Migrant Health Policy in European Union (EU) and a non EU country: Current situation and future challenges for improvement

Aim: The influx of refugees, asylum seekers and migrants in Europe is an ongoing reality and migrant health has become very important public health problem. The aim of this paper is to analyze and compare the health profile, migrant situation and migration integration health policy in Spain as a European Union (EU) country and Republic of North Macedonia as a country in process of European Union accession. Methods: Migration Integration Policy Index (MIPEX) Health strand questionnaire (2015) was applied to compare health policies for migrant integration in both countries. Results: There are differences between Spain and Macedonia in health care coverage and access to health services for migrants. Spain has health strand total score of 52 and is in the same group with Austria, Ireland, Belgium, Netherlands, Denmark and Sweden. Macedonia has lower health strand total score 38 and is in the same group with Turkey, Cyprus, Slovakia. Targeted migrant health policies are stronger and services more responsive in Spain compared to Macedonia which offers migrants legal entitlements to healthcare, but health services should be more culturally responsive to migrant health needs. Conclusion: Health migration policy in both countries is closely tied to the general immigration policy

Migrant Health Policy in European Union (EU) and a non EU country: Current situation and future challenges for improvement

Aim: The influx of refugees, asylum seekers and migrants in Europe is an ongoing reality and migrant health has become very important public health problem. The aim of this paper is to analyze and compare the health profile, migrant situation and migration integration health policy in Spain as a European Union (EU) country and Republic of North Macedonia as a country in process of European Union accession. Methods: Migration Integration Policy Index (MIPEX) Health strand questionnaire (2015) was applied to compare health policies for migrant integration in both countries. Results: There are differences between Spain and Macedonia in health care coverage and access to health services for migrants. Spain has health strand total score of 52 and is in the same group with Austria, Ireland, Belgium, Netherlands, Denmark and Sweden. Macedonia has lower health strand total score 38 and is in the same group with Turkey, Cyprus, Slovakia. Targeted migrant health policies are stronger and services more responsive in Spain compared to Macedonia which offers migrants legal entitlements to healthcare, but health services should be more culturally responsive to migrant health needs. Conclusion: Health migration policy in both countries is closely tied to the general immigration policy.   Conflicts of interest: None declared

Подобрување на човековите права во здравствената заштита во Република Македонија

The rights of patients are based on the general human rights and are an important segment in the process of "Europeanization" of the Republic of Macedonia. The main goal of this study was to analyze the legislative framework of human rights in the health care in the Republic of Macedonia and its implementation in practice. Material and methods: The study was designed as a descriptive-analytical cross sectional study, in which a public health approach, an information-analytical method and evidence synthesis method were applied for the analysis of the relevant legislation. A survey was conducted on a representative stratified sample of patients in the Polog Region in the period from October to November 2017 in the Clinical Hospital Tetovo and the General Hospital Gostivar. Results: The legal system of the Republic of Macedonia was analyzed and compared with 6 transition countries, which had undergone a series of substantial reforms in recent years. The legislative framework in the Republic of Macedonia is a comprehensive frame for protection of patients’ rights, with which the patient is guaranteed legal rights in the process of treatment, respect and protection of his/her personality and integrity. The implementation of patients' rights in practice in this paper was analyzed by implementation of two rights of patients: the right on information about the recommended medical interventions and the right to accept and reject certain medical intervention. 85.2% of the interviewed patients had information on the right to information about the recommended medical interventions, and 14.8% didn’t have. 72.1% of the interviewed patients had personal experience for this right, and 27.9% didn’t have. Regarding the right to accept and reject certain medical intervention, 77% of the interviewed patients had information on this right, while 23% didn’t have. Personal experience was significantly smaller with this right, i.e. only 32.8% of the interviewed patients had personal experience, and 67.2% didn’t have. These differences were significant for both rights, for information and for personal experience. Conclusions: The human rights in the health care in the Republic of Macedonia are reflected in the national legislation, which is harmonized with the European and international legislation. However, it is necessary to improve the implementation of patients' rights in practice by raising the citizens' awareness about the knowledge of patients' rights and encouraging medical staff to respect the rights of patients and their compulsory application in practice.Правата на пациентите произлегуваат од општите човекови права и се важен сегмент во процесот на ,,европеизација“ на Република Македонија. Главна цел на оваа студија беше да се анализира легислативната рамка на човековите права во здравствената заштита во Република Македонија и имплементацијата во пракса. Материјал и методи:  Студијата е дизајнирана како дескриптивно–аналитичка студија на пресек, во која беше применет јавноздравствен пристап, информатичко-аналитичен метод и метод на синтеза на евиденција (evidence synthesis) за анализа на релевантната легислатива. Беше спроведено  анкетно истражување на репрезентативен стратифициран примерок на пациенти во Полошкиот Регион, во период од два месеци, октомври-ноември во 2017 година, во Клиничката болница во Тетово и Општата болница во Гостивар. Резултати: Беше анализиран правниот систем на Република Македонија и беше спореден со 6 држави во транзиција, кои претрпеа низа суштински реформи во последниве години. Легислативната рамка во Република Македонија претставува сеопфатна рамка за заштита на правата на пациентот, со која на пациентот му се загарантирани законски права во процесот на лекувањето, почитувањето и заштитата на неговата личност и интегритет. Во овој труд имплементацијата на правата на пациентите во пракса беше анализирана преку имплементацијата на две права на пациентите, и тоа: право на информираност за препорачаните медицински интервенции и право на прифаќање и одбивање на определена медицинска интервенција. 85,2% од анкетираните пациенти имале информации за правото на информираност за препорачаните медицински интервенции, а 14,8% немале. 72,1% од анкетираните пациенти имале лично искуство за ова право, додека 27,9% немале. Во однос на правото на прифаќање и одбивање на определена медицинска интервенција, 77% од анкетираните пациенти имале информации за ова право, а 23% немале. Значително помало беше личното искуство за ова право, односно само 32,8% од анкетираните пациенти имале лично искуство, а 67,2% немале. Разликите беа сигнификантни во одговорите за двете права, и за информацијата и за личното искуство. Заклучок: Човековите права во здравствената заштита во Република Македонија се рефлектирани во националната легислатива која е хармонизирана со европската и меѓународната. Меѓутоа,  потребно е подобрување на имплементацијата на правата на пациентите во пракса, преку подигнување на свеста на граѓаните за познавање на правата на пациентите и поттикнување на медицинскиот персонал за почитување на правата на пациентит

Проценка на епидемиолошката состојба и оптовареноста со COVID-19 на глобално, регионално и национално ниво

The current pandemic of corona virus disease 2019 (COVID-19) is an infectious disease caused by a newly discovered severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Global COVID-19 burden is characterized by a high variability in death rate across countries. Several possible explanations have been proposed, but it is not clear whether this variability is due to a single predominant factor or instead to multiple causes. The aim of this paper was to present and analyze the epidemiological situation and burden of the COVID-19 pandemic in Kosovo compared to other countries in Europe and the world. Material and methods: Public health approach and desk review were applied to present and analyze the trends over time of selected epidemiological indicators for COVID-19 based on multiple sources of data as well as WHO epidata and literature review. The assessment of the epidemiological situation in EU/EEA member states was done using the surveillance data routinely collected by ECDC. Official medical records from the National Institute of Public Health, other relevant health institutions; State Statistical Office and Ministry of Health in Kosovo were used. Results: According to ECDC as of 11 February 2021, 106,472,660 cases of COVID-19 (in accordance with the applied case definitions and testing strategies in the affected countries) have been reported, including 2,323,103 deaths. COVID-19 cases have been reported from: Africa: 3,673,181 cases, Asia: 20,438,608 cases, Europe: 34,681,426 cases, America: 47,620,931 cases; Oceania: 57,809 cases, Others: 705 cases. Deaths have been reported from: Africa 95,128 deaths, Asia 343,886, America 1,107,066, Europe 775,883, Oceania 1,210 and Other 6 deaths. In Kosovo from 13 March 2020 until 15th February 2021 there have been 64,298 cases of COVID- 19 with 1534 deaths. Absolute values of the indicators remain high in all countries in Europe, including those with stable or decreasing trends in these indicators, suggesting that transmission is still wide spread. The epidemic trajectory over the next months will be determined by the balance of four factors, with many different outcomes possible: the continued scale-up of vaccination, declining seasonality, the spread of new variants and increased behaviors that favor COVID-19 transmission. Conclusion: Findings from this paper can help to develop evidence-based policy interventions in Kosovo for risk assessment of COVID-19 and protection of general population and especially vulnerable groups with higher risk from COVID 19.Тековната пандемија со корона вирус од 2019г.(COVID-19) е инфективно заболување предизвикано од новооткриениот корона вирус 2 кој предизвикува  тежок акутен респираторен синдром (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Глобалниата оптовареност со COVID-19 се карактеризира со голема варијабилност во стапката на смртност во државите. Предложени се неколку можни објаснувања, но не е јасно дали оваа варијабилност се должи на единствен доминантен фактор или на повеќе причини. Целта на овој труд беше да се презентира и анализира епидемиолошката состојба и оптовареноста со  пандемијата COVID-19 во Косово и да се спореди со другите земји во Европа и светот. Материјал и методи: Јавноздравствен пристап и прегледот на документи се применети за да се презентира и анализира трендот на избраните епидемиолошки индикатори за COVID-19 врз основа на податоци од повеќе извори, како и епидата на СЗО и преглед на литература. Проценката на епидемиолошката состојба во земјите-членки на ЕУ/ЕЕА беше направена со користење на податоците за следење, рутински собрани од ECDC. Беа користени официјални медицински извештаи од Националниот институт за јавно здравје, други релевантни здравствени институции; Државниот завод за статистика и Министерството за здравство на Косово. Резултати: Според ECDC заклучно со 11 февруари 2021 година, во светот пријавени се 106.472.660 случаи на COVID-19 (во согласност со применетите дефиниции на случаи и стратегии за тестирање во погодените земји), вклучително и 2.323.103 смртни случаи. Пријавени се случаи со COVID-19 од: Африка: 3.673.181 случаи, Азија: 20.438.608 случаи, Европа: 34.681.426 случаи, Америка: 47.620.931 случаи; Океанија: 57 809 случаи, други: 705 случаи. Пријавени се смртни случаи од: Африка 95.128 смртни случаи, Азија 343.886, Америка 1.107.066, Европа 775.883, Океанија 1.210 и други 6 смртни случаи. Во Косово од 13 март 2020 година до 15 февруари 2021 година пријавени се 64.298 случаи на COVID-19 и 1.534 смртни случаи. Апсолутните вредности на индикаторите остануваат високи во сите земји во Европа, вклучително и оние со стабилни или трендови на опаѓање, што укажува дека трансмисијата е сè уште широко распространета. Текот на епидемијата во следните месеци ќе биде одреден од рамнотежата помеѓу четири фактори, со можни  различни исходи: континуирано зголемување на вакцинацијата, сезонско намалување, ширење на новите варијанти на вирусот и зголемено однесување што придонесува за преносот на COVID-19. Заклучок: Наодите од овој труд можат да помогнат да се развијат политики и интервенции засновани на докази во Косово, за проценка на ризик за COVID-19 и заштита на општата популација и особено на ранливите групи со поголем ризик од COVID 19

Estimating health impacts and economic costs of air pollution in the Republic of Macedonia

Aim: This paper assesses the magnitude of health impacts and economic costs of fine particulate matter (PM) air pollution in the Republic of Macedonia. Methods: Ambient PM10 and PM2.5 monitoring data were combined with population characteristics and exposure-response functions to calculate the incidence of several health end-points known to be highly influenced by air pollution. Health impacts were converted to Disability-Adjusted Life Years (DALYs) and then translated into economic terms using three valuation approaches to form lower and higher bounds: the (adjusted) Human Capital Approach (HCA), Value of a Statistical Life (VSL) and the COI (cost of illness). Results: Fine particulate matter frequently exceeds daily and annual limit values andinfluences a person‟s day-to-day health and their ability to work. Converting lost years of life and disabilities into DALYs - these health effects represent an annual economic cost of approximately €253 million or 3.2% of GDP (midpoint estimate). Premature death accounts for over 90% of the total health burden since this represents a loss of total life-long income. A reduction of even 1μg/m3 in ambient PM10 or PM 2.5 would imply 195 fewer deaths and represent an economic savings of €34 million per year in reduced health costs. Conclusion: Interventions that reduce ambient PM10 or PM2.5 have significant economic savings in both the short and long run. Currently, these benefits (costs) are „hidden‟ due to the lack of information linking air quality and health outcomes and translating this into economic terms. Policymakers seeking ways to improve the public‟s health and lessen the burden on the health system could focus on a narrow set of air pollution sources to achieve these goal

Фактори кои влијаат на природното движење на населението во Република Северна Македонија

The planning of public health programmes is directly related with the demographic characteristics and  the population change has longterm impact on the health, health care and community interventions. The objective of this paper is to analyze the factors influencing the trend of population change  in the Republic of North Macedonia. Material and methods: Data from the National Statistical Office and World Health Organization have been used. Literature review was conducted applying public health approach and descriptive method. Results: The natural population change in North Macedonia has negative trend in the last 10 years, the birth rate has declined, while the mortality is increasing. The biological factors and fertility rate have significantly influenced the birth rate, while the burden of chronic noncommunicable diseases, road injures, violence and COVID-19 are lead causes of mortality.  Numerous factors indirectly affect the negative trend of population change such as the high rate of unemployment, poverty, socioeconomic and political context, migration and availability and quality of health care. Conclusion: А detailed analysis of the factors affecting the natural population change and an appropriate national response with the aim of reducing the negative trends is needed.Планирањето на јавноздравствените програми е директно поврзано со демографските карактеристикии природното движење на населението и има долгорочно влијание врз здравјето,здравствената заштита и интервенциите во заедницата. Целта на овој труд е да се анализираат факторите кои влијаат на трендот на природното движење на населението во Република Северна Македонија.  Материјал и методи: Користени се податоци од датабазата на Државниот завод за статистика иСветската здравствена организација, кои се статистичкиобработени и прикажани табеларно и графички. Извршен е преглед на литература, а применет е јавноздравствен пристап и метод на дескриптивна анализа. Резултати: Природното движење на населението во Македонија покажува негативен тренд во последните десет години, односно се намалува наталитетот додека морталитетот е во позитивна насока, со зголемен  број на починати лица. Биолошките фактори и стапката на фертилитет значајно влијаат на намалување на наталитетот, а од друга страна оптовареноста со хроничните незаразни болести, сообраќајните несреќи, насилството и Ковид-19 се главните причини за зголемената смртност. Бројни индиректни фактори влијаат на негативниот тренд на природното движење на населението, како што се високата стапка на сиромаштија и невработеност, социоекономскиот и политички контекст, миграциите и пристапот и квалитетот на здравствена заштита. Заклучок: Потребна е детална анализа на факторите кои влијаат на природното движење на населенето и соодветен национален одговор со цел намалување на негативниот тренд

Stigma Associated with Tuberculosis Disease in Republic of Macedonia – Results from a Cross-Sectional Study

BACKGROUND: Stigma and discrimination are interrelated and are breaking the fundamental human rights. Both are associated with tuberculosis (TB) disease since ever and have negative influence on activities aimed at TB prevention, treatment and control, both at individual, community and societal level.AIM: To determine the magnitude of TB stigma in Republic of Macedonia, identify root causes and detect main determinants associated with it.MATERIAL AND METHODS: Cross-sectional study was performed on 315 TB patients registered in the period Jul, 2012-Jun, 2013, using selected module from World Health Survey questionnaire. Self-reported data is collected through face to face interview conducted by trained directly observed treatment (DOT) nurses in the patients’ home.RESULTS: 16.7% TB patients have not received any assistance when diagnosed with TB and 8.4% were treated badly by a member of the family or close friends because of the disease, consequences ranging from living the patient completely, refusal to talk or telling other people that the person is infected. An odd for such behavior were higher if the patient is male, married, have no formal education or have completed only primary school, is unemployed and lives in rural area.CONCLUSION: Understanding the origins of TB stigma is integral to reducing its impact on health. Our survey has provided a baseline on the magnitude of existent stigma associated with TB disease and has identified main determinants that trigger stigmatizing behavior

Estimating health impacts and economic costs of air pollution in the Republic of Macedonia

Aim: This paper assesses the magnitude of health impacts and economic costs of fine particulate matter (PM) air pollution in the Republic of Macedonia.Methods: Ambient PM10 and PM2.5 monitoring data were combined with population characteristics and exposure-response functions to calculate the incidence of several health end-points known to be highly influenced by air pollution. Health impacts were converted to Disability-Adjusted Life Years (DALYs) and then translated into economic terms using three valuation approaches to form lower and higher bounds: the (adjusted) Human Capital Approach (HCA), Value of a Statistical Life (VSL) and the COI (cost of illness).Results: Fine particulate matter frequently exceeds daily and annual limit values andinfluences a person‟s day-to-day health and their ability to work. Converting lost years of life and disabilities into DALYs - these health effects represent an annual economic cost of approximately €253 million or 3.2% of GDP (midpoint estimate). Premature death accounts for over 90% of the total health burden since this represents a loss of total life-long income. A reduction of even 1μg/m3 in ambient PM10 or PM 2.5 would imply 195 fewer deaths and represent an economic savings of €34 million per year in reduced health costs.Conclusion: Interventions that reduce ambient PM10 or PM2.5 have significant economic savings in both the short and long run. Currently, these benefits (costs) are „hidden‟ due to the lack of information linking air quality and health outcomes and translating this into economic terms. Policymakers seeking ways to improve the public‟s health and lessen the burden on the health system could focus on a narrow set of air pollution sources to achieve these goals

Social determinants of equity in access to healthcare for tuberculosis patients in Republic of Macedonia – results from a case-control study

Background: Health is a complex phenomenon and equity as a basic human right an integral part of constitutions in almost all countries in the world. In Republic of Macedonia (RM), Tuberculosis (TB) is clustered regionally and in certain ethnic groups. The main objective of this study was to analyze Social Determinants of Health (SDH) and equity in access to healthcare services for TB patients in RM, aimed at complex analysis of factors that cause inequities. Methods: Case-control study was conducted in the period March–December, 2013; “cases” are households of TB patients registered in the period July, 2012–June, 2013 and controls are households with no TB patients in their immediate vicinity. World Health Organization (WHO) World Health Survey questionnaire was used to collect data. Results: Analysis of SDH of TB patients shows that patients are mostly males, of lower socio-economic status, are less educated, unemployed and TB is clustered in certain ethnic groups. Analysis of access has identified these determinants as important barriers in access to health services. Conclusion: The study has documented the basic SDH of TB patients in RM, as well as barriers in access to healthcare, providing useful baseline information to facilitate determination where to concentrate future efforts

Violence and Injury Prevention – Challenges For Health Promotion in Macedonia

World Health Organization estimated 5.1 million deaths from injuries in 2002 in the world or 9% of all deaths, disproportionately affecting the young. These are a leading cause of premature death and DALYs at age of 5 to 45 years. In Europe injuries are third leading cause of death, after cardiovascular diseases and cancers with 800,000 or 8.3%. Injuries can be avoided and prevented. Many effective strategies can be used to target high risk groups and to reduce health consequences for victims of injuries. The health sector can play a key role in injury and violence prevention and control, by providing care and services to victims, prevention and advocacy, and engaging in partnerships with other sectors and across all levels of government and society. Decreasing the burden from injuries will require political commitment across all government levels and with this the allocation of adequate resources to take these activities forward. Future challenges for injury and violence prevention and health promotion, that the countries including Macedonia would face are: developing national action plans for unintentional injury and violence prevention, forming an intersectoral injury prevention committee, improving national surveillance system, strengthening national capacity to respond to the burden of injuries and violence through both primary prevention and care, promoting evidence-based practice by facilitating the exchange of knowledge and experience across the Region, recognize gaps in knowledge and prioritize research and development in both primary prevention and care, as well as studies on costs