for Macedonian citizens and they could for the first time travel freely throughout Europe. Good news for everyone, bar some hardcore groups, satellites of the ruling party of the time. Their positions were laid out by a famous pro-regime pundit, in a newspaper column, where he correctly predicted that visa removals could result with a massive flow of people out of Macedonia. To prevent this, he proposed a rather radical measure. Even though Macedonia fought hard to remove visas, he thought that it was the right time to introduce exit-visas, meaning that no one could travel outside the country without permission by the state. At the time this proposal was met with general ridicule as primitive and authoritarian, appropriate only for a regime.

Just when we thought that these ideas are a thing of the past, gone for good with the fall of the regime, we begin to hear similar ideas from the new government. What is worse they no longer come from the mediatic and pundit sphere close to the new ruling party, but directly from the top of government, i.e. the Health Minister himself. Speaking about the massive outflow of physicians and nurses from the country, he announced the possibility of asking the relevant state institutions of Germany to prohibit he long-term employment of health personnel from Macedonia in Germany. In other words his solution to the outflow of physicians and nurses is to keep them here by force!

Problems in public health were rightly at the top of priorities of the ruling party’s pre-election programme, and then found their way into the official government programme. SDSM’s promises in general were in the direction of stopping the outflow of health workers through better working conditions here in Macedonia, chiefly through pay raises for public health workers. There were even specific numbers mentioned, up to respectable salaries of 100.000 denars for specialized physicians. Overall it was thinking in the right direction. By creating better conditions in Macedonia the outflow would stop or be minimized, and we could even imagine that it would stimulate some workers to return back to the country. The programme of “life for all in Macedonia” sounded especially tempting for physicians.

Unfortunately after a year of SDSM’s government, things in the health sector seem to change for the worse. Income gains for health workers have been modest, and there is no idea or initiative in the horizon to reform the collapsing health system. As a result the outflow has not only not stopped, but has accelerated. Latest figures show that over 1.000 health workers have left the country in the last year alone, a far higher figure than any previous year. Thus rather than an improved health system, we are quickly moving towards a total collapse of the whole system. The worst part of it is that the Health Minister Filipce was probably honest in his announcement. He, and the Government as a whole, probably have no idea how to deal with this collapse, and have to resort to keeping physicians here by force!

Rationally or instinctively, people seem to understand this very well. After an initial optimism when the new government came to power, expectations that anything will change seem to be quickly fading away. The best indicator are the polls of public opinion which measure the trust in state institutions and satisfaction with their work. Thus during the first months when the Ministry was led by Taravari, it was in first place as the institution that people trust the most and are most satisfied with. Now, barely six months after the rotation at that department, the Ministry of Health is dead last in this list. This type of fall must be a record of some kind. Of course much of the problems stem from factors outside Ministry’s control and we cannot expect solutions with a magic wand. The fall from first to last place in six months, however, indicates serious shortcomings within the institution itself. Most of all it speaks of an alarming lack of ideas for any type of reform, that in the end forces the Ministry to seek salvation through restrictive measures by another country, in this case Germany.

As a reminder, we were to expect something else barely six months ago. And I am not speaking of pre-election promises and government programmes. Six months ago SDSM persisted in its demands to take over the Health Ministry, even at the price of ending its coalition with the Alliance and shake up the stability of its own government. At the time they claimed that it was too important an institution to leave to a small party. SDSM’s insolence went so far as to claim that Alliance or any other coalition partner cannot have a better candidate than the SDSM proposal, and that public health is a problem that only SDSM knows how to handle. For what? To finally propose to a foreign government to keep our physicians here by force.

Robert Nesimi

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