COVID-19 strained health systems around the world, reducing capacities to maintain preventive and curative services—particularly for underserved communities. North Macedonia’s health care system was similarly challenged and as a consequence a range of essential health services (EHS) were disrupted or suspended across the country.

During 2020, WHO/Europe’s Clinical and Health Interventions pillar of the COVID-19 Incident Management Support Team developed and implemented a four-step approach for countries to maintain EHS in the context of the pandemic. This was adapted with WHO’s Country Office in North Macedonia (WCO)  and the MoH, tailoring the process to the North Macedonian context. In June 2020, WCO supported the MoH, the Health Insurance Fund and the Agency for Medicines and Medical Devices to conduct a rapid assessment and situation analysis of the impact of COVID-19 on EHS. The MoH in cooperation with WCO subsequently established a technical working group to develop an action plan for maintaining EHS during North Macedonia’s COVID-19 response. WCO and MoH recognized the importance of securing the government’s endorsement of the EHS action plan and established an EHS focal point within the national emergency management team—enabling a consensus on the list of EHS to be maintained during all future health emergencies.

MoH supported by the WHO country team is now implementing an Action Plan to restore and maintain the continuity of EHS centred around addressing the needs of those most vulnerable or at risk. In order to achieve this, North Macedonia is strengthening institutional and human resource capacities, prioritizing safeguarding the mental health and wellbeing of frontline workers, prioritizing the health of mothers and children, providing continuous immunization, rolling out palliative services and leveraging technology to reach every last mile of the country.

Strengthening institutional and human resource capacities to maintain EHS alongside the nation’s COVID-19 response

In response to the pandemic, MoH bolstered institutional and human resource capacities, increasing the number of physicians, nurses epidemiologists at the IPH and beds within infectious disease departments and clinics). Strengthened the surveillance and lab capacities as well as governance for EHS to ensure maintaining continuity of the EHS. Further, to address the surge in demand for health services, MoH utilized prefabricated modular hospitals, created special pathways in healthcare institutions, and repurposed existing facilities to provide care for COVID-19 patients, alongside maintaining essential health services.

Safeguarding the mental health and wellbeing of frontline workers

COVID-19 put a tremendous strain on health care workers (HCWs)—both physically and psychologically. WCO recognized that frontline health workers staffed at primary care facilities across North Macedonia were facing the brunt of increased demands for services and required additional support. WCO therefore worked with the MoH to deliver three training modules on mental health and psychosocial support services for HCWs in North Macedonia. Over 1,000 HCWs availed this training within the first month of its launch. WCO thus raised awareness on the importance of mental health and psychosocial support—both for the general population and HCWs. Furthermore, WCO enhanced the capacity of HCWs to identify symptoms associated with increased stress, utilize strategies for self-help in emergencies, and thus manage their own well-being. Primary health care workers were also trained to identify psychosocial needs of their patients and provide appropriate care and support.

Prioritizing the health of mothers and children

Prior to the pandemic, WCO had worked closely with MoH to reverse a trend of increasing perinatal death rates. In order to keep up the momentum of these efforts, a National multi-year master plan to enhance perinatal care outcomes was presented at the 2^nd National Health Forum in early 2020. WCO’s technical inputs, advocacy and mobilization of financial resources to implement recommended maternal healthcare reforms lead to two pilot projects implemented in 2020 and a national roll-out planned for 2021. These efforts were informed by a national perinatal mortality audit.

Leveraging technology for last mile reach to ensure EHS coverage.

In November 2020, WCO supported MoH to deploy an Integrated Telemedicine initiative in public and private health institutions across North Macedonia. This initiative enables general practitioners and health specialists to schedule and perform secure video consultations with patients using existing e-health infrastructure (MojTermin). Through WCO’s support, MoH leveraged a range of e-health interventions for last mile reach: telephone consultations for primary care, e-prescriptions for patients with chronic diseases, telemedicine for consultations, e-modules for immunization and a digital roster for healthcare workers. These e-health interventions ensured that vulnerable and underserved groups—rural communities, migrant groups, elderly persons, people living with disabilities, and refugees—had access to EHS. Technological advances facilitated the exchange of knowledge and best practices among practitioners, and between patients and healthcare providers. Additionally, an  e-module for immunization was implemented during this period—enabling better monitoring of routine vaccination services, enhancing immunization coverage and paving the way for COVID-19 vaccination roll-out.

North Macedonia’s EHS action plan emphasizes that EHS provision is a cornerstone in any health emergency response. With the support of WHO’s regional and country level efforts, North Macedonia achieved an optimal balance by implementing a true dual-track response between responding to the COVID-19 pandemic and delivering EHS. E-health infrastructure will be leveraged in the future to expand EHS coverage and provide e-learning opportunities for health professionals. Working in partnership with North Macedonia’s MoH to streamline service delivery during an emergency, WCO has ensured that the country is better prepared and thereby better protected in the event of future health emergencies.

Photo caption: Efforts to reverse a trend of increasing perinatal death rates in North Macedonia.

Photo credit: WHO

Disclaimer: This image was taken during a time of no community transmission of COVID-19. Community transmission is defined as the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories). Preventative measures such as mask wearing and physical distancing should be used to prevent the spread of COVID-19.