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Reconfiguration of North Korea’s Healthcare System Following the Completion of the Pyongyang General Hospital and Kangdong County Hospital, and Tasks for Inter-Korean Health Cooperation |
| December 15, 2025 |
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Eunju CHOIResearch Fellow, Sejong Institute | ej0717@sejong.org
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In the second half of 2025, North Korea completed the Pyongyang General Hospital and began its operation, while also holding a completion ceremony for the Kangdong County Hospital as a flagship project of the “20×10 Regional Development Policy.” In addition, North Korea announced that several facilities currently under construction—including the Kusong City Hospital, the Ryonggang County Hospital, and the emergency medical center in the Wonsan–Kalma Coastal Tourist Zone—would also be completed within the year. These developments indicate that healthcare policy under the Kim Jong Un era has entered a new phase. The Pyongyang General Hospital is positioned as the highest-tier tertiary medical institution in the capital and, over the long term, as a symbolic “standard hospital” for the national healthcare system. The hospitals in Kangdong County, Kusong City, and Ryonggang County were designed as “standard models for city- and county-level hospitals” integrated with the 20×10 Regional Development Policy, giving them the character of pilot cases intended for nationwide replication.
North Korea has designated 2025 as the “first year of the healthcare revolution” and has defined national healthcare capacity around four pillars: medical facilities, medical equipment, the capacity of healthcare personnel, and the procurement of medicines. On this basis, it has announced a comprehensive plan to raise all four elements simultaneously. This policy orientation reflects both an acute awareness of the vulnerabilities and regional disparities in North Korea’s healthcare sector exposed during the COVID-19 pandemic and the linkage between healthcare reform and the broader regional development strategy embodied in the 20×10 policy.
These changes in North Korea present both opportunities and constraints for inter-Korean healthcare cooperation. Since the May 24 Measures of 2010 and the closure of the Kaesong Industrial Complex in 2016, inter-Korean health cooperation has effectively come to a halt. During the COVID-19 border closures, international organizations and NGOs largely suspended their activities in North Korea, making it difficult to assess on-the-ground changes and actual needs. Nevertheless, when North Korea’s policy direction and emerging demands are considered comprehensively, the need to proactively organize strategies and project concepts for inter-Korean healthcare cooperation has, in fact, increased, particularly in anticipation of potential changes in U.S.–North Korea relations and the sanctions environment.
Against this backdrop, this paper seeks to take the completion of the Pyongyang General Hospital and the Kangdong County Hospital as a point of departure to assess the current state and structural challenges of North Korea’s healthcare system, evaluate the opportunities and constraints facing inter-Korean healthcare cooperation, and present mid- to long-term policy recommendations along with concrete directions for potential cooperation projects. -
From the early period of Kim Jong Un’s rule, the regime has promoted the principle of “people-first politics,” advancing policies aimed at normalizing and modernizing the socialist healthcare system, including the system of free medical care. In the process of restoring the basic public health system that had been severely weakened by the economic crisis and marketization of the 1990s, healthcare was repositioned not merely as a welfare policy but as a sector underpinning regime legitimacy and national development strategy.
Following the Eighth Party Congress in 2021, North Korea identified the reduction of regional disparities and provincial modernization as national priorities and began to closely integrate healthcare policy with its regional development strategy. As the COVID-19 pandemic exposed serious gaps in disease control and the fragility of medical supply systems, the authorities rapidly pushed through legal, institutional, and administrative restructuring, including the enactment of an emergency quarantine law, the establishment of disease prevention and control centers, and the reorganization of hospital nomenclature and administrative systems.
Against this backdrop, the designation of 2025 as the “first year of the healthcare revolution,” together with the explicit identification of medical facilities, medical equipment, healthcare personnel, and pharmaceutical supply as the four pillars of national health capacity, can be interpreted as a clear statement of intent to elevate healthcare from a peripheral sector to a core component of national strategy. The policy significance lies in the fact that healthcare is no longer treated as a standalone sector but is being reconfigured as a strategic axis layered across regional development, industry, science and technology, and population policy.
In terms of infrastructure, the most notable change is the simultaneous restructuring of the hospital network in Pyongyang and at the city and county levels. The Pyongyang General Hospital, planned as a tertiary medical institution with approximately 1,000 beds, is a symbolic facility equipped with advanced diagnostic and treatment capabilities and digital hospital management systems. It represents both the concentration of high-end medical services in the capital and, over the longer term, a hub intended to set nationwide standards for clinical practice, education, and research.
At the regional level, the modernization of city- and county-level people’s hospitals has been actively promoted since 2024 as part of the 20×10 Regional Development Policy. In February 2025, groundbreaking ceremonies for hospitals in Kangdong County, Ryonggang County, and Kusong City were held simultaneously. At the Kangdong County ceremony, Kim Jong Un emphasized that constructing modern healthcare facilities and multifunctional cultural and living hubs in cities and counties was of major strategic value for achieving “simultaneous and balanced development across all sectors and all regions” and for accelerating the “complete victory of socialism,” stressing that it was an urgent task that could not be postponed. This statement clearly illustrates that hospital construction in provincial areas is viewed not simply as an expansion of welfare infrastructure, but as a core instrument of regional development strategy.
Subsequent measures—including the establishment of clinical training bases centered on Pyongyang Medical University Hospital, the dispatch of central-level medical staff to provincial hospitals, and intensive training programs conducted during the preparation for the opening and operation of the Kangdong County Hospital—can be understood as efforts to redesign linkages between central and local institutions and between tertiary and primary and secondary levels of care. In summary, while the Pyongyang General Hospital symbolizes top-tier, capital-centered medical infrastructure, the Kangdong County Hospital represents a standard model for city- and county-level hospitals integrated with the 20×10 policy and intended for nationwide replication. Together, these two initiatives function as interlocking pillars of the reorganization of the central–local and upper–basic healthcare system.
North Korea has consistently emphasized the quality and competence of healthcare personnel as a core element of national health capacity. Its healthcare system is structured hierarchically, with ri- and dong-level clinics and people’s hospitals constituting primary care, city-, county-, and district-level people’s hospitals forming secondary care, provincial people’s hospitals as tertiary care, and central institutions such as the Korean Red Cross General Hospital at a fourth level. At each level, healthcare workers are classified into senior, mid-level, and auxiliary cadres, reflecting a vertically and regionally tiered personnel deployment system.
In 2025, in connection with the construction of hospitals in Kangdong County, Ryonggang County, and Kusong City, North Korea established training bases for provincial medical personnel at Pyongyang Medical University Hospital, developed intensive training programs for department heads and head nurses, and outlined management and operations training for hospital directors and technical vice directors at the city and county levels. These steps are significant in that they indicate the activation of a systematic retraining structure designed to diffuse knowledge and skills from the center to the periphery. The rotational dispatch of central-level medical staff to provincial hospitals, combining clinical service with skills transfer, can likewise be seen as a practical effort to reduce regional disparities. State media’s repeated emphasis on improving “professional competence” and prioritizing “science and technology” among healthcare workers, along with the prominent highlighting of medical personnel in reports on new hospital construction, suggests that policy emphasis is shifting toward the simultaneous upgrading of both material and human infrastructure.
Pharmaceuticals and medical equipment are areas in which the North Korean authorities themselves have acknowledged structural weakness. In recent years, the renovation and modernization of pharmaceutical, medical device, and medical consumables factories have continued, alongside efforts to upgrade traditional medicine production facilities such as the Jangsu Koryo Medicine Factory. These initiatives can be interpreted as attempts to establish a system capable of stably producing and supplying essential medicines, traditional drugs, and medical consumables domestically at a minimum acceptable level.
Closely linked to this effort is the nationwide construction of “standard pharmacies,” which carries important policy implications for the restructuring of pharmaceutical distribution and healthcare service delivery. Introduced first in Pyongyang and some provincial capitals, these pharmacies are designed to meet standardized facility requirements and service scopes, offering the sale of new medicines, traditional drugs, and health supplements, along with basic consultation, medication guidance, and elementary health management functions. This integration of “sales” and “management” functions is supported at the legal and institutional level. The Law of the Democratic People’s Republic of Korea on Drug Management defines the storage, supply, and sale of medicines as important activities (Article 28) and stipulates that, with approval from central health authorities, pharmacies, medicine counters, or direct sales outlets may be established within designated areas to sell commonly used medicines, medical devices, and medical consumables (Article 38). It further requires that medicines for specialized treatment be sold only at designated pharmacies upon presentation of prescriptions issued by medical and preventive institutions, and prohibits the sale of medicines that have not undergone inspection by authorized drug testing bodies.
These provisions can be understood in several ways. First, they represent an attempt to partially re-integrate a fragmented pharmaceutical supply structure—previously divided among state pharmacies and hospitals, military medical systems, and market-based transactions—into a state-managed public distribution network. Second, by creating local primary access points for everyday ailments that do not require hospital visits, standard pharmacies complement a hospital-centered system and improve accessibility for residents. Third, within the framework of maintaining the principle of free medical care, they can be seen as an effort to absorb limited forms of paid pharmaceutical provision into the formal system in order to keep prices, product categories, and quality within a manageable range. In this sense, the standard pharmacy policy is not merely a construction project, but part of a broader effort to reposition pharmaceutical production, distribution, and consumption within state planning and management systems and to reconstruct a community-level healthcare network linking hospitals, pharmacies, and households. Moreover, such a network could potentially serve as a local-level platform for improving access to medicines and as a testing ground for cooperation should inter-Korean or multilateral health cooperation resume in the future.
At the same time, North Korea has intensified efforts to strategically utilize external cooperation in the healthcare sector. Acknowledging the limits of self-reliance in areas such as medical equipment, pharmaceuticals, vaccines, and medical education, it has moved to expand cooperation primarily with Russia, selected European countries, and other socialist states. In particular, following summit-level meetings with Russia, North Korea concluded intergovernmental agreements on cooperation in healthcare, medical education, and medical science, and has pursued more structured collaboration through visits by Ministry of Public Health delegations, discussions on medical personnel training, and equipment supply. Similar references to experience sharing and expanded cooperation in healthcare, medicine, and pharmaceuticals with countries such as Vietnam and Belarus suggest efforts to leverage networks with states that have experience in socialist systems and reform and opening.
This reconfiguration of external health cooperation indicates that North Korea is no longer treating healthcare solely as an internal policy issue, but is also seeking to employ it as a channel for external relations, the introduction of science and technology, and the mitigation of constraints imposed by the sanctions environment. -
While the 20×10 Regional Development Policy, the modernization of city- and county-level hospitals, and the construction of standard pharmacies outwardly signal an ambition to improve healthcare infrastructure nationwide, their capacity to eliminate structural disparities in the short term is inherently limited. Even if new hospitals and pharmacies are constructed, infrastructure risks remaining largely symbolic rather than functional unless there is a stable supply of specialized medical personnel by department, along with the technical and financial capacity to operate and maintain expensive diagnostic and treatment equipment on a continuous basis.
This limitation is particularly acute in rural and mountainous areas with weak road and transportation infrastructure. When hospitals are concentrated in city and county seats, the time, transportation costs, and opportunity costs associated with traveling to these facilities can impose significant burdens on residents. In such contexts, hospital construction does not automatically translate into improved access to care, creating a situation in which symbolic value is high but substantive effects on healthcare accessibility remain limited.
Similar issues arise within pharmaceutical distribution networks. As standard pharmacies open first in Pyongyang and major cities and then expand outward, there is a risk that some localities will experience delays in medicine supply or staffing even after buildings are completed. If linkages among hospitals, pharmacies, clinics, and households fail to operate evenly, disparities between the center and the periphery, and between urban and rural areas, in healthcare utilization and access to medicines may not only persist but become further entrenched.
Although North Korea maintains free medical care as a constitutional and legal principle, there is consistent reporting that, in practice, hospitals post treatment fees and require cash payments for services and medicines. This reflects a structural reality in which the state’s capacity to finance healthcare remains constrained by the overall size of the economy, forcing hospitals and pharmacies to rely on paid services to cover operating costs and procure medicines. Moreover, the Law of the Democratic People’s Republic of Korea on Drug Management institutionalizes the storage, supply, and sale of pharmaceuticals (Article 28) and permits the sale of certain categories of medicines and medical consumables through pharmacies with approval from central health authorities (Article 38). This legal framework suggests that even under the formal banner of free medical care, pharmaceutical access and distribution can coexist with the institutionalization of sales mechanisms.
Such arrangements deepen the gap between the formal principle of free medical care and on-the-ground realities, reinforcing disparities in healthcare utilization based on income levels and place of residence. Residents of Pyongyang or relatively better-off households may be able to pay for hospital services and medicines to access higher-quality care, while low-income populations in rural or mountainous areas may postpone treatment due to cost burdens or turn to unregulated and potentially unsafe medicines acquired through informal channels.
Given the current trajectory of state investment in hospital and pharmacy modernization and equipment procurement, there is also a medium- to long-term risk that sustained fiscal pressures will be shifted onto local governments, healthcare facilities, or ultimately residents who use medical services and consume pharmaceuticals. This dynamic can undermine both equity and trust within the healthcare system, weakening public perceptions of the legitimacy and fairness of state health policies.
North Korean discourse repeatedly emphasizes the need to improve the competence and professionalism of medical personnel, which implicitly underscores the structural constraints facing the quantity, quality, and distribution of healthcare workers. Personnel deployment is determined by state planning rather than market mechanisms or individual choice, yet the rapid expansion of hospitals and standard pharmacies under the 20×10 policy is generating demand for medical staff that outpaces the capacity of medical universities and health education institutions to train and supply qualified personnel. As a result, more experienced doctors, nurses, and technicians are likely to be concentrated in Pyongyang and provincial capitals, while city, county, and village-level primary and secondary facilities face chronic shortages and are staffed disproportionately by less experienced or lower-skilled personnel. This creates a structural risk of reproducing imbalances between hardware and software, in which modernized buildings and equipment exist without the human capacity required to deliver high-quality care.
Although state media frequently highlight examples of medical workers studying diligently and engaging in research to improve their skills, access to up-to-date medical textbooks, academic journals, and training opportunities remains limited in practice. Systems for credentialing and evaluating professional competence according to internationally recognized standards are also underdeveloped, leaving few objective mechanisms to verify whether practitioners possess sufficient expertise in specific specialties or procedures. This makes it structurally difficult to maintain consistent standards of care and reduce variation across regions and institutions.
External sanctions and international isolation impose additional structural constraints on North Korea’s healthcare system. While UN and U.S. sanctions do not explicitly prohibit humanitarian assistance involving medicines or medical equipment, restrictions on financial transactions, shipping, insurance, and strict screening of dual-use items significantly complicate and raise the costs of importing or upgrading high-end diagnostic imaging equipment, advanced testing devices, and vaccine production facilities. Consequently, North Korea is often compelled to rely on aging equipment or lower-quality substitutes, with direct implications for the accuracy and safety of diagnosis and treatment.
At the same time, North Korea’s disclosure of health statistics and data remains limited, and standardized indicators collected in line with international norms are scarce. Without reliable data on births and deaths, disease prevalence, vaccination coverage, and healthcare utilization patterns, it is difficult even domestically to set rational policy priorities or allocate scarce resources efficiently. In the absence of robust monitoring and evaluation systems, assessing the actual impact of specific policies or projects on different regions and social groups, and devising appropriate corrective measures, becomes extremely challenging.
This combination of information asymmetry and opacity constitutes a structural constraint on the formation of a virtuous cycle linking policy design, implementation, and evaluation. As a result, North Korea’s healthcare system faces intertwined limitations across infrastructure, human resources, finance, public health capacity, external conditions, and data availability, all of which complicate the achievement of the regime’s stated goal of a “healthcare revolution.” These structural constraints simultaneously heighten the potential need for inter-Korean health cooperation while also defining the key parameters and challenges that such cooperation would need to address in its design and implementation. -
North Korea has designated 2025 as the “first year of the healthcare revolution,” identifying medical facilities, medical equipment, healthcare personnel, and access to medicines as the core components of national health capacity, while simultaneously advancing reforms in institutions, infrastructure, human resources, and external cooperation. Alongside the construction and operation of key hubs such as the Pyongyang General Hospital and Kangdong County Hospital, the regime has intensified efforts to comprehensively reorganize the healthcare system through the modernization of city- and county-level hospitals linked to the 20×10 Regional Development Policy, the nationwide construction of standard pharmacies, the retraining of health personnel, and the expansion of external health cooperation. These moves are closely tied to an intent to elevate healthcare from a welfare function to a central sector for demonstrating regime performance and state capacity.
As discussed in the previous section, however, North Korea’s healthcare system remains constrained by interlocking limitations in infrastructure, human resources, financing and pharmaceutical supply, the sanctions environment, and data availability. Under these conditions, outward modernization is unlikely to translate quickly into substantive outcomes. This reality simultaneously heightens the need for inter-Korean health cooperation and defines the objectives, instruments, scope, and pace such cooperation can realistically assume. Inter-Korean healthcare cooperation thus represents an area with clear necessity and normative justification, yet one in which political, sanctions-related, informational, and governance constraints must be carefully managed in the process of implementation.
Nevertheless, North Korea’s stated policy direction of strengthening national health capacity across four domains aligns in significant ways with major international health agendas, including universal health coverage (UHC) and global health security (GHSA) as promoted by the World Health Organization. Hospital modernization, enhanced quarantine and infectious disease response capacity, and securing essential medicines and vaccines address not only internal needs but also carry public-good characteristics directly linked to health security on the Korean Peninsula and in Northeast Asia. In particular, given the possibility of border reopening and increased mobility, strengthening surveillance, diagnosis, and response capacities for infectious diseases can serve shared interests by enhancing the safety of both Koreas. This provides a persuasive foundation for shaping cooperation agendas in anticipation of changes in the sanctions environment and broader international engagement.
The existence of concrete institutional anchors such as the Pyongyang General Hospital, the Kangdong County Hospital, and the expanding network of standard pharmacies also offers practical entry points for cooperation once engagement resumes. The presence of facilities that function as symbolic and standard-setting models within North Korea helps prevent cooperation from remaining purely abstract. These sites could support pilot projects focused on “software-oriented” areas such as hospital management and administration, infection control, quality management of services, medical information systems and records, and the rationalization of pharmaceutical supply and use. Even if limited in scale, such initiatives can generate significant policy symbolism and spillover effects. In particular, standard pharmacies, which integrate institutional elements related to procurement, quality control, prescriptions, and patient guidance, may serve as platforms with the potential to improve trust and equity within the healthcare system.
North Korea’s expanding health cooperation with Russia, Vietnam, Belarus, and other friendly states, as well as its accumulated experience in humanitarian engagement with WHO, UNICEF, and international NGOs, also warrants attention. Despite its emphasis on self-reliance, North Korea has demonstrated relative pragmatism in leveraging external cooperation in the health sector. This suggests room for future multilateral cooperation involving international organizations, third countries, and NGOs in a context of sanctions easing or expanded exemptions. In such a framework, South Korea could position itself as a participant, coordinator, and provider of technology and capacity within the international health and development cooperation ecosystem. Anticipating and preparing for such a role in advance would constitute a significant asset when cooperation opportunities emerge.
South Korea’s own healthcare capacity and cooperation experience further strengthen the opportunity structure. Korea possesses experience with universal health insurance, an integrated primary–secondary–tertiary care system, and advanced diagnostic, epidemiological, critical care, and infection control capabilities developed through responses to infectious disease outbreaks. It also has strengths in healthcare digitalization and remote education platforms. These assets directly correspond to North Korea’s policy emphasis on workforce retraining, hospital management and quality assurance, infectious disease risk management, and the development of health information systems. Moreover, Korea’s experience in coordinating among central and local governments, international organizations, NGOs, and expert communities provides a foundation for building future cooperation governance structures.
At the same time, significant constraints remain. North Korea’s adoption of the “hostile two-state” doctrine, the continuation of nuclear and missile development, and heightened military tensions on the peninsula narrow the political space for health cooperation and undermine its stability. There is also the possibility that North Korea, calculating strategic benefits, may prioritize cooperation with the United States, Russia, or international organizations while relegating South Korea to a secondary or selective role. Within South Korea, skepticism toward cooperation absent sanctions relief persists, and shifts in the external environment can affect domestic policy consistency, further constraining the durability of cooperation initiatives.
Sanctions and international norms pose especially complex constraints at the implementation stage rather than at the planning stage. Even where humanitarian exemptions apply, practical obstacles arise related to links with sanctioned entities, concerns over dual-use equipment and materials, and restrictions on finance, insurance, and transport. Cooperation involving quarantine and laboratory infrastructure, vaccines and pathogens, or advanced diagnostic equipment may intersect with biosecurity and weapons of mass destruction proliferation concerns, making such projects difficult to pursue without phased approaches, high levels of transparency, and close coordination with international organizations. These factors structurally limit both the scope and speed of cooperation.
Information asymmetry and limitations on monitoring further affect the credibility and legitimacy of cooperation. Given North Korea’s cautious approach to external access and data disclosure, uncertainty may persist throughout the cooperation cycle regarding project selection, performance evaluation, and the prevention of diversion or misuse. Even if limited access to flagship facilities is permitted, obtaining information from rural and mountainous areas—where health vulnerabilities are often most acute—may remain difficult. Without robust joint monitoring and evaluation mechanisms, securing domestic and international confidence in cooperation projects will be challenging.
Against this backdrop, it is necessary to clarify principles and modes of implementation for future cooperation. The primary objectives should be framed around public goods such as the right to health for North Korean residents, infectious disease risk management, and disaster response capacity, which serve as minimum standards for domestic consensus and international coordination. Cooperation agendas should respect North Korea’s stated priorities while being reconfigured to align with international health norms and South Korea’s ethical standards. In the initial phase, a focus on capacity building—operations and management, infection control and quality assurance, education and training, and information systems—rather than on high-cost equipment or large-scale material transfers is likely to be the most realistic approach for accumulating results. Cooperation should be designed not as a single large-scale initiative but as a set of modular options that can be recombined as conditions change, with multilateral frameworks used to distribute roles and burdens. Spatial prioritization should avoid excessive concentration on Pyongyang and instead utilize city- and county-level hospitals and standard pharmacies as regional anchors to improve accessibility and equity. Finally, mechanisms for joint monitoring and evaluation, transparency, and domestic coordination among diverse participating actors should be prepared in advance to prevent duplication and confusion during implementation. -
With the completion of the Pyongyang General Hospital and the Kangdong County Hospital, North Korea has repositioned healthcare as a core pillar of regional development and national strategy under the banner of the “first year of the healthcare revolution.” Through the expansion of standard pharmacies, the retraining of health personnel, and the enlargement of external cooperation, Pyongyang is pursuing a restructuring of its health service delivery system. At the same time, however, structural vulnerabilities accumulated across infrastructure, human resources, financing, pharmaceutical supply, sanctions constraints, and information limitations continue to operate as binding constraints—not only on North Korea’s ability to achieve its self-declared objectives, but also on the design and implementation of inter-Korean health cooperation.
Precisely because North Korea is now publicly committing to strengthening national health capacity and integrating healthcare into its regional development strategy, the need for South Korea to organize cooperation concepts in advance has, if anything, become more urgent. Future health cooperation should place public objectives—such as the protection of North Korean residents’ right to health and the management of infectious disease risks—at the forefront, while preparing phased project structures, multilateral divisions of labor, and strengthened regional-level entry points capable of managing sanctions, information, and implementation risks.
Ultimately, North Korea’s designation of the “first year of the healthcare revolution” does not guarantee the immediate resumption of cooperation. It does, however, indicate that healthcare is likely to emerge as one of the earliest and most practicable areas for cooperation should inter-Korean relations improve. What is therefore required at this stage is not passive waiting for a favorable political moment, but the steady accumulation of executable policy designs and implementation capacity through careful planning and broad-based social discussion, ensuring readiness to respond flexibly to any future political or diplomatic shift.
| Reconfiguration of North Korea’s Healthcare System: Institutions, Infrastructure, Human Resources, and External Cooperation
| Structural Constraints and Challenges of North Korea’s Healthcare System
| Inter-Korean Healthcare Cooperation: Opportunities, Constraints, and Implementation Strategies
| From the “First Year of the Healthcare Revolution” to a Vision for Shared Health Security on the Korean Peninsula
※ The contents published on 'Sejong Focus' are personal opinions of the author and do not represent the official views of Sejong Institue
