Policy responses for North Macedonia - HSRM

North Macedonia

Policy responses for North Macedonia

1. Preventing transmission

The section on PREVENTING TRANSMISSION includes information on key public health measures that aim to prevent the further spread of the disease. It details how countries are advising the general public and people who (might) have the disease to prevent further spread, as well as measures in place to test and identify cases, trace contacts, and monitor the scale of the outbreak.

1.1 Health communication

The Ministry of Health has started a vigorous risk communication campaign in social media, on TV and other channels of communication. There has been a positive public response to, compliance with and trust in the Government’s protective measures and instructions for social distancing.

The Minister of Health is providing updates after receiving technical advice from the Commission for Communicable Diseases within the Ministry of Health and is the single voice for government measures taken and for reporting cases officially for press releases, media and social media.

Since the COVID-19 outbreak began in North Macedonia, the main messages conveyed in the past few weeks have been for citizens to strictly adhere to government recommendations in order to stop the spread of the virus.

On 29 March 2020, the Minister of Health sent a clear message: “the most difficult period is ahead, and cases will grow globally and in the country. All must respect the instructions and the success of this fight will depend on each one of us.“

On 29 March 2020 the authorities informed that North Macedonia is using NATO’s Next-Generation Incident Command System (NICS) to coordinate its national response to the COVID-19 crisis and to provide its public with real-time information and advice.

As of 2 April 2020, a new Government webpage for all official COVID-19 related information is available in Macedonian and English: www.koronavirus.gov.mk

The Ministry of Health website has a section entirely dedicated to COVID-19 (http://zdravstvo.gov.mk/korona-virus/) where all information, recommendations, questions and answers related to COVID-19 are posted. The Government’s website (https://vlada.mk/covid19) also has a section on COVID-19 where the measures and recommendations for prevention and protection from COVID-19 are regularly updated, including decisions from the Government. The Ministry of Health posts on social media (Facebook:@filipce.venko/@zdravstvomk) every day at 12:00 about any new cases registered in the past 24 hours, and the Minister of Health has at least one press conference in the afternoon to present the COVID-19 situation and developments, as well as any updates on government recommendations.

Public health experts – either from the Institute of Public Health or other departments – also appear in the media providing recommendations to the public for protection and prevention.

With WHO support, the Institute of Public Health and the Ministry of Health have both produced a number of self-explanatory videos based on WHO material, published on TV and social media in three different languages (Macedonian, English and Albanian). They have also published health advice notices (HANs), health declaration forms (HDFs), posters, leaflets and other materials.

As of March 12, 2020, the Ministry of Information Society and Administration initiated messages with recommendations for preventing COVID-19 transmission through mobile applications (text message, Viber message, etc.), especially to the younger population, to observe the conclusions, measures and recommendations for the prevention and spread of COVID-19 disease. This was in collaboration with the Ministry of Health and telephone and national mobile operators. For travellers an SMS is sent automatically, as soon as mobile phones connect to the local telecom network, with helpline number and instructions on how to seek medical help in case of symptoms.

Information for travellers and WHO leaflets in local languages and English were initially distributed at the airport and interviews and screening at points of entry was practiced assessing high-risk situations, in addition to thermal cameras. The International Federation of the Red Cross (IFRC) has also been active through the translation and distribution of WHO and IFRC’s educational materials for the prevention of COVID-19 into the Macedonian and Albanian languages. All UN agencies disseminated WHO educational and awareness material through their social media channels (e.g. Facebook and Twitter), websites and other means. 
On 5 April 2020, the Minister declared that the country had entered a new phase of the epidemic, as it was still a few weeks away from the peak of the outbreak. The number of cases and deaths was expected to rise markedly. The Minister sent a clear message to health workers: “protect yourselves at and outside of your workplaces. The health of the citizens and many lives depend on you.”

On 6 April 2020, the Prime Minister declared that additional restrictive measures are part of the response to this critical phase of COVID-19 to protect the health of the people. The Minister of Health urged the citizens to adhere to the restrictions to be able to reduce the number of cases and to maintain the stability of the health system.

The Government’s Call Centre (02/324-8040) for the support of businesses and citizens and the provision of information related to economic measures in response to COVID-19 is operational.

On 7 April 2020 the government adopted the regulation for the creation of the “StopKorona!” application for mobile telephones, which the citizens can use on a voluntary basis. Another regulation adopted by the government will allow the Ministry of Health to use electronic and smart solutions for handling the ongoing COVID-19 situation.

The app StopKorona can be downloaded here (https://stop.koronavirus.gov.mk/en). The goal is to assist the identification of close contacts of confirmed COVID-19 cases and thus to contribute to reducing the spread of the virus. More than 45,000 citizens have so far downloaded the StopKorona app as of 23 April 2020, and the Ministry of Health has advised family doctors to recommend the app to patients.

On 7 April 2020, the Minister of Health, Venko Filipce, on the occasion of the World Health Day, addressed all health workers in North Macedonia via a video message, congratulating them to the World Health Day. “I dedicate this address to all of you out there who are currently working on combating the epidemic of COVID-19. This virus completely changed our ways of life, but you are the heroes in this battle, and we rest all our hopes with you. Your hard work and sacrifice is of crucial importance for us, and I understand that you are all very tired already, but I also believe that you understand how important your job is to all of us, in a time when you are the main pillar of the state. I ask of you to also be extremely cautious and protect yourselves properly. Protect yourselves from viruses and diseases at work and anywhere else you go. Please, take care of yourselves, because we really need you now, all of you.” 

On 8 April 2020, 16 applications have been picked out of more than 500 sent to the CREATON public call to tackle COVID-19 challenges, issued by the Fund for Innovations and Technology Development. The public call was supported by the Embassy of Switzerland to North Macedonia, USAID, UNDP, UNICEF, and the Chamber of Commerce for Information and Communication Technologies (MASIT). Nearly 158 applications were shortlisted. Of those that made the cut, there are solutions involving medicine, digital tools as support to micro, small and medium-sized enterprises to weather the crisis, digital tools for education, and tools for culture and leisure. The total budget is 10 million denars and each proposal can receive up to EUR 10,000 in the local currency. The call is the first in a series of the Fund’s initiatives to tackle the COVID-19 consequences.

Translations of WHO guidelines on Safe Ramadan practices in the context of the COVID-19 are available in Macedonian, Albanian, Turkish and Roma languages.

The Government call centre is to be expanded to other institutions to strengthen the support for companies and citizens in providing COVID-19 related questions.

The Ministry of Health and WHO are launching a countrywide campaign on 5 May for Hand Hygiene and Nursing. The WHO Country Office translated a 2-page document about Hand Hygiene & COVID-19 to be distributed to relevant facilities and through social media channels.  The WHO campaign materials have been shared with the Ministry of Health.

The Government expanded the COVID-19-related information channels to include “Коронавирус МК Koronavirus” on Viber and urged citizens to use this channel for access to official and verified information related to the COVID-19 response from their phones.

The University Clinic for Hematology published advice and recommendations for its patients during the COVID-19 crisis and established phone lines for doctors’ consultations.

WHO initiated in partnership with the National Institute of Public Health a COVID-19 behavioral survey to gain an understanding of issues such as: trust in health authorities, recommendations and information;  risk perceptions; acceptance of recommended behaviours; knowledge; barriers/drivers to recommended behaviours; misperceptions; and stigma. The results will be available to policy makers to assess and modify risk communication strategies on aspects related to COVID-19. The results will also inform post-pandemic actions, e.g. addressing possible family, mental health, or other adverse events as a result of the crisis. The final results are expected around mid-May 2020.

The Minister of Health awarded certificates to medical teams who are dedicated to patients with COVID-19 at the Clinic for Infectious Diseases and Febrile Conditions in Skopje, the General Hospital 8 September, and the Stip, Bitola, and Debar Hospitals.

“The scenes I see today from Struga are extremely disappointing to me. I interpret them as a complete disrespect to the health workers and all those who work around the clock to overcome this crisis. From the beginning of the crisis, I keep repeating that without the support of the citizens, the health workers cannot do anything. If we want to keep this positive trend, we must respect the measures without any exceptions. I also call for an investigation into how this gathering which is strictly forbidden, was allowed to take place,” wrote the Minister of Health on 8 May 2020 after the news that in Struga the traditional Church Liturgy took place, which gathered hundreds of believers.

The Ministry of Health published a video summarizing the key measures for COVID-19 prevention and protection.

On 12 May the country celebrated the International Nurses Day. The Minister of Health thanked the nurses for their dedication and hard work and recognized all those who stand in the front lines of COVID-19.

On 13 May 2020, the health authorities shared online recommendations for using public transportation. The recommendations are available here: https://www.facebook.com/photo/?fbid=2384932128480473&set=pcb.2384932901813729 

The Ministry of Health developed guidance for pregnant women and COVID-19, in collaboration with UNFPA and HERA. The brochures are available in Macedonian and Albanian language. More information can be accessed here: https://vlada.mk/node/21384

The Government expanded the team working in the Contact Centre for the economic measures in response to COVID-19, with representatives from the Ministries for Labour and Social Policy, Economy, Finance, Information Society and Administration, the Public Revenue Office and the Employment Agency. The goal is to provide accurate and timely information to support citizens to obtain the assistance they need from the different institutions. 2,674 phone calls by citizens and companies were recorded in the Contact Centre during the last month.

On 19 May 2020, the Minister of Health highlighted that many of the new cases are related to gatherings or home celebrations and urged the citizens to refrain from engaging in such activities.

On 5 May 2020, the campaigns “Clean hands save lives” and “Applaud health-care workers” were celebrated in North Macedonia (http://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/news/news/2020/5/clean-hands-save-lives-and-applaud-health-care-workers-campaigns-celebrated-in-north-macedonia).

The Minister of Health expressed concern that, despite the appeals of health institutions not to hold mass gatherings and to comply with measures for physical distancing and movement restrictions, this did not happen during Ramadan celebrations in the places of worship.

On the occasion of World Mental Health Awareness Week (May 18-22), the University Clinic for Psychiatry emphasized the importance of promoting mental health, especially in the context of the current Covid-19 pandemic. More activities for promotion and prevention related to mental health will be organized in the next period for the entire population, as well as certain groups at risk, such as older people, children and adolescents, various groups at increased risk for violence, persons treated for mental disorders, as well as health workers. The University Clinic for Psychiatry has opened more phone lines, intended for psychological support of adults in self-isolation, for mothers in pregnancy and childbirth, for parents of children of preschool and school age, for adolescents, for parents of children with disabilities, as well as a hotline for psychological support in Albanian. Helpline numbers for psychological support are: adults in self-insulation 072 919 009; mothers in pregnancy and childbirth 078 378 766; parents of children of preschool and school age 072 912 676; adolescents 078 378 728; parents of children with development disabilities 070 291 574; psychological support in Albanian language 070 291 657.

Research conducted in the period from 16 to 22 May 2020 via telephone among 1,000 respondents by the Macedonian Centre for International Cooperation (MCIC) found that a quarter of respondents postponed medical examinations due to the corona crisis.  The survey found that, in terms of negative feelings caused by the crisis, over 70% of respondents rarely or never cried, 48% said they did not feel nervous, and 50% said they did not feel depressed. For most respondents (71%) family relations did not change due to the corona crisis, and almost every fifth citizen (19%) said that the relations in the family have improved.  National news on the pandemic were on average rated 3.4 out of a maximum of 5 points. Almost half of the respondents (48%) said that the information was conflicting and confusing. More than half of the respondents (55%) said they were not ready to use the "Stop Corona" application, but 21% said they were fully or somewhat ready for it.

On 15 June 2020, the Health Minister urged parents to make sure that children and young people wear protective masks and are not gathering, since they are usually asymptomatic but can still spread the infection.

The Health Minister urged all political actors to respect the preventative measures and protocols during the entire election process. He also urged all election-related activities to be tailored in line with the recommendations, expressing an expectation that all political parties agree on how to conduct the campaign and prioritize activities that will not endanger people’s health.

The Head of the Islamic Religious Community reminded believers that the coronavirus is still here, and that the virus is dangerous and spreading rapidly; he urged believers to respect the protection measures and recommendations of the experts.

A number of Official Statements were released on 23 June 2020 to clarify the importance of effective risk communication and maintaining preventative behaviours:

“More rigorous implementation of the measures will yield results. Many events took place in the past period, after which neither control nor sanctions have been implemented, and new cases have emerged from these events. We are witnessing every day that events that are banned are being organized. I think that the control must be more rigorous,” declared the Minister of Health.

“The claim that North Macedonia has the highest mortality rate in the region as a result of the COVID-19 virus is inaccurate, as North Macedonia is among the countries most transparent in publishing figures and statistics," stated the World Health Organization's representative in North Macedonia, reminding people that it is necessary to be careful when communicating about COVID-19 and making comparisons between countries.

“The increased number of cases in the country and in many other countries is a huge warning. Responsible behavior as a collective begins with our individual actions by maintaining the recommended physical distance, wearing protective masks and frequent hand washing or disinfection. It is imperative that we continue to be cautious and accept that in the coming months there is a great threat to our lives and societies,” stated the United Nations Resident Coordinator in North Macedonia.

Citizens in the country fear an increased risk of coronavirus infection, and the worsening situation with the epidemic has reduced citizens' support for the government in dealing with the crisis, according to a recent survey conducted by BRIMA (a member of the agency "Gallup International Association") conducted in the first two weeks of June in 19 countries around the world, including North Macedonia. During this period the number of people infected with the COVID-19 in North Macedonia rose to a three-digit number and reached its maximum since the beginning of the crisis, while measures and restrictions were slowly easing. North Macedonia is among a minority of countries where fears of coronavirus infection are on the rise in comparison to March 2020. The survey identified increased fear of the possibility of infection, and decreased support of citizens for the government's handling of the coronavirus, and over half of participants (57%) thought the pandemic was still out of control. At the same time, the number of people who believe that the threat of the virus was exaggerated has been reduced from 73% in March to 44% in June. However, 53% percent of respondents said that their family income had declined since the crisis began. According to another poll conducted by "M Prospect" among 1,003 respondents in Telma TV from 16-21 June, 36.1% of respondents responded that COVID-19 would not prevent them from voting in the elections.

As of 30 June 2020, WHO completed and is now analysing the results of two rounds of behavioural surveys that will contribute to the understanding behaviours of citizens and the communication messages needed for COVID-19 prevention and control.   It has helped improve understanding about the following issues: compliance with  public health measures; trust in health authorities; risk perception; acceptability of recommended behaviours; public knowledge; barriers and enablers for recommended behaviours; misperceptions, and stigma. The results – soon to be published – will help tailor risk communication and support better COVID-19 prevention at the national level. This work has been done with the contribution of social medicine team from the Institute of Public Health.

WHO collaborated with the office of the First Lady in launching a new media campaign led by the first lady for proper wear and disposal of fabric and medical masks, to be followed by information on handwashing. The infographics and media spots are disseminated through social media and other audiovisual means and can be accessed on YouTube, Facebook and Instagram.