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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.