An audit has revealed that insufficient funding for 23 healthcare programs in 2023 led to impaired liquidity in public health institutions, medicine shortages, and control weaknesses. The State Audit Office also found that capital projects, like building new clinical centers, have faced long delays and financial issues impacting the quality and accessibility of healthcare for citizens.
The State Audit Office issued an unfavorable opinion on the financial statements’ accuracy and compliance with laws, guidelines, and policies, citing these problems.
In 2023, 5.3 billion denars were allocated to 23 healthcare programs, but this was insufficient to cover public health institutions’ obligations on time, resulting in disruptions.
Specifically, the Rare Diseases Treatment Program provided medications for around 235 patients at a cost of 878 million denars, but lacked evaluations of therapy effectiveness and suffered from poor distribution control due to outdated data.
917 million denars were spent on insulin and medical devices for diabetes patients, but planned preventative activities were not carried out, and data from “Moj Termin” did not align with institutional reports.
The early detection of malignant diseases program spent 22.9 million denars in 2023, but lacked clear indicators, had low coverage, and faced delays in screening results.
A planned 3.1 billion denars for mandatory health insurance saw a shortfall of 1.5 billion denars for the last five months due to budget constraints and rising salaries, which disrupted payments to public health institutions.
The HIV protection program spent 89.3 million denars, including 17 million for engaging associations without established selection criteria and with a weak link between measures and budget.
Regarding capital investments, the audit highlighted long-term delays and significant costs for the Kichevo General Hospital project, with potential for additional costs due to ongoing legal proceedings.
Projects for new clinical centers in Skopje and Shtip, initiated in 2015 with a CEB loan, remain unfinished. The Skopje component was canceled, and the Shtip contract was terminated, leading to arbitration for 45 million euros in damages claims. Of the 97 million euro loan, 83.4 million euros have been irrevocably withdrawn.
Construction works on PHI “St. Erazmo” – Ohrid and the Struga City Hospital, begun in 2015 and 2016, are over 90% complete but not operational due to extended deadlines, contract amendments, price increases, and court proceedings, with delays reaching almost 10 years.
Vaccination coverage rates range from 56.3% to 87.7%, showing a decline after 2020 because of vaccine hesitancy and delays.
The audit also analyzed the status, staffing, and financing of the Project Implementation Unit for the new clinical center, revealing 8.4 million euros in unused funds, including 6.01 million from bank guarantees and 2.4 million in withdrawn but unused credit funds. Uncertainty surrounds future costs to be covered by these funds.
Recommendations have been issued to relevant institutions to improve the situation.