This report analyzes procurement trends in North Macedonia’s public health sector between January 2023 and April 2025. It explores how high single-bid rates, supplier concentration, and price overruns undermine transparency, efficiency, and equitable access to healthcare. Drawing on systematic monitoring of over 19,000 awards, it identifies key integrity risks and institutional dependencies shaping the procurement landscape.

Integrity in Public Healthcare Procurement in North Macedonia (January 2023 – April 2025): Patterns, Risks, and the Price of Limited Competition