3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
National officials communicated that the main priority of the current COVID19 response at this phase is to maintain the capacity of the health system to cope with increasing numbers of cases needing intensive medical care, as well as to protect all health care workers.
WHO has helped the Ministry of Health to prepare a list of critical needs in terms of protective supplies and testing kits for the next three months and to coordinate with partners how to meet the identified needs, under the coordination of the office of the Deputy Prime Minister for European Affairs.
Critical needs: Laboratory kits and reagents; personal protective equipment (PPE); mechanical ventilators/respirators (respirators from operating rooms are not adapted to the need of respiratory diseases and cannot be used for the ICU); intensifying risk communication
Protecting health care workers who are not working in the COVID-19 designated facilities.
Procurement: Access to local or international supplies, in particular respirators, due to international shortages.
Shortages in the health workforce if the situation progresses
Ensuring sustainability of health facilities and health care
Community support and outreach activities for the vulnerable
Ensuring treatment for all citizens, including vulnerable groups with other diseases and pathologies.
Isolation and mental health of older people and people with disabilities.
Compliance of the population with instructions of the government and self-isolation where advised.
The country’s strategic preparedness and response plan and the Contingency Plan for COVID-19 has been adjusted to have capacity for 2000 patients. The plan provides strategic interventions in line with 8 pillars.
On 24 March 2020, the Government made a decision regarding the emergency procurement of protective masks for the duration of the state of emergency. Private health care institutions that have intensive care and treatment units will provide such services for COVID-19 patients under an agreement with the Health Insurance Fund. The Government abolished all custom administration expenses for the import of protective medical equipment such as face masks, gloves, disinfection products etc.
On 27 March 2020, the Government decided to abolish all custom duty for the import of medical consumables and on the drug chloroquine.
Health authorities informed on 27 March 2020 that a donation of 3000 masks and another 3000 canvas and surgical masks was donated and they will be distributed to family doctors, who are fully involved in the system of patient detection, examination and scheduling.
The procurement of 12,000 N95 or similar masks, 20,000 protective suits, 50,000 surgical masks, 5,000 visors and 1,200 rubber protective suits is in progress as of 12 April 2020.
The health authorities prepared a plan for the distribution of assistance from the Czech Republic (1 million protective masks) across the country’s health facilities according to the plan, needs and intensity of use as of 13 April 2020.
WHO has completed assessment surveys for infection prevention and control at the national and facility level, including primary, secondary and tertiary healthcare. It has been implemented with support of the Macedonian Association for Intra-hospital Infections as part of a USAID grant to WHO. It will contribute to identifying key gaps in this area and to provide guidance and recommendations for improvement of the IPC practices.
WHO contributes to the recently established National Commission on Mental Health, appointed by the Minister of Health, for preparing two plans: the National mental health plan for the response to the COVID-19 crisis and the national Mental Health strategy for the next 10 years. The first meeting took place on 1st June and discussed all aspects related to the planning and implementation process of activities regarding mental health in the country. WHO works to guide the process using a typical “Mental health and psychosocial support (MHPSS) response framework” (https://www.who.int/mental_health/emergencies/en/), starting with the broad, population-based actions for everyone’s benefit (Mental health promotion and literacy) and then moving through the levels of psychosocial support at community level (especially vulnerable groups) before considering more specialized services and associated opportunities for reform and innovation (digitalization, community mental health centres etc.).