Corruption And Quality Of Public Services In North Macedonia: Assessing Healthcare And The Civil Registry Through Public Opinion Research

Tuesday, March 14, 2023

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In North Macedonia, petty corruption is a particular risk in public service delivery because public servants can seek kickbacks from citizens in the form of money, gifts, or favors in return for services rendered.

This study, which used two methods – interviews and mystery shopping – conducted between June and September 2022, assesses institutional drivers of corruption in government service delivery. Mystery shopping is a method of analyzing service delivery where participants are trained observers noting the substance and quality of service delivery against stipulated procedures and norms for later evaluation. Both methods provided information about the risk of corruption by identifying which practices within the service delivery process are susceptible to corruption. They also helped identify places where exposure to corruption was realized, including observable cases of public servants attempting to involve respondents or researchers in corruption. Together, these two approaches explored the quality of service delivery and provided proof of generally opaque corruption practices.

The interviews were conducted in the healthcare sector by surveying patients in two hospitals: City General Hospital 8th September in Skopje, the second largest hospital in the country, and Tetovo Clinical Center, where previous research showed that citizens have experienced corruption. Mystery shopping research was conducted in multiple offices of the Civil Registry to assess the risks and exposure to corruption faced by citizens when trying to acquire certificates needed from public institutions. These sectors were selected based on a 2021 NDI general population survey, which indicated higher ground-level corruption experience at the individual level.

The research confirmed that risks and exposure to corruption persist in public healthcare and civil registry. Four percent of participants in the healthcare study and three percent of participants in the civil service delivery study experienced corruption pressure in public services. This result is significant because it shows that fraud and abuse are present in these important systems. It also suggests that there are thousands of instances of corruption each year when citizens interact with these institutions. Corruption also disproportionately impacts ethnic Albanians, who are often requested to pay bribes in the healthcare sector representing approximately 55 percent of the average minimum monthly wage in North Macedonia. In civil registry service delivery, citizens experience barriers to service delivery, and clerks frequently request payments to deliver basic services.

The key takeaways include the need to improve anti-corruption efforts through better control mechanisms within the institutions, political oversight and judicial mechanisms to assist victims of corruption; capacity-building investments; and addressing resource limitations in public healthcare equipment and wages to ensure that citizens can receive healthcare at a lower cost as well as to decrease the incentive for healthcare works to request payments in exchange for service delivery. Public service managers should conduct regular screenings to test existing integrity mechanisms and then seek to improve them accordingly through novel resilience-building approaches. Political actors in the legislative and executive branches should have more regular and persistent oversight of these sectors to communicate that institutional managers will be held accountable. Finally, political leaders should increase investments to strengthen institutional resilience to corruption.

This program is funded by the National Endowment for Democracy (NED).


NDI is a non-profit, non-partisan, non-governmental organization that works in partnership around the world to strengthen and safeguard democratic institutions, processes, norms and values to secure a better quality of life for all. NDI envisions a world where democracy and freedom prevail, with dignity for all.


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