National Action Plan For Health Security For The Republic Of North Macedonia 2024-2030

Objectives

North Macedonia’s National Action Plan for Health Security (NAPHS), covering 1 January 2024 to 31 December 2030, is a country-owned, multi-year framework for implementing International Health Regulations (IHR) core capacities through an all-hazards, One Health approach. It aims to prevent, protect against, control and respond proportionately to the international spread of disease, translating evaluation findings and national risk priorities into sustained health security action.[1][2][3][4]

• Harmonise legislation, institutional mandates and coordination arrangements for IHR implementation, including clearer stakeholder roles and a uniform coordination structure.[1][5][4]
• Secure sustainable financing for IHR capacities and establish mechanisms for timely emergency funding.[1][5][6]
• Strengthen One Health collaboration across human health, veterinary, food safety, environmental, security and other sectors, including joint risk assessment, information sharing, training, exercises and incident management.[1][5][6][7]
• Improve prevention, detection and response capacities for antimicrobial resistance, zoonotic and vector-borne diseases, food safety emergencies, immunisation, laboratories, biosafety and biosecurity, and communicable disease surveillance.[1][8][9][10]
• Develop real-time antimicrobial resistance data exchange between human and veterinary sectors, integrated surveillance for foodborne disease and contamination, and linked surveillance, laboratory and hospitalisation data systems.[1][4][11][10]
• Enhance emergency preparedness, including risk communication, points of entry, medical countermeasures, hospital safety, chemical incidents, radiation emergencies and safe transport of infectious and biological materials.[12][4][10][13]
• Build and retain a multidisciplinary workforce through updated training, professional incentives, workforce mapping, field epidemiology education and long-term workforce planning.[5][10]

The plan responds to strategic risk assessments that ranked COVID-19 and seasonal influenza as very high risks in separate sub-national workshops, alongside high or moderate risks from measles, air pollution, West Nile fever, foodborne disease, avian influenza, floods, wildfires, earthquakes and other hazards.[14][4]The first operational plan, for 1 January 2024 to 31 December 2025, contains 135 activities across 19 technical areas and principally focuses on preparatory assessments, procedures, regulations, guidance and curricula needed for longer-term implementation.[12][6][15]

Implementation

Implementation combines government strategic steering with Ministry of Health-led multisectoral coordination, supported by a NAPHS Secretariat as the operational coordination body and 19 technical working groups. The approach uses a seven-year strategic plan and a costed two-year operational plan, aligning actions with national risks, existing plans, evaluation recommendations and available resources.[1][12][4][15]

• Steer implementation through the Government, which holds overall policy decision-making responsibility following plan endorsement, while involving all relevant sectors.[12][13][15]
• Lead cross-sector delivery through the Ministry of Health, including implementation guidance, activity organisation, monitoring and evaluation, information dissemination and reporting to Government.[12][15]
• Coordinate operational delivery through the Secretariat, including stakeholder engagement, progress communication, transparent information-sharing meetings, annual review and reduction of duplicated activities and investments.[12][15]
• Engage institutions including the Institute of Public Health, medical faculties, Crisis Management Centre, Ministry of Interior, Protection and Rescue Directorate, Directorate for Radiation Security, Red Cross, health and veterinary services, laboratories, points-of-entry staff and relevant security authorities.[1][4][10][16]
• Develop legislation, technical guidelines, standard operating procedures, contingency and operational plans, communication protocols and terms of reference for coordination bodies and nominated representatives.[12][6][7]
• Strengthen delivery systems through laboratory upgrades and networks, electronic surveillance and stockpile-management systems, hospital and emergency-response capacity, immunisation training, reference laboratories and laboratory quality-management arrangements.[12][9][11][16]
• Conduct regular table-top, field and full-scale simulation exercises for IHR risks, zoonoses, food safety emergencies, chemical, biological and radiation incidents, points of entry and emergency coordination, and use results to improve procedures.[7][10][16]
• Mobilise resources through annual budget processes, the Mid-Term Expenditure Framework, mapping of national and donor resources, and engagement with partners and donors to address capacity and financing gaps.[3][13]

Monitoring draws on the IHR Monitoring and Evaluation Framework, including mandatory annual reporting, after-action reviews, simulation exercises and voluntary external evaluations such as the Joint External Evaluation.[2]The Secretariat is expected to develop the monitoring and evaluation methodology, organise annual evaluation of the operational plan and prepare updates for Government decision-making.[12][15]The source does not provide a consolidated indicator framework, detailed reporting timetable or quantitative performance targets for all activities.[12][13][15]

The two-year operational plan has a preliminary cost of 3,408,000 US dollars.[2][15]Costing uses the World Health Organization NAPHS Planning and Costing Tool, national unit prices and thematic working-group estimates for the 135 activities.[12][2]Priority resource allocations are Biosafety and Biosecurity at 34.2%, Radiation Emergencies at 20.8%, and the National Laboratory System at 20.3%.[15]The estimate primarily covers preparatory work and excludes full procurement and operating costs for equipment, accreditation, national coordination bodies and curriculum implementation.[2][15]

Monitoring & Evaluation

Monitoring and evaluation combine International Health Regulations (IHR) assessment tools, routine surveillance, exercise-based testing and annual operational-plan review. The evidence base includes the State Party Self-Assessment Annual Reporting Tool 2022, Joint External Evaluation 2019, Strategic Tool for Assessing Risks 2023 and Vulnerability and Risk Analysis and Mapping 2022.[1]The IHR Monitoring and Evaluation Framework provides for mandatory annual reporting, after-action reviews, simulation exercises and voluntary external evaluations.[2]

• Coordinate monitoring, evaluation and reporting to Government through the Ministry of Health, while the National Action Plan for Health Security Secretariat organises annual evaluation of the two-year operational plan and prepares updates for Government decision-making.[12][2][15]
• Use annual review findings, lessons learnt, and changes in context or available resources to revise implementation, mitigate risks and progress from preparatory work towards operational delivery.[2][13]
• Strengthen integrated surveillance for communicable diseases, foodborne diseases and food contamination, antimicrobial resistance, zoonoses, chemical events and other hazards through electronic reporting, laboratory networks, shared databases and links between surveillance, hospitalisation and laboratory data.[6][7][11][10]
• Maintain reporting to the World Health Organization, Food and Agriculture Organization and World Organisation for Animal Health through national reporting networks, protocols and focal-point arrangements.[17][6][10]
• Test laws, standard operating procedures, financial mechanisms and response arrangements through regular and full-scale simulations, including exercises for zoonotic, chemical, radiation and biological incidents, points of entry and emergency coordination.[7][10][16]
• Assess preparedness through peer review, expert discussion, field visits, consensus scoring, hospital safety assessments and national risk assessments.[5][8][18][19][10]
• Strengthen accountability through defined terms of reference, nominated representatives, institutional biosafety officers and multisectoral coordinating bodies.[7][9][11]

Routine communicable-disease surveillance includes individual case reporting across health-service levels, syndromic ALERT surveillance, sentinel surveillance for severe acute respiratory infection, event-based surveillance and laboratory-based COVID-19 surveillance.[20][21]The Institute of Public Health coordinates national data collection and produces weekly, monthly, periodic and annual reports.[21]The available material does not provide a consolidated indicator framework, quantitative performance targets, a detailed reporting timetable or an independent accountability mechanism.[6][7][13][15]

Costing & Financing

The first two-year National Action Plan for Health Security operational plan for 2024-2025 was costed using the World Health Organization planning and costing tool, national unit prices, expert-defined quantities and estimates for 135 activities.[12][2]The plan is intended to support sustainable financing for IHR implementation, including gradually increased funding and a dedicated emergency budget mechanism within the state budget.[5][6][7]

• Use costing and resource-gap analysis to inform annual ministerial budget allocations, the Mid-Term Expenditure Framework and mobilisation of additional external financing.[3][13]
• Map national and donor resources, identify capacity and financing gaps, and seek partner and donor support alongside increased Government health allocations and improved financial management.[3][13]
• Prioritise resource allocations for biosafety and biosecurity, radiation emergencies and the national laboratory system.[15]
• Ensure financing for the human resources required to operationalise the Public Health Emergency Operations Centre.[6][7]

One source gives the preliminary operational-plan total as 3,408,000 US dollars, equivalent to 192,211,200 Macedonian denars at 56.4 Macedonian denars per US dollar on 21 December 2023.[2]A separate cost summary gives the same US dollar total but 190,993,453 Macedonian denars, creating an inconsistency in the reported local-currency equivalent.[15]Costing primarily covers preparatory activities, such as needs assessments, procedures, draft regulations and training curricula, rather than full implementation.[2][15]

Excluded or unquantified costs include equipment procurement and operation, accreditation, establishment and operation of national coordinating bodies, and curriculum implementation.[2][15]Budgetary constraints and financial barriers remain implementation risks, but no quantified funding gap, committed domestic allocation, external financing commitment or resource-mobilisation target is specified.[12][2]Tourism figures are reported as economic context rather than health-security financing.[20]