2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
The country worked hard to ensure its hospitalization surge capacity with the necessary personnel was in place, in case of larger community-based transmission of COVID-19. The National Infectious Disease Clinic (Clinic for Infectious Diseases and Febrile States) in Skopje was named as the designated reference and referral clinic for patients with COVID-19. If needed, the whole capacity of the National Infectious Disease Clinic (beds and human resources) was able to be shifted to COVID-19, although nurses would need specific training to work in intensive care units and management of severe cases. Other infectious disease wards existed in the hospitals of Debar, Kumanovo, Shtip and Gostivar.
On 30 March, the Ministry of Health began working with the military to establish a mobile hospital, increasing capacity by an additional 130 beds. Assisted ventilation was available in the ICU of the National Infectious Disease Clinic but with only 6 assisted ventilators. Additional capacities was flagged as necessary in case of an increased number of COVID-19 cases.
In March the Minister of Health announced that there were 120 ventilators in the country, 90 of which were in facilities in Skopje. However, not all the ventilators would be compatible with COVID-19 case management of Severe Respiratory Distress Syndrome. As a result, the government enlisted capacity support from the private sector, managed under an agreement with the Health Insurance Fund. The government also made numerous procurements of additional ventilators through partners such as UNOPS and UNDP. WHO also supported the procurement of 5000 new lab kits.
In late April, the government annulled the procurement for 31 mechanical ventilators, after the contracted companies notified that they could not deliver the ventilators by the required deadline. The contract is being rescinded and a new attempt at procurement will be made. North Macedonia tried to purchase the respirators from Brazil, Turkey and Italy but all those attempts failed, given the global situation with respirators available and the EU exports ban. However they eventually succeeded in procuring them from Japan and Germany. A total of 70 respirators had been secured by June, including the respirators from the EU. According to the Ministry of Health’s assessment, the total number of respirators that the country would have at its disposal would now be sufficient for the needs of the clinics.
As of 5 April 2020, two new COVID-19 treatment centres had been established in the 8th September hospital in Skopje and in the hospital in Bitola, increasing overall hospital capacity. With WHO and USAID support, the health emergency operations room at the Ministry of Health was also equipped and functional with new premises, refurbishing and IT equipment. By June an extra twenty monitors, 25,000 N95 masks, 100,000 surgical masks, 750,000 pairs of gloves, 10,000 goggles had arrived in the country from the EU.
A new modular hospital next to the Clinic for Infectious Diseases has been set up, doubling the capacities of the Clinic. With support from the Swiss Embassy, the Ministry of Health procured and installed “prefabricated modules” that accommodate hospital beds, outpatients and triage area, staff rooms, wardrobes and meeting rooms. The whole structure was connected with the Clinic for Infectious Diseases and it was equipped with the necessary non-medical equipment.
By May, the existing hospital facilities for the hospitalization of patients with COVID-19 had only been filled to 10% since the beginning of the epidemic in the country. It was announced on 20 May 2020 that a mobile hospital installed at the Infectious Diseases Clinic in Skopje would be dismantled and located in the Ilinden barracks, since the number of COVID-19 patients did not exceed the capacity of the Clinic. The mobile hospital had been donated by Norway and had a capacity of 130 beds and complete equipment.
Despite a subsequent increase in COVID-19 cases by June, still only 14% of COVID-19 patients had been hospitalized, with 86% of confirmed cases asymptomatic or mild. As of 16 June 2020, a total of 318 COVID-19 patients had been hospitalized in the infectious departments throughout the country.
The Prilep General Hospital has received new equipment, the gynecology-obstetrics department and the first aid stations have been refurbished, and an emergency department has opened. An increasing number of diagnosed and hospitalized COVID-19 patients throughout June delayed the return to normal functioning of the public health facilities. However, only non-urgent operations are delayed: emergency operations were still being conducted.
To support supplies and equipment, WHO has organized supply lists for the Ministry of Health covering 4 institutions dealing with COVID-19 to be submitted with the MOH to partners for funding through the secretariat for European Union Accession. On 30 October 2020, NATO donated 60 respirators valued to the total of 1.4 million euros.
By the end of November 2020, the construction of a 400sqm modular hospital in Gevegleija was underway.
As of 15 December 2020, the modular hospital in Gevgelija was installed and the process for installing modular hospitals in Shtip, Kichevo, Struga, Bitola and Strumica was initiated.
On 15 December, the Komercijalna Bank donated two ambulances, 280 oxygen concentrators, masks for non-invasive ventilation and 7120 tests.
The World Health Organization is supporting North Macedonia to prevent, detect and respond to the COVID-19 pandemic with a focus on readiness for deployment COVID-19 vaccination national plan. On 30 December 2020, WHO delivered 84 ventilators and 100 pulse oximeters as part of the COVID-19 German Fund, with a value of approximately USD 1,049,902,00 to enable people working on the frontlines, respond effectively and provide proper care to those suffering from severe respiratory illnesses. Procurement was done through WHO for country emergency needs. In the longer term the equipment will also strengthen the country’s hospital capacities to respond to public health emergencies.
On 11 January 2021, WHO delivered laboratory equipment to the Institute of Forensic Medicine & Criminalistics and to Institute of Microbiology & Parasitology, to strengthen country’s capacities for diagnostics and expanding laboratories which perform molecular testing for SARS-CoV-2 presence. WHO has also delivered freezers to the Ministry of Health/Institute of Public Health and rapid diagnostic tests to the Laboratory for Virology, to strengthen testing capacities and the operation of COVID-19 prevention and response in North Macedonia on 30 January 2021.
The World Health Organization (WHO) is supporting North Macedonia to prevent, detect and respond to the COVID-19 pandemic with a focus on readiness for deployment COVID-19 vaccination national plan. On 1 February 2021, WHO donated freezers to the Ministry of Health/Institute of Public Health and rapid Ag diagnostic tests to the Laboratory for Virology, to strengthen testing capacities and the operation of COVID-19 prevention and response in North Macedonia. The freezers have a combined storage capacity of over 400,000 vaccines. They will support the country’s COVID-19 vaccination response, as well as national diagnostics capacity in the longer term. On 16 February 2021, WHO also donated PPE to University Dental Clinical Center and Clinic of maxillofacial surgery, to support frontline health care workers.