Building trust and fostering collaboration for equitable access to medicines in North Macedonia

Abstract Under Phase IV of the UHC Partnership, North Macedonia focused on strengthening health system governance and health policy development, with key investments in institutional capacity, health workforce planning, primary health care (PHC), sustainable health financing, and access to medicines. Efforts included training Ministry of Health professionals in policy analysis, strategic planning, and evidence-based decision-making while enhancing coordination and policy coherence. Recognizing the significant share of total health expenditures allocated to medicines and the high out-of-pocket burden on patients, Phase IV of the partnership in North Macenoia prioritized reforms in pharmaceutical governance. Continuous engagement with key national authorities - including the MoH, Health Insurance Fund, and National Medicines Agency - alongside other stakeholders such as professional associations and patient groups, aimed to build trust and foster collaboration. Major milestones included initiating a high-level policy dialogue in the National Parliament to secure political commitment for equitable access to medicines and establishing a National Platform on Access to Medicines. Additionally, efforts were launched to revise medicine pricing mechanisms, analyze and streamline purchasing channels, and enhance transparency in medicines expenditures. These efforts have collectively reinforced North Macedonia's health system resilience, improved service delivery, and positioned the country for sustainable progress toward UHC.