First ever national health forum in North Macedonia looks to revitalize primary health care


North Macedonia is among the first countries globally to review its commitment to primary health care (PHC) in line with the Declaration of Astana, adopted at the Global Conference on Primary Health Care held in October 2018 in Kazakhstan. The country continued this process during the first ever national health forum on PHC, held on 13 February 2019.

Dr Venko Filipce, Minister of Health of North Macedonia, opened the forum in the presence of Prime Minister Zoran Zaev and high-level participants from the government, international organizations, national institutions, civil society and the private sector.

In his opening statement, Dr Filipce said, “The goal of the forum is to initiate public debate about the country’s new vision on primary health care as a key national priority aimed at improving the overall performance of the health system, and to commit to working together to accelerate progress towards its implementation”.

The country faces a growing number of health challenges, including measles outbreaks and low childhood immunization rates, suboptimal maternal and child health, and an increasing burden of noncommunicable diseases such as cardiovascular disease and diabetes, often exacerbated by unhealthy lifestyle choices.

A PHC approach, when properly implemented, would protect against many of these health challenges and bring balance back to health care, putting families and communities at the centre of the health system.

Currently, PHC has little influence on overall national health policy and the resulting health status of the population. PHC services are fragmented and scattered between health and social service providers at various levels, increasing pressure on secondary and tertiary care. More than a third of all health-care expenditure is through out-of-pocket payments.

Investing in health to enhance development

At the forum, Prime Minister Zaev reiterated his commitment to health as a key pillar in the country’s development and economic plans. “With rising health-care costs, investing in primary health care will consolidate our ability to invest resources wisely, and to meet the needs and expectations of people. With primary health care we can produce a higher level of health for the same investment,” he said.

Dr Hans Kluge, Director of the Division of Health Systems and Public Health, WHO/Europe, congratulated the country for this move towards better and stronger PHC. “People-centred, integrated primary health care has the ability to help improve health, save lives and reduce inequities and inefficiencies in health care, if well implemented,” he said.

A roadmap for people-centred PHC

WHO has supported the Ministry of Health in the development of a PHC roadmap for 2020–2030, by providing technical expertise for evidence-based assessment and planning, exchanging good practices, analysis of data and building local capacity. The formulation of the roadmap was based on a consultative process. A series of consultations with national experts and various sectors provided the opportunity for the Ministry of Health to present its vision and plans and get feedback from participants.

To steer the health system towards better performance, based on an integrated and people-centred PHC approach, the roadmap proposes tackling 4 main areas:

  • Empowering communities and engaging patients: by tailoring services to population health needs across a broad continuum of care and linking to social support; by supporting the development of health literacy and patient education, home-based care and patient self-management.
  • Reorganizing services delivery and providers: by defining PHC regions and zones, for better provider accountability to their communities, and considering population size, remoteness and cultural aspects; as well as by defining providers’ roles and responsibilities and scope of practice, including nurses.
  • Improving quality in PHC: by focusing on the development of clinical skills through continuing health education.
  • Offering stronger and more strategic financial incentives to health-care providers: by aligning incentives with the redefined scope of their work in all areas (preventive, curative and rehabilitative practices). Patient benefit packages from the Health Insurance Fund and health workforce payment mechanisms will be formulated in line with current national health priorities, with a greater focus placed on outcomes and groups.

An action plan for strengthening PHC in the country will now be formulated, integrating the forum’s conclusions, and the views and perspectives captured during the event.