the contributions regularly paid, probably due to the weak economy and lack of existing functional system for ensuring regularity in insurance fees payments by the employer10 or the corresponding body. As a result they can not use the health services according to their needs. Speaking about the cervical cancer prevention programs, the Government estimated that the total number of these two categories of women, referred to as “women without regulated health insurance” is 60-65.000. This represents ~10% of the target group, currently defined as “the women aged 19-65”. Under pressure and lobby of the women’s organizations at first place, and under the influence of the WHO “Health for All” strategy, emphasizing the importance of cancer control (O_03_SK_a), in 2004 the cervical cancer screening was declared as one of the basic rights of the women in Macedonia as per the Law on Health Protection (Official Gazette of the Republic of Macedonia 2004). This induced the need for design of a program which would be targeted especially to the women without their health insurance regulated (I_12_NGO_SK_g; IN_07_MC_SK_b). Allocating financial resources for this purpose, the Government made a big step forward in showing the willingness for promotion of the “women’s health”, and showing the determination for nondiscrimination on the basis of health insurance, thus protecting the principle of “affordability” in the protection of the rights of the patient (Official Gazette of the Republic of Macedonia 2008b). Another starting stand-point for the current design of the cervical cancer prevention strategies is the fact that although the PAP screening was historically offered free of charge at primary level gynecologists, there were only estimated 10% of the women, which took this opportunity and had their PAP test done within the one year interval, as per the practical recommendations by the physicians. The screening in Macedonia has never been systematically organized, with certain exceptions of some pilot projects and attempts for introduction of regional organized screening to a defined population group, which were not long-lived (IN_13_PAT_SK_a; I_10_TG_SK_a; IN_11_TG_SK_a). This fact undoubtedly is one of the root causes of the low coverage. Even so, if a comparison is made with the coverage data from other European countries, where no organized screening is still implemented, the conclusion is that the coverage of 10% annually is still very low. In Germany for example, the smears are similarly offered through the health insurance scheme without a call-recall, but the annual uptake is ~50% (Anttila et al. 2004; European Communities 2008b). The reasons behind the low coverage in Macedonia might lie in the traditional view-points of the Macedonian women and families, limited access to the gynecological services, stigma, fear of cancer, non-confidence in the health facilities, lack of information and education, lack of public organized action and promotion (I_12_NGO_SK_h).
This situation is expected to be improved, due to reforms of the salary payment system, launched in January 2009.
DISCUSSION
10
53