According to the Bank’s website, the objective of this project is to improve (i) quality and efficiency of hospital and long-term care services and (ii) pandemic preparedness and response capacity in North Macedonia.

The proposed Project supports the Government's reform agenda to improve the quality, efficiency, equity and resilience of health service delivery through four main complementary areas.

First, the project finances the construction and full equipping of three regional clinical hospitals - in Shtip (Eastern Region), Tetovo (Polog Region), and Kichevo (Southwestern Region) - to address decades of infrastructural neglect, rationalize the hospital network away from its current Skopje-centric concentration, and reduce avoidable referrals to the capital. The three facilities will serve a combined catchment population of over 450,000 residents and are designed to European clinical, accessibility, and climate resilience standards.

Second, the project supports digital health integration, including hospital information systems for the three new facilities, the legal and technical foundations of a National eHealth Interoperability Framework, and alignment with the European Health Data Space (EHDS) Regulation.

Third, the project addresses the critical gap in long-term care (LTC) services through the repurposing of underutilized acute hospital capacity for geriatric and palliative care, development of a national LTC governance and financing framework, and piloting of community-based care models - responding to a rapidly aging population in which 28.8% of residents are projected to be aged 65 or above by 2042.

Fourth, the project strengthens public health preparedness and response capacities through the MAKE-READY Pandemic Fund grant financing early warning and surveillance systems, laboratory strengthening, and health workforce development for emergency response, fully integrated with the hospital infrastructure and digital health systems financed under the preceding areas.

Across all these four areas, the project provides technical assistance for hospital network governance, clinical quality standards, HIF provider payment reform, and health workforce development.

Environmental and Social Risk Classification: Substantial

At this stage the risk is assessed as Substantial. The main risks lay within construction and equipping of regional clinical hospitals in Stip, Tetovo, and Kicevo, improving pandemic preparedness, and digitalization of the health systems. The anticipated environmental risks are predictable, mostly site-specific and predominantly temporary if well managed through ESF and WB EHSG mitigation measures and GIIP. The key construction environmental risks include dust, noise, vibration, construction waste, materials management, OHS, management of radon and hazardous equipment, risk of fires. Main operational risks include medical waste (infectious and other) management including storage, treatment and disposal, appropriate infection prevention and control (IPC), hazardous materials management, fire safety and BSL3 laboratories, and OHS.

The social risk is rated Substantial due to the multiple worksites and the Ministry of Health’s limited ESF experience. The anticipated social risks are primarily associated with construction activities, i.e. community and health and safety risks for hospitals patients, visitors and the staff, and are expected to be site-specific, temporary, and manageable through established mitigation measures. Potential risks include temporary disruption also to neighboring communities, labor and working conditions risks associated with contractors and subcontractors, OHS concerns, community health and safety impacts, and the need for effective stakeholder engagement throughout project preparation and implementation.

World Bank
Mrike Aliu
Senior Human Development Specialist

Borrower/Client/Recipient
Ministry of Finance

Implementing Agencies
Ministry of Health

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