On Friday, September 8, workers from the public pharmacy Apoteka Beograd held a protest in Belgrade. They protested due to unpaid wages and the ongoing shortages of medicines needed for daily activities.
Jelena Šikuljak, president of the trade union Opstanak (Survival), informed the public that the director of Apoteka Beograd had announced that the company lacks sufficient funds and that all earnings are going toward salaries and the purchase of supplies (with medicines categorized as special non-cash goods). She also said that the last payment to workers was half of the June salary, along with an advance for July.
Almost at the same time, the mayor of Belgrade, Aleksandar Šapić, stated that the only solution for Apoteke Beograd is to sell it. He claimed he was unaware of the reasons behind the company’s deterioration and announced that a decision on their future would be made by the end of the year.
Why are public pharmacies important?
The first state pharmacies in Serbia were established around 1830, but most public pharmacies emerged after World War II. Throughout Yugoslavia, public pharmacies were set up in larger cities, while smaller towns had branch pharmacies linked to major urban centers. Apoteka Beograd opened in 1971, Apoteka Niš in 1947, Ljekarna Zagreb in 1966, and Apoteka Sarajevo in 1949, to name a few.
At the time, the mission of pharmacies (which remains the mission of pharmacy in general) was to ensure adequate drug supply for the population. Public pharmacy branches were even established in rural areas that served as centers of their respective districts. This was made possible because public health, not profitability, was prioritized. Some of these public pharmacies still exist today.
Many public pharmacies also established galenic laboratories. Most larger pharmacies, like those in Niš and Belgrade, still have their galenic laboratories today. These are facilities that produce pharmaceutical preparations like boric acid drops, nasal drops, skin creams, and more. These products, of proven quality and trusted by doctors and citizens alike, are often less expensive than those produced by private pharmacy chains.
A key distinction between private and public pharmacies lies in the preparation of magistral medicines—custom-made prescriptions for individual patients. Every public pharmacy institution has capacities dedicated to this. Magistral medicines are regularly made there, requiring the appropriate permits, work conditions, and skilled staff. This personalized service is often not offered by private chains due to low profitability and longer production and delivery times.
Public pharmacies can also adapt more readily to population needs. During the COVID-19 pandemic, public pharmacies coordinated with public health authorities and adjusted working hours based on people’s needs. Most 24-hour pharmacies are public institutions, and in cities where public pharmacies have closed, on-call pharmaceutical services are often nonexistent.
Decline and privatization
Despite surviving sanctions and wars, public pharmacies in Serbia have been gradually (and purposely) destroyed by poor management. As a result, today’s authorities often claim privatization is the only “cure” for these institutions, viewing them as a budgetary burden.
Health Minister Zlatibor Lončar has expressed the intention to “equalize” private and public pharmacies, though he has not explained how this would benefit citizens. This so-called “equalization” can be taken as synonymous with privatization. In practice, under the pretext of introducing “equal conditions for all,” public pharmacies are denied financial support, despite them not being profit-oriented institutions.
This exacerbated pharmacies’ debts to suppliers and drug manufacturers. An equally significant blow to public pharmacies came in 2014, when private pharmacies were allowed to fill prescriptions, stripping public institutions of a key revenue source. No support measures were put in place to mitigate this loss.
Another major challenge for public pharmacies arose from the 2013 Public Procurement Law, which requires them to purchase medicines through centralized tenders. This added bureaucracy often results in frequent drug shortages and leaves public pharmacies vulnerable to fraud. Private pharmacies, on the other hand, face no such restrictions. Procurement in private pharmacies can occur on a daily basis and, as a result, the companies can negotiate better drug prices, which is often the case.
As a result, public pharmacies have been closing across Serbia. The city of Šabac was one of the first in Serbia to lose its public pharmacies. Under the pretext of protecting public funds, the city administration, led by Nebojša Zelenović, effectively shut down the municipal pharmacy company and leased out its spaces. This pattern was repeated in other towns, including Kikinda, Sombor, Apatin, Gornji Milanovac, Prokuplje, Trstenik, Ljig, and Mionica, all of which are now without public pharmacies. In Pirot, the public pharmacies were leased to the private chain Benu, while in Subotica, the number of public pharmacies was reduced from 20 to just two after similar leasing arrangements. The city of Leskovac also closed its public pharmacy, Apoteke Leskovac, with the promise that the spaces would be rented out only if they would be used to open new pharmacies. However, the closure left many smaller towns in the area, which are poorly served by public transport, without their own pharmacies.
Citizens and workers in cities like Kragujevac and Kraljevo are fighting to protect their public pharmacies. In Kraljevo, residents are collecting signatures to hold a referendum on the privatization of their local pharmacy, while city authorities have begun selling off its assets.
The future of pharmacies in Serbia
In early 2017, a draft law on pharmacy was published, promising to regulate this sector. It proposed two important changes: banning new pharmacies within a 300-meter radius of an existing one and requiring a pharmacy in every town with over 4,000 residents. Both provisions aimed to prevent the concentration of capital in specific areas and ensure equitable geographical access to medicines.
However, the draft of this law was withdrawn without any clear explanation. This outcome is not surprising, considering the significant influence of large private pharmacy chains on the sector. Companies like Benu, which operates 447 pharmacies in Serbia, along with Dr. Max and Lilly Drug Stores, have capitalized on the unregulated pharmacy market, creating a major obstacle for public pharmacy institutions while generating huge profits.
Pharmacy activity in Serbia has become profit-driven, with public health taking a backseat. Neither the state nor local authorities are considering efforts to save public pharmacies; instead, they contribute to their closure and sale. The legal framework has been altered in ways that disadvantage public institutions rather than protect them.
To preserve public pharmacy institutions and safeguard healthcare, the state must take decisive action. First, laws and regulations should prioritize the interests of citizens over those of individuals and capital. Currently, Serbia is the only country in the region without a law regulating pharmacy operations. Public pharmacies must be freed from burdensome tender procurement processes, with continuous oversight to ensure they serve the public good. Healthcare should not be governed by profit motives.
This article was originally written in Serbian by Robert Kasumović and published by Mašina.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.
