HEALTH WORKFORCEIN REPUBLIC OF MACEDONIA

Jovanka Karadzinska-BislimovskaSnezana ChichevalievaFimka TozijaJovanka KostovskaMirjana Aleksevska

Taiex Multicountry Workshop on Health workforces needs and mobility in EU and SEE countries, June, 2008 Brussels

Health workforces needsand mobility

Human resources are critical in ensuring the delivery of quality health care servicesNeeds and mobility-multidimensional aspects :

Labor, Health and MigrationCooperative and comprehensive approach, partnership, building awareness are requiredAction at all levelsImportance of policy intervention, innovative solutions and participation of all stakeholders

SOCIO-ECONOMIC EFFECTS OF TRANSITION ON HEALTHCARE WORKFORCE AT NATIONAL

LEVEL

WORKING CONDITIONS, HEALTHCARE SERVICES -RAPID CHANGES, EDUCATIONAL NEEDSNEW TECHNOLOGIES, HIGH DEMANDS FOR REALISATION, WORKPLACE REMODELING LOSS OF JOB, UNEMPLOYMENT, CONCURRENCE, RESTRICTION OF FUNDING, RESTRUCTURING AND PRIVATISATION OF THE HEALTH CAREGLOBAL HEALTH THREATS, MIGRATION

Legal Framework

Law on health careLaw on High Education– Undergraduate studies– Internship– Specialization– Licensing– Practice

MINISTRY OF HEALTH

MEDICALCHAMBER

EDUCATIONALSYSTEM

MINISTRY OFEDUCATION

EDUCATION - PREREQUISITE OF MOBILITY OF HEALTHCARE WORKFORCE

MEDICAL EDUCATION DEVELOPMENT AT ALL LEVELS, IN DIFFERENT PROFILESMEDICAL FACULTY, SCHOOL OF PUBLIC HEALTH, FACULTY OF DENTISTRY, FACULTY OF NURSING …3 CYCLES EDUCATION ACCORDING TO BOLOGNA DECLARATIONHARMONISATION OF CURRICULANEW PROGRAMS, MODULAR FORMAT, ECTS, NEW TEACHING AND LEARNING METHODSMOBILITY OF STUDENTS AND TEACHERSFREE MOVEMENT OF RESEARCH AND SCIENTIFIC IDEAS

HEALTH ORGANIZATIONS AND PERSONNEL EMPLOYED IN R.MACEDONIA IN 2006

No/100000

44,0

Private

897

No/100000

209,7

Public

4279

No/100000

253,7

Total

5176

<= 600

<= 500

<= 400

<= 300

<= 200

No dataMin = 100

Physicians per 100000

Lastavailable

European Region338.23

<= 25

<= 20

<= 15

<= 10

<= 5

No dataMin = 0

Physicians graduated per 100000

Lastavailable

European Region10.39

0 50 100 150 200

2005Belgium2006France2006Finland2006Austria2005EU members before May 2004 2005Eur-A2006Germany2006EU 2006TFYR Macedonia2005Italy2004Luxembourg1998Malta2006Turkey2004Iceland2004Denmark2006Lithuania2006Norway2006Spain2006Czech Republic2003Israel2006Romania2006European Region2004United Kingdom2006Bulgaria2006Serbia2006Croatia2006EU members since 2004 or 20072006Hungary1997Turkmenistan2006Estonia2006Armenia2006Republic of Moldova2005Portugal2006Latvia2002Sweden2006Switzerland2006Netherlands2005Ireland2005Albania2005Slovenia2006Andorra2005Slovakia2006Eur-B+C2006Belarus2006Ukraine2006Montenegro2006Kyrgyzstan2006CIS2006Russian Federation2006Georgia2005CARK2006Kazakhstan2006Tajikistan2005Bosnia and Herzegovina2006Azerbaijan2005Uzbekistan

General practitioners (PP) per 100000, Last available

PHC doctor Number< 41 years 57941-50 years 667> 50 years 735Total 1,981

Age structure of existing PHC doctors in 2005providing health services to insurers

Primary healthcare: urban/rural area(2006)

• PHC doctors No No/100 00urban/rural 1697/273 139,7/33,2

• Nurses urban/rural 3304/358 271,9/43,6

432690457723472757Total

WomenTotalWomenTotalWomenTotal

Registered unemployed31.12. 2005

Registered unemployed31.12. 2006

Registered unemployed31.12. 2007

DOCTORS

OVERVIEW OF REGISTERED UNEMPLOYED DOCTORS

70

80

90

100

110

120

1995 2000 2005 2010 2015

TFYR MacedoniaEuropean Region

Physicians, medical group of specialties (PP), per 100000

<= 250

<= 200

<= 150

<= 100

<= 50

No dataMin = 0

Physicians, medical group of specialties (PP), per 100000

Lastavailable

European Region108.35

<= 200

<= 160

<= 120

<= 80

<= 40

No dataMin = 0

Dentists (PP) per 100000

Lastavailable

European Region51.19

45

50

55

60

65

70

1995 2000 2005 2010 2015

TFYR MacedoniaEuropean Region

Dentists (PP) per 100000

<= 200

<= 160

<= 120

<= 80

<= 40

No dataMin = 0

Pharmacists (PP) per 100000

Lastavailable

European Region50.6

10

20

30

40

50

60

1995 2000 2005 2010 2015

TFYR MacedoniaEuropean Region

Pharmacists (PP) per 100000

<= 2000

<= 1600

<= 1200

<= 800

<= 400

No dataMin = 0

Nurses (PP) per 100000

Lastavailable

European Region720.29

300

400

500

600

700

800

1995 2000 2005 2010 2015

TFYR MacedoniaEuropean Region

Nurses (PP) per 100000

<= 200

<= 160

<= 120

<= 80

<= 40

No dataMin = 0

Nurses graduated per 100000

Lastavailable

European Region34.49

40

50

60

70

80

1995 2000 2005 2010 2015

TFYR MacedoniaEuropean Region

Midwives (PP) per 100000

298135542964357128613473Total

998899Paediatric nurse12

9210510412990118Dental Nurse11

7978810Dental Assistant10

157289159281124235Dental technician9

121336RTG technician8

225315220315215307Lab technician7

4610141318Sanitary technician and medicallab technician6

151178138162137165Pharmaceutical technician5

305433563353Sanitary technician 4

118119119121110112Pedagogy nurse3

495501506513449455Midwife2

155017961510177715201790Nurse1

womentotalwomentotalwomentotal

Registered unemployed 31.12.2005

Registered unemployed 31.01.2006

Registered unemployed 31.01.2007

Profile of nurses

OLD-NEW PROBLEM SPECIFIC OCCUPATIONAL RISKS IN

HEALTHCARE WORKERS

Recent studies in Republic of Macedonia suggest that infectious and psychosocial agents’ problem among healthcare workers (HCW) is present and should become public health priority

Institute of Occupational Health of RM, WHO Collaborating Center has a leading role in health surveillance of healthcare workersResearch projects - focused on infectious and psychosocial hazards

• Therefore, a global approach is necessary in order to develop preventive strategy for protection of the HCW exposed to occupational risks

Public Health Priority

0,401222 (56,4%)

134 (63,5%)Lack in work-organization

0,055918 (46,2%)

132 (62,6%)Low opportunity for professional success

0,580726 (66,7%)

150 (71,1%)Low estimation

0,0014915 (38,5%)

126 (59,7%)Working with infectious diseases

0,3517 (43,6%)

109 (51,7%)Working with “uncritical behavior” patients

pControl group

Examined group

Stress factor

Frequency of workplace stress factors in Examined and Control group of Healthcare workers (N=250 subjects), Institute of OH, WHO CC, 2006

PRIORITIES WITH REGARD TO THE IMPROVEMENT OF THE PLANNING AND QUALITY OF HUMAN RESOURCES

The Ministry of Health will develop a long-term projection about the needs for health care personnel based on several indicators: number of staff, age structure and profile of the staff, territorial distribution, migration, and needs for specialist and sub-specialist staff.The projection about the need for health care staff according to the priorities set in this strategy will be available to the public and will be the basis for designing the enrolment policy of the relevant faculties, colleges and secondary schools.

The territorial distribution of the staff will be achieved by providing financial and other types of incentives in order to provide for an even distribution of the health care staff in all parts of the country.The Medical, Pharmaceutical and Dental Chambers will continue to carry out the process of licensing and re-licensing according to established legal criteria.The curricula and syllabi for under-graduation and post-graduation studies and specializations of all health staff profiles will be further harmonized with the EU legislation.

Actual and future steps at international level

SEE Network on Workers Health (Occupational health expert’s network in SEE)

Project-proposal: ”How to promote the health in healthcare workers in transitional countries?”

UN MILLENIUM DEVELOPMENT GOALSWHO, ILO AND IOM - INTERNATIONAL DIALOGUE ON MIGRATIONEU STRATEGY FOR ACTION ON THE CRISES IN HUMAN RESOURCES FOR HEALTH IN DEVELOPING COUNTRIESWHO GLOBAL PLAN OF ACTION ON WORKERS’ HEALTH 2008–2017, WHA60.26, 2007

ACT OF BALANCING

Solutions are not easy – but migration of healthcare personnel can be a ‘win-win’scenario given the right policy choices.

S. Maybud. International dialogue on migration, Geneva, 2006

Thank you

Jovanka Karadzinska-BislimovskaSnezana ChichevalievaFimka TozijaJovanka KostovskaMirjanka Aleksevska

Taiex Multicountry Workshop on Health workforces needs and mobility in EU and SEE countries, June, 2008 Brussels

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.