Two-thirds of North Macedonia’s public health institutions led by acting directors, panel says

A panel in Skopje brought the country's persistent problem of politicized hospital leadership into sharp relief, with participants saying that two-thirds of public health institutions are currently run by acting directors and that recent legal changes do not yet guarantee merit-based appointments.

“Two thirds of public health institutions have acting directors,” panelists said, adding that the Law adopted by the Assembly on February 11 removed the director’s discretionary hiring power but left key gaps. The session was titled “Depoliticising the appointment of directors of public health institutions.”

Goce Kocevsky, co-author of an analysis on the subject, warned that the new law defines selection criteria in overly general terms — for example requiring five years’ work experience, a proposal of a programme and foreign language knowledge — and that this framework makes it difficult to verify whether candidates truly meet the standards.

Panels call for collective, expert selection

Kocevsky said the legislation relies on a process in which the management board issues a public advertisement, the minister issues the appointment and the procedure ends there, which prevents independent assessment of candidates’ competence. He noted that the Ministry of Health provided data showing that two thirds of public health institutions are led by acting directors.

He also highlighted that what the law treats as an exception — a six-month acting appointment after an unsuccessful competition — has in practice become a rule, with mandates extended repeatedly. “What can be done, what is missing, is obligatory verification of the expertise and suitability of the candidate,” Kocevsky said, arguing that such checks should be carried out by a collective body — the management board, a health council or an ad hoc panel — not by the minister who appoints the director.

Dr. Bojan Trajkovski stressed that the core problem is weak, non-objective selection criteria and partisan placements. “The main problem is that literally all echelons are appointed without absolutely any criterion. It is not justified for institution directors not to be physicians. They should be physicians always, except in exceptional situations,” Trajkovski said, adding the oft-repeated anecdote among doctors: “Every director in health first thing does is change tiles.”

Journalist Sonja Kolevska-Delevska recounted a reported case from two years ago in which a pharmaceutical wholesaler alleged extortion by a hospital director and said payment of public invoices sometimes depended on discretionary decisions. The newsroom said it had offered to provide information to the Basic Public Prosecutor’s Office in Skopje but that prosecutors have not requested it so far, Kolevska-Delevska said.

European Ambassador Michalis Rokas called the topic central to the country’s structural reforms and welcomed the law’s adoption while warning it remains limited in scope. Rokas urged clearer selection boards, transparent methodologies and objective dismissal criteria in order to restore trust so that medical professionals can expect career progression within the public system.

Speakers at the panel included the initiative “Zamisli”, legal experts, clinicians and civil society representatives. Minister Aliu was quoted in coverage of the event saying he intends to abolish the discretionary hiring power that allowed partisan cadres to be placed in hospitals.

Photo: SDK.MK)