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.
Across March about 20 medical and nursing staff 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 was made 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 was 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. By 26 April this rose to 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.
As of 22 October 2020, 8 healthcare workers in North Macedonia had 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 2 November 2020, all internal clinics within the Clinical Center are ready to receive COVID-19 patients and will not stop normal work. The Minister of Health, Dr. Venko Filipche, had a meeting with clinical directors, 150 hospital beds were provided and staff are ready to work with COVID-19 patients, in addition to ongoing work with treatment of non-COVID-19 patients on a daily basis.

The care of COVID-19 patients will be under special protocols, red and green zones division has been made, i.e. the parts where COVID-19 patients will be hospitalized and parts for patients needing regular checkups or interventions. The clinical center is fully mobilised to provide health care to everyone in need.
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.

As of 25 November 2020, the contracts of 40 nurses in PHC Skopje employed on a fixed-term contract were being extended so that they could return to work. As of 28 November 2020, primary care doctors in Prilep were being mobilized to support the COVID-19 ward at the Hospital in Prilep. As of 30 November 2020, 12 doctors and 20 nurses from the Military Center began to be involved in the work of the COVID-19 wards.

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)

The ePROTECT course for health professionals is also available on OpenWHO in Macedonian: 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.

As of 18 February 2021, the OpenWHO training course "Clinical Management of Patients with COVID-19 – general considerations" is now available in Macedonian and Albanian languages. The training course were developed for all healthcare workers during the COVID-19 pandemic, and translated as part of the WHO project: “Support for the public health and emergency care during the second wave of COVID – 19 in North Macedonia”, funded by the UK Government. It can be accessed through the Ministry of Health e-health platform (https://obuki.zdravstvo.gov.mk) and is an officially accredited course by the Macedonian Medical Chamber.