The Declaration of Astana is put into practice in the former Yugoslav Republic of Macedonia

WHO Country Office in the former Yugoslav Republic of Macedonia

Participant signing the poster as the testimony of the adherence to the PHC values.

A National Expert Consultation Meeting was held in Skopje on 14–15 November 2018 to define the strategy and action plan for the Primary Health Care Strengthening Programme in the former Yugoslav Republic of Macedonia.

The former Yugoslav Republic of Macedonia provides an example of how a country can tackle essential primary health care reforms in a focused way. Under the leadership of the Minister of Health, Dr Venko Filipče, the country is one of the first working to make the Declaration of Astana a reality. The Ministry of Health developed the Primary Health Care Strengthening Programme with the aim of building a responsive primary health care system that supports individual health protection, disease prevention and primary curative services, but also population-based and social interventions. The WHO Country Office in the former Yugoslav Republic of Macedonia and the WHO European Centre for Primary Health Care are helping the Ministry of Health to realize this aim.

Country context

While maternal and child health care remain a challenge, the country is facing an ageing population and an increase in the number of people living with multiple chronic conditions due to noncommunicable diseases and risk factors like smoking, unhealthy diets and obesity. Currently, services are scattered between different health and social care providers in various settings, increasing unnecessary pressure on secondary and tertiary care. Primary health care does not have a priority status in the overall national health policy and this is reflected in the health of the population.

Developing a primary health care approach

At the National Expert Consultation Meeting, different stakeholders discussed current challenges in primary health care and ways to implement the commitments of the Declaration of Astana, seeking to build a modern people-centred primary health care system, using a “whole-of-society approach” to maximize the level and distribution of health and well-being. Over 40 experts participated in the meeting, including representatives of the Ministry of Health, professional associations, universities, insurance funds, nongovernmental organizations and other stakeholders.

Participants at the meeting identified a set of activities to strengthen primary health care that can be implemented in the current context, including: establishing an appropriate regulatory framework; providing adequate funding for the model of care; and integrating primary health care with public health services, secondary and tertiary care, and social services.

Other factors discussed as crucial system enablers for the successful strengthening and modernization of primary health care included: governance and accountability, aligned financial incentives, a competent health workforce, responsible use of medicines, innovative health technologies and e-health.

Participants provided valuable input in the attempt to build primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone everywhere; provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated and committed.

Quality of care assessment

In parallel to this event, a WHO mission on quality improvement in primary health care took place on 12–16 November. The mission aimed to review the current scope of practice, clinical knowledge and skills of primary health care nurses and doctors – family doctors, general practitioners, paediatricians and gynaecologists.

What is next

The outcomes of these initiatives will inform the Primary Health Care Strengthening Programme in the former Yugoslav Republic of Macedonia, which will be presented at the National Primary Health Care Forum on 13–14 February 2019, in Skopje.