TOWARD POVERTY REDUCTION AND ACHIEVING MILLENNIUM DEVELOPMENT GOALS IN THE REPUBLIC OF MACEDONIA Donev Doncho 1, Lazarevik Vladimir 1, Kishman Marija2 Institute of Social Medicine, Faculty of Medicine “Ss Cyril and Methodius” University, Skopje, R. Macedonia 2 WHO Country Office in Skopje 1
Introduction:
Political, social and economic transformation of Macedonia started in 1991 by gaining independence. It was followed by transformation from a socialist towards a market-oriented economy, and from single-party political system towards pluralistic democracy. The reforms have been implemented concurrently, in both normative and social and economic perspective. The process of transition was accompanied with privatization, restructuring and closure of a big number of unprofitable industrial capacities with increasing the rates of unemployment and poverty, and decreasing the living standard for the majority of population in the country. The process of transition in Macedonia has been quite slow and widespread and poverty remains a serious problem. The process of transition resulted in intensive changes in the socio-economic life and the social structure of the population which, accompanied by weak economic growth, led to the impoverishment and social exclusion of a large portion of population. Since 1999, there has been an increasing trend in the number of households as social assistance beneficiaries (Box 1).
Box 1. Republic of Macedonia, general information, 2010 • Placed in the SEE part of Europe, land area: 25,713 sq km • Population (2002 Census): 2,022,577 (urban population 60%) • Birth rate: 11.8 per 1,000 population • Mortality rate 9.3 per 1,000 population • Population growth rate of 2.5% • Infant mortality rate: 7.6 per 1000 live births • Maternal mortality rate: 14.8 per 100,000 births • GDP per capita (US$), 2010: 4460; PPP US$ (HDI) 10400 • Unemployment rate (%): 32 • Poverty level: 29.4% of the population living below the poverty line of US$ 75 per month or per capita consumption below US$ 2.15 per day • Social assistance beneficiaries: 92.1% unemployed, majority of them from 31-50 years of age, and in terms of qualification 45% unqualified and 21% with secondary education; • HDI (Human Development Index) / World rank: 0,728 / 79th • Gini Index (The World Bank) (2008): 44 Source: State Statistical Office of R. Macedonia The most important weaknesses of Macedonian economy were low –practically stagnant – GDP growth rates and enormously high unemployment, which brings about high costs in terms of economic, social and budgetary funds losses. Economic unfairness can include: deficient household, living in unsuitable housing conditions, insufficient and irregular nourishment, insufficient education in the adolescent period, incapacity due to industrial injury or uncertain employment etc. Poverty and unemployment have a serious impact on the health status of the population and accessibility to health services (Box 2). Box 2. The cosequences of unemployment and poverty • social and economic exclusion • increased human insecurity and the psychosocial stress • increased sensitivity to new and activate the existing diseases • changes in the lifestyle, physical and mental health deterioration • increased rates of smoking, alcohol and drugs consumption • irregular nourishment, family crises, violence and divorce • higher morbidity due to cardiovascular diseases, malignant neoplasms and other diseases, mental breakdowns and suicides, growth of alcohol dependency, smoking and drug addiction etc. • increased mortality due to cardiovascular diseases, lung cancer, accidents and suicides • deterioration of the health status of the population, in general • extensive utilization of health services (“closure of factories” studies)
Objectives:
Encouraging economic growth and increasing employment opportunities were the key priorities for the first and all subsequent Governments of R. Macedonia. The Ohrid Framework Agreement, signed in 2001, created a vision for a democratic and multiethnic society and a model for functional multiethnic democracy in R.Macedonia. In December 2005 R.Macedonia got status of a country candidate for EU membership, with strategic goal of the country to join the European Union and NATO Alliance. By adopting the Millennium Declaration, R.Macedonia committed itself to reducing the poverty, to ensuring a quality primary education and sustained environment, to improving gender balance and reducing infectious diseases, including TBC and HIV/AIDS, and to lowering maternal and child mortality. Having accepted the Millennium Declaration, R.Macedonia is committed to fight for eradication of the most severe poverty forms, for providing comprehensive primary education, promotion of gender equality, reduction of infant mortality rate, creation of conditions for improving the health status of mothers, undertaking of decisive measures against serious diseases, as well as to ensuring environmental sustainability and global partnership for development.
Learning Objectives 1. To describe components of the strategy for achieving MDGs in R. Macedonia
2. To present goals of the Economic program of the Government of R. Macedonia
3. To evaluate the progress in implementation of the strategy and outcomes
Methodology and activities:
The basic goal of the Economic programme, adopted by the Government in 2006, is to create conditions and presumptions for higher economic growth, and new job openings. Therefore, a heavy emphasis is laid on the business climate improvement, introduction of one-stop shop, benefits for the exporting companies in accordance with the World Trade Organization principles, promotion of small and medium-sized enterprises, speeding-up of the bankruptcy procedures, attracting foreign investors, building inexpensive apartments, as well as health insurance entitlements for all the citizens in the country, introduced from June 2009.
Results:
The Program of the Government of the R.Macedonia, started from 2006, is aimed at improving living standard of the population and decreasing the poverty rate, increasing employment, fighting corruption, developing democracy, improving inter-ethnic relations, political stability of the country and its integration into the EU and NATO. Political and reform activities in R. Macedonia for more dynamic economic development are directed toward increasing competitiveness of Macedonian companies (structural reforms, increased investments in computer technology & knowledge), increasing attractiveness of the country for foreign and domestic investors, improving work quality of public institutions for reform implementation, macroeconomic policy, and particularly the fiscal policy. There is continuous tendency for more dynamic economic growth, employment increase, decrease of public consumption and efficient state administration, de-politisation and professionalism of the public administration, development, investments and modernization of agriculture, as well as communal activities and water supply improvement. The Stabilization and Association Agreement, following the process launched in 2001 between R.Macedonia and the European Union, has been ratified by all European countries and entered into force as of 1 April 2004. The implementation of the agreement accelerated the much needed reforms to ensure stable, functioning institutions, the rule of law and economic development. The basic intention of the system of social assistance in R. Macedonia is to ensure a minimum living standard for individuals and households with an income below a certain minimum. By implementing the Economic Programme, conditions shall be created conducive to a more successful medium term achievement of the MDGs. To overcome problems in the educational sphere, the Government developed a Programme for Education Development, which states “one of the key challenges in the coming period will be to raise the level of education of all adolescents and adults, with a special emphasis on the enhancement of the quality of their expert/working and social competencies”.
Lessons learned:
Economic programme, adopted by the Government, is to create conditions and presumptions for higher economic growth, and new job openings. Poverty, by its nature is a multidimensional phenomenon and, therefore, the reduction of poverty does not imply solely economic measures but rather complex and coordinated efforts in several areas, such as education, health, gender equality, environment, etc. It is realistic to expect that by 2015 the current poverty rate (29.4%) would drop to 27%. The realization of the Millennium Development Goals is an integral part of these programmes and the MDG indicators should be used in order to measure and evaluate progress.
Topic Selection: Achieving Millennium Development Goals: Vital for Global Health Equity Board number: 12
Correspondence: Doncho M. Donev, M.D., Ph.D. Professor and Director Institute of Social Medicine Faculty of Medicine 50 Divizia 6, 1000 Skopje, R. Macedonia
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