1. Migration of the healthcare workforce Macedonia 2015 3/24/2015 1

2. About Macedonia 3/24/2015 2 Located in the central Balkan peninsula in Southeast Europe Bordered by Kosovo to the northwest, Serbia to the north, Bulgaria to the east, Greece to the south, and Albania to the west. It is one of the successor states of the former Yugoslavia, from which it declared independence in 1991. It has about 2,1 million inhabitants, and about 500.000 live in the capital city of Skopje Ethnic structure: 64,2% Macedonians, 25,2% Albanians, 3,9% Turks, 2,7% Romani, 1,8% Serbs and 2,25 other. (2002 Census) The GDP in 2014 is 3,8% and the unemployment rate is around 28% Health care system: around 6.000 doctors, from which around 3.500 are specialists

3. Involved researchers: Vladimir Lazarevik Project Coordinator of the project current working place: Healthgrouper Neda Popovska-Kamnar Senior Researcher on the project current working place: National bank of the R. Macedonia Blasko Kasapinov Senior Researcher on the project current working place: Healthgrouper Sanja Spasova Junior Researcher on the project current working place: Healthgrouper 3/24/2015 3

4. The main activities performed by the team: Organized focus groups with doctors; Interviews with policymakers, university professors, embassies and other relevant institutions; Organized workshop in Skopje and Tirana; Preparing the Survey on migration of health workers and distributed to the country teams; Implementation of the Survey; Analyzing the results of the Survey; Preparing the country report. 3/24/2015 4

5. Focus groups Group of young doctors; Group of doctor with longer working experience; Group of medical nurses (not achieved). 3/24/2015 5

6. Major points from Focus group with doctor s General thoughts of leaving the country Mainly those who work at the hospital think of leaving, while those that work as general practitioners in their own practices do not, since they have put a lot in the practice. The main reasons for migration abroad Economic and professional reasons Economic reasons for migration abroad Better salaries Professional reasons for migration abroad There is no opportunity to upgrade and progress as a doctor. Profession recommendation to younger generation No, not in Macedonia Political reasons for migration of health professionals from Macedonia Mostly important if you want to become a manager What would they change if they could Invest in equipment, education, training, better salaries for doctors, law on doctor’s rights. The conclusion that is chosen as the best one in this focus group Doctors said that their status of the doctors in Macedonia is as low as the lowest. They have to protect as a doctor, since the law only protects the patients. Doctors in Macedonia every day faced with threats from patients if they don’t give them what they ask for. In small country such as our Macedonia, health is centered in Skopje, there are very few specialists in the other towns. The most important reasons for which people are leaving the country are the inability of employment, poor working conditions and low wages. 6

7. Major points from Focus group with young doctors, both employed and unemployed General thoughts of leaving the country No professional progress Sizing the network of those who left the country Almost 20 % of the young doctors leave the country The main reasons for migration abroad Opportunity for professional upgrade and progress Economic reasons for migration abroad Better salaries Professional reasons for migration abroad No change to prosper here in Macedonia Political reasons for migration abroad If you are opponent to the government, you cannot get employed. Social reasons for migration abroad Better status as a doctor there Profession recommendations to younger generation No, not in Macedonia General satisfaction with work Those that are employed are merely satisfied. Those that are on specialty training are not satisfied because they are not treated as trainees, but as technicians What would they change if they could The enrollment policy and education system CONCLUSION The education system in Macedonia needs to be changed regarding the training of doctors and medical staff. The enrollment policy needs to be planned in advance in order to keep the balance between the supply and demand. 7

8. Conclusions from the interviews with policy makers The main messages that left impression on you from the interviews: About 300 young doctors left the country in the last 2 years. Doctors are burdened with administrative procedures and under constant threat of punishments. There is no strategy for enrolling new students in the medical faculties. The society lacks planning of production and demand of doctors and medical staff. The doctors that left to work abroad never come back. Doctors leave because of economic and professional reasons. 3/24/2015 8

9. Conclusions from the interviews with Embassies The main messages that left impression on you from the Ambassadors: The Global Code of Ethical Recruitment is an important document that is very much respected in the recipient country. The education system in Macedonia should change. There are too many universities in the country that do not contribute to quality in the education. 3/24/2015 9

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11. Sociodemographic characteristics Total participants: 573 (427 via web link and 146 via Facebook) Duration: (December 2014 to February 2015) 11

12. Factors influence the migrations Salary, Working and Living conditions are the dominate factors that influence migration Career and employment opportunities are also highlighted by the migrants and unemployed 12

13. Economic reasons-part I Around 60% of the respondents consider the economic reasons as very important. Opportunities for additional income and to make savings-between 40-50% of respondents consider them as very important 3/4/201513

14. Economic reasons-part II Migrants For most respondents better salary is not the solution Potential migrants Increase of over 100% of the salary as possible solution Inner migrations Increase between 50-100% of the salary as possible solution Unemployed For most respondents job proposition is not the solution 3/24/2015 14

15. Political reasons-part I Around 50% of the respondents consider the political situation as very important 3/24/201515

16. Political reasons-part II Most of the respondents had experience of political influence in order to gain employment and less in professional promotion 3/24/201516

17. Professional reasons Above 60% of respondents consider the working conditions, improving the skills and professional promotion as very important, and the interpersonal relations as less important 3/24/201517

18. Personal reasons Most of the respondents are not too optimistic about their home country, and the reason that they didn’t left yet is the family Above 60% of those who left are not considering coming back 3/24/201518

19. Satisfaction index Around 50% of the respondents are not satisfied of their work as a doctor and would not recommend their profession to the younger generations 3/24/201519

20. Conclusions: Salary, Working and Living conditions are the dominate factors that influence migration, as same as the Career and employment opportunities from the aspect of migrants and unemployed The economic reasons are considered as very important, and also opportunities for additional income and to make savings Increase of over 100% of the salary as possible solution Most of the respondents had experience of political influence in order to gain employment and less in professional promotion Most of the respondents consider the working conditions, improving the skills and professional promotion as very important, and the interpersonal relations as less important The respondents are not too optimistic about their home country, and the reason that they didn’t left yet is the family. The ones that left, are not considering coming back Most of the respondents are not satisfied of their work as a doctor and would not recommend their profession to the younger generations 3/24/2015 20

21. Future plans: Preparing the Country Report with the Survey Results Preparing two publications: Publication with comparative analyze between the countries base on the survey results and Publication of Literature review on migration Policy brief -prepare and deliver to the Ministry Round table-presenting the results of the Project Media coverage - press info 3/24/201521

22. Thanks for your attention 3/24/2015 22