How North Macedonia’s Digitised Health System Leaves Vulnerable Patients Behind

Research by the United Nations assessing the digital gap and the use of digital tools reveals that globally gender differences in access to digital devices are minimal, with 95 percent of respondents stating that there are no differences between men and women in their households when it comes to access to digital devices. But this is not the situation in North Macedonia. 

According to the Health Education and Research Association (HERA), a Skopje-based NGO, in North Macedonia digital literacy is underdeveloped among older women, women in rural areas, and Roma women, which is why they often struggle to use digital healthcare platforms independently.

HERA says although it can increase efficiency, online booking remains a barrier for many women even if they have access to the internet and a proper device. They face delayed check-ups, uncertainty about appointments, and increased stress due to dependence on third parties. For them, digital administration is another form of exclusion, as the healthcare system becomes less accessible than ever.

“The system was designed from a technical perspective, without gender analysis, without consulting women users, and without providing alternative channels for those who are digitally excluded. Women as a target group were not recognised at any stage of the planning, implementation, or evaluation of e-health services,” said Olivera Stojkovska, project coordinator for HERA.

The Moj Termin system allows patients to monitor available time slots for services in the public healthcare system. However, since it began operating, long waiting lines have continued to be present, even though the initial idea of introducing the system was to eliminate waiting lists. Patients wait for weeks, and sometimes even months, to receive medical services. Women without digital access are particularly affected by this situation.

Unused app

To overcome this, the Ministry of Health introduced an app in May 2023 called Moe Zdravje (My Health). The app is part of the Moj Termin system, so appointment schedules, prescriptions, diagnostic results, vaccination records and more are accessible via the app in both iOS and Android. The problem is, only a fraction of people are downloading it, and this could be because they are unaware of its existence. 

Nearly two years after its launch, fewer than 10 per cent of North Macedonians have downloaded the app, former Health Minister Arben Taravari admitted to BIRN earlier this year. 

“Very few people have downloaded the app. We have discussed implementing a campaign to promote the app so that citizens can make appointments directly without needing to visit a doctor. This way, they can also request prescriptions from their doctor. Currently, less than 10 per cent of the population has downloaded this app,” Taravari said.

The Ministry of Health confirmed to BIRN it has no data on who is using the application, nor have they conducted any research to see if it is exclusive to some citizens.

“​​At present, no analysis has been conducted to determine whether more women or men use the Moe Zdravje application, nor are there official statistics disaggregated by gender, age or region,” it said. “Likewise, the Ministry has not carried out any specific research related to the barriers women face when using digital healthcare tools, including those from rural or digitally illiterate communities.”

According to Disha, family doctors are currently required to schedule appointments for citizens, even if they see them as unnecessary. If doctors were given back the power to decide on whether appointments are needed, in his view it would help quicken the system. 

“The doctor should decide if a patient needs an appointment, not the other way around. This would reduce long queues in hospitals and provide better services for all patients who truly need care. Let’s be clear, the healthcare system should serve patients, not just people. Because not every person is a patient. Determining who is a patient should be up to the doctor, not the people,” said Disha.

As retired teacher Abazi says: “I call and ask for an appointment, and they tell me the first available one is in a few months. I can’t wait that long. It worked much better when I went with a doctor’s referral, and they accepted me. Now I wait all day until everyone with an appointment is served, and then I beg the doctor to accept me because I have a priority case.”

Digitalisation – for some