Policy responses for North Macedonia - HSRM

North Macedonia


Policy responses for North Macedonia

2.2 Workforce

Human resources for health in North Macedonia are limited compared with peer countries. In 2013, there were 421 nurses per 100 000 population. This is below the averages for countries in the South-Eastern European Health Network (546 per 100 000 population) and countries in the WHO European Region (738), and far below the average for EU countries (856). The lack of nurses is especially sensitive in secondary care, with hospitals having difficulty in recruiting skilled nurses. In total there are 1533 primary care doctors.

In 2018 the total number of health workers in all public hospitals was 18,661, out of which 4,182 (22.2%) were physicians, 6,876 (36.5%) were nurses, and 7,603 (41.3%) were other medical and non-medical staff. There were 2,747 specialists in all public hospitals, 1,856 (76.6%) at the secondary health care level and 891 (23.4%) at the tertiary health care level.

On 15 March 2020, the government adopted a decision to mobilize all medical staff from all public and private hospitals to be ready to be involved in the response to COVID-19.

On 17 March 2020, the Minister informed the public that, in addition to the health workforce already involved in the COVID-19 response, 200 anaesthesiologists and 400 medical nurses were ready to join the response.

About 20 medical and nursing staff have so far acquired the infection unsuspectingly while performing regular care in their primary clinics or in professional meetings. This constitutes about 10% of all reported cases so far and is of great concern.  On 26 March, the Ministry of Health decided on the use of PPE in line with WHO specifications for the protection against SARSv2 by all healthcare professionals and in all health care facilities countrywide.

As of 25 March 2020, the online WHO training course for COVID-19 for health care and infection control and protection is available in the Macedonian language on the WHO learning platform for health workers (https://openwho.org/). UNFPA and WHO are currently working to produce an Albanian language version.

As of 31 March 2020, WHO’s training module on Emerging respiratory viruses, including COVID-19: Methods for detection, prevention, response and control in Macedonian language is available in Macedonian language (https://openwho.org/courses/introduction-to-COVID-19-MK).

As of 2 April 2020, the total number of affected medical staff is 41, out of which 28 have acquired the infection while in their primary clinics, which constitutes about 11% of the total number of confirmed COVID-19 cases.

The protection of health workers was the focus of a meeting of the Operational Crisis Committee on 4 April 2020. The State Health and Sanitary Inspectorate will continue monitoring and sanctioning non-compliance of health workers with established protocols.

As of 5 April 2020, a rotation mechanism involving doctors and nurses from various health facilities throughout the country will help support and relieve health personnel dealing with COVID-19 patients.

As of 9 April 2020, 82 COVID-19 cases were among health professionals, amounting to 12.4%of all detected cases.

As of 13 April 2020, 121 COVID-19 cases were among health professionals, accounting for 14.2% of all detected cases.

As of 26 April 2020, there were 227 COVID-19 cases among health professionals, accounting for 16.4% of all detected cases in the country.

The termination of employment contracts of health professionals due to reaching retirement age has been postponed for the duration of the state of emergency as of 13 April 2020.

Minister Filipche informed that starting on 23 April 2020, a well-known cardiologist and expert in management of patients in ICU from the University Clinic in Maribor will be working with and supporting the team at the University Clinic for Infectious Diseases.

At the University Clinic for Oncology clinic 8 health professionals tested positive on COVID-19 and 20 contacts are isolated, thus the work of the clinic is reorganized. The subcutaneous treatment for the patients will be available at the Clinical Hospital in Tetovo, Shtip and Bitola and these patients would not need to travel to Skopje.

2,300 health professionals completed the COVID-19 Response Training programme of Project HOPE and the Brown University. The training is based on WHO recommendations for the management of the spread of the disease and the protection of health professionals.

As of 4 May 2020, 135 COVID-19 cases were detected among health professionals, accounting for 15.5% of all detected cases in the country.

As of 11 May, 217 of the 243 health professionals infected with coronavirus recovered and most of them have returned to work.

As of 14 May 2020, 245 COVID-19 cases were detected among health professionals, accounting for 14.2% of all detected cases in the country. Of those, 220 have recovered.

As of 22 October 2020, 8 healthcare workers in North Macedonia have died from COVID – 19, and over 1100 have been infected.

As of 23 October 2020 the Minister of Health announced the full mobilization of health workers to support infectious disease departments countrywide and to be involved in the treatment of COVID – 19 patients.

As of 26 October 2020, 50 students from the higher classes of the medical faculty will support the epidemiological teams with contact-tracing.


WHO COVID-19 courses for health professionals:
The following WHO online COVID-19 courses for health professionals are currently live in local languages as of 19 May 2020 :
Clinical Care Training for Respiratory Infections (SARI) in Macedonian language (https://openwho.org/courses/severe-acute-respiratory-infection-MK)
How to put on and remove PPE in Macedonian language (https://openwho.org/courses/IPC-PPE-MK). The course is currently being finalized in Albanian and will be available soon.
ePROTECT Respiratory Infections in Macedonian and Albanian languages (https://openwho.org/courses/eprotect-acute-respiratory-infections)

As of 19 May 2020, almost 93% of the health professionals infected with SARS-CoV-2 have recovered and all the health facilities and units are now functional.

As of 20 May 2020, there were 253 COVID-19 cases among health professionals, accounting for 13.6% of all detected cases in the country.

The ePROTECT course for health professionals in Macedonian is now available on OpenWHO: https://openwho.org/courses/eprotect-acute-respiratory-infections-MK. This course provides a general introduction to Acute Respiratory Infections (ARIs) and basic hygiene measures to protect against infection.

On 28 May 2020, a WHO Academy webinar was organized about the new COVID-19 mobile learning app for health workers. Health professionals and representatives of the Ministyr of Health and the Institute of Public Health attended the session. The app is designed to enable health workers to expand their life-saving skills to battle the COVID-19 pandemic.  It delivers mobile access to a wealth of COVID-19 knowledge resources developed by WHO, including up-to-the-minute guidance, tools, training, and virtual workshops to support health workers in caring for patients with COVID-19 and in protecting themselves. 

As of 30 May 2020, there were 262 COVID-19 cases among health professionals, accounting for 12.3% of all detected cases in the country, of which 241 (92%) have recovered and one death case is registered.

As of 2 June 2020, there had been 273 COVID-19 cases among health professionals, accounting for 11.5% of all detected cases in the country, of which 242 (88.6%) have recovered and one death has been registered.

As of 9 June, 329 (10.2%) cases were registered among health workers of which 249 (76%) had recovered.

As of 16 June 2020, 16 health workers in the 8 September Hospital were newly infected with SARS-CoV-2 and about 20 health workers (doctors, nurses and technical staff) were in domestic self-isolation on the basis of contact with infected people.

The health system is activated and mobilized to support the COVID-19 response. Three doctors and 27 medical nurses from all over the country are designated to support the work of the Clinic for Infectious Diseases and 6 doctors and 27 medical nurses are designated to support the work of the 8 September Hospital.

As of 12 June 2020, 371 (10%) cases were registered among health workers of which 249 (67%) had recovered.

As of 23 June 2020, the entire health system is mobilized: 54 medical doctors and nurses from all over the country were in Skopje to support the work of the 8 September Hospital and the Clinic for Infectious Diseases.

As of 23 June 2020, six doctors and 25 nurses were infected with SARS-CoV-2 in the 8 September Hospital. Additionally, two health workers in the Clinic for Infectious Diseases in Skopje were infected.

As of 20 June 2020, 464 (9.1%) cases were registered among health workers of which 261 (56%) had recovered.
As of 29 June 2020, 539 (9.0%) cases were registered among health workers of which 299 (55%) had recovered.
Five WHO online COVID-19 trainings have been translated and adapted into national languages. More than 1300 health professionals undertook the various trainings between May and June 2020. In order to ensure sustainability of the capacity building process and to monitor it, the WHO Country Office,  with support from a USAID grant, has implemented a system for monitoring training uptake in collaboration with the E-health directorate. All the trainings have been accredited by the Macedonian Doctors Chamber and will be part of the continuous medical education for medical professionals and a system of tracking uptake has been introduced within the Moj Termin system.  The main aim is to rapidly strengthen the capacity of health workers for infection prevention and control for COVID-19, and to reduce the risk of health care worker exposure to COVID-19. The introduction and adaptation of specific training modules about preventing transmission of infectious agents, correct use of PPE and prevention of contamination in the clinic of cloth, skin, and environment – all in line with WHO guidelines – has helped a large number of health workers in North Macedonia access protective information.