HERA – Health Education and Research Association, in partnership with the Association for Support of People Living with HIV (STRONGER TOGETHER – Skopje), the Association for Emancipation, Solidarity, and Equality of Women (ESE), and the Initiative for Women’s Rights from Shuto Orizari, is implementing a partner project titled “Advanced Health Rights of Girls, Women, and Vulnerable Groups.”
The associations began the implementation of the project activities in December 2023, with the project planned to run until October 2026, i.e. for a total of 30 months. The main goal is to improve health protection for vulnerable populations in North Macedonia through intensive cooperation between institutions and the civil sector, focusing on identifying needs, planning measures, and delivering health protection services. The specific goals of the project are as follows: (1) to strengthen the participation of civil society in the development of health policies and budgets of the Government of North Macedonia for the vulnerable groups; (2) to increase the effectiveness and funding of government health programs, ensuring they are evidence-based and tailored to the needs of vulnerable groups; (3) to create a favorable legal environment for civil organizations to serve as national health service providers, contributing to greater sustainability of services for vulnerable groups.
The focus of the project’s activities is to achieve, through program and budgetary improvement of 4 (four) Programs for preventive and curative health protection of the Government of the Republic of North Macedonia for vulnerable populations, enhanced participation of the civil sector in planning, evidence-based budgeting, and creation a legal environment that enables civil society organizations to serve as service providers within these programs.
The four programs that are the focus of the project are:
- The Program for Active Health Protection of Mothers and Children,
- The Program for Early Detection and Screening of Malignant Diseases,
- The Program for the Protection of the Population from HIV/AIDS, and
- The Program for Access to Health Protection for Citizens with Certain Diseases, and Health Protection for Mothers and Infants.
Additionally, the project will address other relevant strategic policies, including the National Health Strategy 2021–2030, and national strategies related to youth, gender equality, equity, non-discrimination, and the inclusion of Roma in the health sector.
Achieved results and activities
Three key results will be achieved through the implementation of the project activities, namely:
- The establishment of a formal consultation process with civil society in the preparation of government health protection programs, ensuring they are based on evidence and the identified needs of vulnerable groups;
- An enhanced commitment by the Government to preventive health protection through increased budgeting and the introduction of measures within preventive health protection programs tailored to the needs of vulnerable groups;
- Amendments and additions to the Law on Health Protection, which legally recognize civil society organizations as providers of health services, have already entered the formal adoption process.
Towards achieving result number one, the following activities will contribute to establishing a formal process of consultation with civil society in the preparation of government health protection programs that are based on evidence and identified needs of vulnerable groups:
Conducting an analysis of the four government health preventive programs. This analysis will include a review of literature and documents, findings from field research among target populations, and a comparison with the methods of preparation and implementation of similar programs in EU countries. It will result in recommendations for improving the preparation process, budgeting, implementation, and monitoring of programs through the active involvement of civil organizations and citizens. The analysis will enable us to prepare and publish a functional report, which will serve as a foundation for advocacy and proposal of measures aimed at promoting program and budget planning and financing of preventive programs with a focus on activities for marginalized groups.
Organizing consultative workshops for the development of four programs for 2025 and 2026. Through consultations with the Ministry of Health, professional bodies, commissions, and public health institutions, we will identify technical support needs and provifr participation in analyses and economic evaluations of the program measures. At multisectoral workshops, we will discuss the findings and recommendations from the research and the budget analysis to enhance the planning, budgeting, and implementation of these 4 programs. Throughout the project, we plan to conduct eight consultative workshops to promote preventive programs.
Organizing local public events, community forums, and creative activism initiatives. These events will be held for the Roma population in Skopje, Kumanovo, Shtip, and Bitola, as well as for communities using HIV prevention services. They aim to identify health priorities, problems, and solutions. Additionally, through the annual creative activism initiatives we will focus on raising awareness of the health issues faced by the Roma population. Throughout the project, we plan to conduct at least 4 (four) local public forums, 2 (two) community forums, and various annual creative activism initiatives.
Holding coordination and advocacy meetings with key stakeholders. The partner organizations will develop an advocacy plan that uses the specific expertise of each partner. This process will be coordinated through monthly meetings to plan and monitor the implementation of activities. Partners will either collaborate or engage with at least two organizations to conduct advocacy meetings with policymakers relevant to the project.
Towards achieving result number two – the following activities will contribute to enhancing the Government’s commitment to preventive health protection through increased budgets and the introduction of measures in preventive programs according to the needs of vulnerable groups.
Preparation of an economic analysis to identify the benefits of investments in preventive health protection. This analysis will illustrate how the appropriate allocation of budget funds can lead to substantial benefits for the state and its citizens by enhancing health and well-being, as well as generating cost savings for both.
Implementation of continuous monitoring related to the planning and implementation of measures from the preventive programs. This monitoring will follow and assess the situation on an annual basis concerning activity planning, budget allocation, and the implementation of the measures from the four programs. The goal is to determine whether there are improvements in processes and if the needs of vulnerable groups are being considered. In addition to the four preventive programs, the monitoring will also include other relevant health policies.
Preparation of documents for the development of public policies on an annual basis based on findings from the analyses and reports generated from the monitoring conducted for each program individually. These documents will include specific requests to the authorities aimed at improving the planning, implementation, and monitoring of the programs through active citizen participation.
Implementation of a media campaign to promote health protection, focused on raising awareness of priority issues and proposing systemic solutions, including increased public funding for health protection. The communication materials developed for different target groups and topics (such as videos and infographics) will use both traditional and new media, and will be based on research and feedback from end users. To ensure effective media representation, we plan to conduct press conferences, prepare and distribute press releases, create and publish short promotional videos, feature guest appearances and stories in the media, and implement paid promotions on social media.
Holding annual national conferences on health protection with key stakeholders and decision-makers. At these conferences, publications from the conducted analyses and research will be presented. The established deficiencies and areas for improvement of the program will also be discussed. Simultaneously, documents outlining public policies will be presented to highlight the specific recommendations and requests of the partner organizations to health authorities and other decision-makers aimed at enhancing the planning and implementation of the four preventive programs and other health policies. Furthermore, national conferences will facilitate open discussions on this topic between different organizations and institutions, all with the goal of promoting health protection for vulnerable categories of citizens.
Towards achieving result number three – amendments and additions to the Law on Health Protection to legally recognize civil organizations as providers of health protection services have entered the formal adoption process. The following activities will contribute to this goal:
Preparation of an analysis for amendments and additions to the Law on Health Protection through which legal arguments and recommendations will be provided for decision-makers from the Government and the Parliament.
Holding meetings with a working group for the preparation of legal and by-law amendments, which will be composed of representatives of civil organizations and the Ministry of Health. The group will prepare the proposed amendments based on the recommendations from the analysis, as well as proposed by-law amendments related to the provision of certain health services for vulnerable groups of the population, with particular importance for public health.
Implementation of parliamentary advocacy will involve meetings with the cross-party parliamentary group on HIV and sexual and reproductive health, in collaboration with the European Parliamentary Forum on SRH, of which the group is a member. Regular communication will be maintained with MPs from other parliaments on relevant health issues, and biannual workshops on legal amendments and priority health issues will be organized for MPs, health protection professionals, and public health institutions.
Organizing a public debate in Parliament to discuss and adopt the proposed amendments and additions to the Law on Health Protection. This will be done in collaboration with the cross-party parliamentary group on HIV and sexual and reproductive health, as well as the Commission on Health and the Commission for Equal Opportunities for Women and Men in the Parliament of North Macedonia.
Impact of the project on improving the health system and health protection for vulnerable groups
With the implementation of this project, a long-term and systemic promotion of several specific health policies is expected through the introduction of new measures and increased coverage of existing ones for girls, women, mothers, children, and vulnerable groups of citizens. The effects of improved, appropriately budgeted, and evidence-based programs—designed with significant civic participation—will lead to adequate prevention and early diagnosis of diseases. This focus on vulnerable groups will not only improve the health of the population in general, but also generate savings in the health system by avoiding expenses for expensive and unnecessary treatments.
We expect the implementation of the project to contribute to the success of the anticipated reform of the health programs initiated through the technical support for the Ministry of Health in executing the National Health Strategy, provided by the EU. We also anticipate that some solutions—such as mechanisms for social negotiation and consultation with the civil sector in planning—will be integrated into the law.
The legal recognition of civil organizations as providers of direct health services will lead to financing from the domestic budget, ensuring greater sustainability of services for vulnerable and hard-to-reach populations in the future.
Project benefits for the partner organizations
Project activities will also benefit partner citizen organizations by enhancing their capacities for advocating program and evidence-based budgeting. This will increase their visibility in addressing essential health-related issues.
Target groups and direct users
The primary beneficiaries of the project implementation include the Ministry of Health, public health institutions, professional bodies and commissions involved in the preparation, implementation, supervision, monitoring, and evaluation of preventive health programs and policies. These include the University Clinic of Gynecology and Obstetrics, the University Clinic for Infectious Diseases and Febrile Conditions, the University Clinic for Children’s Diseases, the Institute of Public Health, Centers for Public Health, health houses, the Committee for Safe Motherhood, and the National Commission for HIV/AIDS. Additionally, the Parliament of the Republic of North Macedonia will benefit, particularly members of the Cross-Party Parliamentary Group on HIV and SRH, the Health Commission, and the Commission for Equal Opportunities for Women and Men.
The direct beneficiaries of the project’s interventions are women and girls of reproductive age (15–49 years), mothers and children, people living with HIV, key populations affected by HIV (including gay men, people who inject drugs, and sex workers), Roma people—particularly Roma girls and women—and socially excluded individuals without health insurance. The policy and legal changes envisaged by this intervention aim to improve access to public health services for these end users. The end users will be involved in field research, public events, and community forums to help identify their needs. Two community organizations—those representing people with HIV and Roma women—are part of this intervention and advocate for the rights of these groups.
Budget of the Project
The total budget for the implementation of the project is 13,905,023 MK denars. This budget is funded with the support of the Government of Switzerland through the Civica Mobilitas.
The role and contribution of Civica Mobilitas to the implementation of the project
HERA – Health Education and Research Association, as a leader organization implementing the project, is supported by Switzerland through Civica Mobilitas.
Civica Mobilitas is a project of the Government of Switzerland aimed at supporting civil society in North Macedonia. It is implemented by the Macedonian Center for International Cooperation (MCMS), NIRAS from Denmark, and FCG from Sweden. The program’s goal is to make social changes in North Macedonia through a strong civil society sector, active citizen engagement, and productive cooperation with the authorities. This results in an expanded civic sector, more sustainable civil society organizations, and more transparent, accountable, and socially inclusive governance at both central and local levels.
