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) is a seven-year framework for 1 January 2024 to 31 December 2030, intended to strengthen preparedness and response to public-health emergencies by implementing and sustaining the core capacities of the International Health Regulations (IHR). It adopts an all-hazards, One Health approach to improve national and international health security, protect travel and trade, and support wider economic and social development.[1][2][3]

• Harmonise national legislation, policy and coordination arrangements with the IHR, including clear mandates, roles and responsibilities for emergency management.[2][4][5]
• Secure sustainable financing for IHR capacities, including a dedicated state emergency-budget allocation and activation protocol, while using annual budget processes and the medium-term expenditure framework to guide resource allocation.[3][5][6]
• Strengthen multisectoral coordination, communication, surveillance, reporting and risk assessment across human health, animal health, food safety, agriculture, environment, security and emergency-management sectors.[2][7][5]
• Advance antimicrobial resistance management, zoonotic-disease prevention and control, food-safety preparedness, biosafety and biosecurity through One Health policies, joint databases, strategies, contingency plans and coordinated technical capacities.[2][6][8][9]
• Improve laboratory systems, immunisation coverage, real-time disease surveillance, incident reporting and the multidisciplinary workforce needed for preparedness and response.[2][5][8][10]
• Enhance preparedness for health emergencies, hospital and mass-casualty events, chemical incidents, radiation emergencies, and risks at points of entry, alongside risk communication and community engagement.[2][11][12][13]

The plan is informed by the 2019 Joint External Evaluation, the 2022 State Party Self-Assessment Annual Reporting Tool, the 2022 Vulnerability and Risk Analysis and Mapping exercise, and the 2023 Strategic Tool for Assessing Risks. These assessments identified priority hazards and capacity gaps, including workforce shortages, brain drain, barriers to multisectoral collaboration and fragmented emergency coordination.[1][4][14][15]

A first two-year operational plan for 1 January 2024 to 31 December 2025 translates the strategic framework into 135 activities across the 19 technical areas assessed through the Joint External Evaluation. Its immediate objectives are to strengthen multisectoral capacities, produce technical guidance, standard operating procedures, operational plans and communication protocols, and reinforce One Health policy and operational planning.[2][5]

Implementation

Implementation is designed as a country-owned, whole-of-government and whole-of-society process that converts assessment recommendations into prioritised actions aligned with national risks, plans and resources. The Government provides overall policy direction and steering; the Ministry of Health leads cross-sectoral coordination, monitoring, information dissemination and reporting to Government; and the NAPHS Secretariat operates as the central operational coordination body.[16][3]

• Coordinate delivery through the Ministry of Health’s IHR multisectoral committee, the NAPHS Secretariat and 19 multisectoral technical working groups covering all Joint External Evaluation technical areas.[1][15][5]
• Engage public and private stakeholders from health, public health, veterinary services, agriculture, food safety, environment, finance, security, emergency management, education, transport, laboratories, hospitals, universities, the Red Cross and relevant humanitarian bodies.[1][3][6][12]
• Develop and update legislation, strategies, guidelines, standard operating procedures, contingency plans, protocols and digital systems that support joint preparedness, outbreak management, laboratory governance, surveillance and risk communication.[2][8][9][10]
• Build workforce capability through professional incentives, applied epidemiology and in-service training, workshops, cascade training, supportive visits, study visits and participation in the European Union Civil Protection Mechanism training programme.[4][7][12][13]
• Conduct joint risk assessments, table-top and full-scale simulation exercises, after-action reviews and regular multisectoral exercises to test legal, policy, financial and operational arrangements.[4][6][10][12]
• Improve operational readiness by strengthening emergency-response teams and hospitals, establishing electronic stockpile information for personal protective equipment and medicines, upgrading laboratory infrastructure and safety systems, and improving links between surveillance, laboratory and health-service information systems.[2][8][10][13]

Existing delivery infrastructure includes the Institute of Public Health, 10 regional Public Health Centres and 21 regional units for communicable-disease surveillance and response, alongside the crisis-management system’s 35 Regional Crisis Management Centres. Surveillance combines individual case reporting, syndromic surveillance, sentinel surveillance, event-based surveillance, epidemiologist teleconferences and laboratory-based surveillance.[17][18]

Monitoring and learning are intended to be continuous. The Secretariat is to organise annual monitoring and evaluation of the operational plan, while the Ministry of Health reports progress to Government; annual review is intended to support operational-plan updates in response to lessons learnt, changing risks and resource conditions.[16][13]The wider IHR monitoring framework includes annual reporting, after-action reviews, simulation exercises and voluntary external evaluations.[3]

The preliminary cost of the first operational plan is 3,408,000 US dollars, equivalent to 192,211,200 Macedonian denars, for 1 January 2024 to 31 December 2025. The estimate focuses on preparatory activities and excludes full costs for equipment purchase and operation, accreditation, national coordination bodies and training-curriculum implementation.[16]Budget constraints, insufficient multisectoral engagement and delays in approving drafted legislation are recognised implementation risks, requiring mitigation and continued domestic and partner support.[2][16]

Monitoring & Evaluation

The National Action Plan for Health Security (NAPHS) uses a layered monitoring and accountability approach combining International Health Regulations (IHR) assessments, routine surveillance, annual operational-plan review, simulation exercises and after-action learning. The Ministry of Health coordinates monitoring and evaluation, information dissemination and progress reporting to the Government, while the NAPHS Secretariat organises annual review of the operational plan.[16]

• Use the 2022 State Party Self-Assessment Annual Reporting Tool, 2019 Joint External Evaluation, 2023 Strategic Tool for Assessing Risks and 2022 Vulnerability and Risk Analysis & Mapping as the evidence base for health-security planning and priority setting.[1]
• Apply the World Health Organization IHR Monitoring and Evaluation Framework, which includes mandatory annual reporting, after-action reviews, simulation exercises and voluntary external evaluations such as the Joint External Evaluation.[3]
• Review implementation annually and use findings to update the two-year operational plan, move activities from preparation to operational delivery, and adjust implementation in response to lessons learned, changing circumstances and resource constraints.[16][13]
• Report infectious-disease intelligence through local, regional and national systems. The Institute of Public Health coordinates national epidemiological and laboratory surveillance, while records support weekly, monthly, periodic and annual reporting.[17][18]
• Maintain surveillance for antimicrobial resistance, zoonoses, foodborne disease, priority diseases, unusual events and chemical, radiological and nuclear hazards. Electronic tools, laboratory referral networks and national reporting protocols are intended to support timely analysis and reporting.[7][19]
• Strengthen real-time surveillance through digital reporting, case classification, cluster and outbreak detection, hospitalisation-data links, and interoperability between EPIS, LIMS and VIS systems. Define weekly, monthly and annual analyses, risk-assessment processes and procedures for digital surveillance and Alert 2.0.[10]
• Conduct regular multisectoral and full-scale exercises, including annual exercises for surveillance, zoonoses, vector-borne diseases and incident reporting. Evaluate food-safety simulation exercises to test standard operating procedures and coordination.[6][10]
• Assess hospital and border-health preparedness using Hospital Safety Index scores and the World Health Organization points-of-entry assessment tool. The Hospital Safety Index was applied to 44 hospitals in 2017, providing a baseline on health-infrastructure vulnerability.[11][12][13]
• Use joint risk assessment, incident management, training, working groups, supportive visits, regional meetings and after-action reviews as practical accountability mechanisms across human, animal, food and environmental health sectors.[4][8][9]

The supplied material does not provide a consolidated indicator framework, indicator definitions, numerical targets, a detailed reporting calendar, or a single formal accountability report for the overall NAPHS. Assessment scores are available across technical areas through Joint External Evaluation and State Party Self-Assessment Annual Reporting processes, but the extract does not specify how these scores translate into plan-level performance targets.[7][19]

Costing & Financing

The first two-year NAPHS operational plan was costed using the World Health Organization National Action Plan for Health Security Planning and Costing Tool. Its preliminary cost for 1 January 2024 to 31 December 2025 is 3,408,000 United States dollars, equivalent to 192,211,200 Macedonian denars using an exchange rate of 56.4 denars per United States dollar on 21 December 2023.[16]

• Cost activities using uniform national unit prices, quantities identified by thematic expert working groups and estimates for each of the 135 operational activities.[16]
• Use NAPHS costing and resource mapping to identify gaps between existing national and donor resources and the resources required to deliver IHR capacities.[3]
• Support evidence-based resource allocation through annual budget processes and the medium-term expenditure framework, while documenting the contribution and impact of donor financing.[3]
• Advocate for a dedicated state emergency-budget allocation for IHR activities and establish a protocol for activating that budget during emergencies.[6]
• Finance human resources needed to operationalise the Public Health Emergency Operations Centre and pursue more sustainable financing for IHR implementation.[5][6]
• Increase health-budget allocations and improve financial management to support efficiency, effectiveness and value for money in financing the Government’s share of NAPHS implementation.[13]

The preliminary estimate focuses on preparatory work and excludes the full costs of equipment purchase and operation, accreditation, establishment and operation of national coordination bodies, and implementation of training curricula.[16]Budget constraints are identified as a major implementation risk, alongside the need for professional and financial incentives to address workforce shortages and brain drain.[2][4]

The material records international partners’ willingness to support the NAPHS and calls for continued support alongside sustainable domestic capacity building, but it does not identify confirmed funding sources, annual government allocations, quantified funding gaps or a financing schedule.[1]Beyond the stated exchange rate and costing methodology, no broader economic assumptions are specified.[16]