Програма За Рана Детекција На Малигни Заболувања Во Република Северна Македонија За 2021 Година

Objectives

The 2021 programme for screening, prevention and early detection of malignant diseases in North Macedonia combines organised cervical, colorectal and breast cancer screening with prevention and early-detection activities for prostate cancer. Its central purpose is to reduce cancer morbidity and mortality through earlier diagnosis, increased participation in screening, public awareness, professional education and stronger screening capacity.[1][2][3][4][5]

• Reduce cervical-cancer incidence and mortality by increasing women’s participation in organised screening, awareness of regular preventive examinations and the number of gynaecologists involved.[6][7]
• Achieve cervical-screening coverage of 75% of the female population over three years, which is identified as the programme’s success threshold.[6]
• Implement pilot colorectal-cancer screening for people aged 50 to 70, aiming to reduce mortality by 20% to 30%, reduce incidence by 20%, increase early detection from 14% to more than 50% within 10 years, improve quality of life and reduce treatment costs.[2][8]
• Promote prostate-cancer prevention and early detection through annual testing and rectal examination for men aged over 50.[3]
• Prioritise organised mammography screening and preventive awareness for breast cancer, which is identified as the most common malignancy among women and a leading cause of mortality in North Macedonia.[9][4]
• Reduce breast-cancer mortality, improve quality of life and lessen the need for early therapeutic and oncological treatment through early detection.[4]
• Strengthen screening systems by expanding facilities’ premises, staffing and equipment; improving data collection, service-quality control and radiology training; and supporting mammography centres that meet equipment and staffing standards.[10]
• Finance the programme through the 2021 state budget, with total approved funding of 25,500,000 Denari for cervical screening, pilot colorectal screening, breast-cancer promotion, organised mammography screening and outstanding obligations from the 2017 to 2020 programme.[5]

Implementation

Implementation uses an organised, multi-level delivery model led by the Ministry of Health and the Institute of Public Health of the Republic of North Macedonia, with public health centres, family doctors, gynaecological services, cytology laboratories, hospitals, specialist clinics, the Electronic Health Directorate, professional commissions and contracted providers undertaking defined screening, referral, reporting, education and quality-control functions.[11][12][8][13][14]

• Coordinate national planning, procurement, financing and monitoring through the Ministry of Health, while expert commissions provide professional oversight and advice on programme organisation.[8][15]
• Organise cervical screening through gynaecological organisations that identify eligible women, collect and submit samples to cytology laboratories, communicate results and report activity to public health centres.[11]
• Analyse cervical-screening samples in cytology laboratories, issue patient-specific reports and submit regular reports to public health centres.[11]
• Refer women with abnormal cervical findings for further diagnostic procedures, including colposcopy for women with a positive human papillomavirus test in a public health institution.[7][16]
• Support cervical-screening participation through family-doctor counselling, self-testing kits and instructions, promotional materials, local campaigns, professional education and national coordination of action plans.[17][16][18]
• Deliver colorectal screening using faecal occult blood tests for the target population, provide free testing through participating public health centres, repeat testing after two years following a negative result and refer positive results for colonoscopy in public health institutions.[2][19]
• Exclude from routine colorectal screening people already receiving diagnostic or therapeutic colorectal-cancer care, those with specified inflammatory bowel conditions or previous colon resection, and people with a recent documented normal colonoscopy, while offering counselling and referral for people and families at increased risk.[19]
• Use the Electronic Health Directorate to prepare participant lists, notify patients and family doctors, develop registry software and support monitoring tables in collaboration with the Institute of Public Health.[8][15]
• Maintain organised-screening databases and a colorectal-cancer registry through the Institute of Public Health, which coordinates nationally, provides methodological support, evaluates implementation and submits quarterly reports to the Ministry of Health.[19][15][13]
• Conduct breast-cancer awareness activities and mammography screening, with primary-care doctors recommending preventive examinations for women aged 50 to 55 and for women aged 40 to 50 with family risk; organised mammography is directed at women without clinical symptoms in the specified target age group.[9][4]
• Monitor mammography delivery through screening-coverage, recall, referral, positive-finding and early-stage detection indicators, alongside technical and diagnostic image-quality reporting, equipment-performance monitoring and radiation-dose reports.[10]
• Apply specialist quality control to mammography centres through daily image checks, annual testing and reporting for participating screening and diagnostic facilities.[20]
• Require monthly reporting by family doctors and gynaecological providers, quarterly consolidation by public health centres and quarterly and annual reporting by the Institute of Public Health to the Ministry of Health.[11][16][18]
• Disburse implementation funds to public and contracted private providers on the basis of invoices and reports documenting completed activities.[13][5]

Monitoring & Evaluation

Monitoring combines programme-coverage targets, activity and process indicators, routine reporting, screening registries and quality control across cervical, colorectal and breast cancer screening. Cervical screening identifies 75% coverage of the female population within three years as its success threshold, while colorectal screening assesses participation, timely reporting of positive findings, referral to colonoscopy, and longer-term reductions in mortality, morbidity and disability.[6][3]

• Track cervical-screening activity through numbers of tests and analyses, invitations, attendance, abnormal findings, detected cancer, participating gynaecologists, media events and promotional materials.[7]
• Require gynaecological organisations and cytology laboratories to report monthly or quarterly to public health centres; require the Institute of Public Health of the Republic of North Macedonia to compile quarterly and annual reports and analyses for the Ministry of Health.[11][21]
• Use the organised-screening database and periodic laboratory or public-health-centre reports for monitoring and evaluation, with authorised providers continuously entering and updating screening data.[12][13]
• Require quarterly colorectal-screening implementation reports from the Institute of Public Health to the Ministry of Health, supported by a colorectal cancer registry and Electronic Health Directorate registry software and indicator tables.[19][8][15]
• Apply defined cervical-screening reporting deadlines: family doctors report monthly, public health centres report quarterly, and the Institute submits consolidated quarterly and annual reports to the Ministry within 30 days of the relevant period.[16]
• Measure cervical-screening invitations, uptake, HPV testing, exclusions, refusals, results delivery, inadequate tests, programme coverage, positive and negative results, and referrals for colposcopy.[22]
• Monitor breast-screening delivery through examinations and coverage among women aged 50 to 69, recalls, imaging, referrals, positive findings including early-stage findings, and image technical and diagnostic quality.[10]
• Conduct mammography quality assurance through daily image checks, annual testing, facility reports, and monitoring of equipment performance and patient radiation doses.[10][20]
• Track mammography-support activities through screening-result tables, quarterly and annual reports, numbers of women invited and screened, numbers of trained nurses and doctors, and trained screening teams.[23]

Formal accountability is principally exercised through Ministry of Health oversight, expert professional supervision, routine reporting, and evaluation against defined indicators. The available material does not set out a single cross-programme evaluation methodology, data-quality protocol, surveillance case definition, or independent accountability mechanism.[8][15][3]

Costing & Financing

The 2021 financial framework totals 25,500,000 Macedonian denars from the approved North Macedonia state budget, administered through the Ministry of Health and disbursed to public and contracted private providers against implementation invoices and reports.[5]

• Allocate 9,600,000 Macedonian denars to cervical-cancer screening, 5,572,000 Macedonian denars to pilot colorectal-cancer screening, 200,000 Macedonian denars to breast-cancer prevention and early-detection promotion, and 7,736,000 Macedonian denars to organised mammography screening.[5]
• Provide 2,392,000 Macedonian denars for outstanding obligations under the 2017-2020 programme.[5]
• Fund cervical-screening coordination and promotion, supplementary examinations and material delivery, cytology laboratory analysis, public-health-centre coordination, national strategy preparation, HIV testing, information materials, monitoring, reporting and mobile gynaecological activities.[24][25]
• Fund colorectal-screening coordination, faecal occult blood test analysis, software data entry, quarterly reporting, and family-doctor testing, counselling, referral and reporting.[26]
• Fund breast-screening programme organisation, information-technology equipment, mammography delivery, quality control, evaluation, awareness activities, studies, training, reports and promotional materials.[14][27][20][28][23]
• Assign the Ministry of Health responsibility for financing screening implementation and procuring colorectal-screening tests and materials.[19][8]

Several activity tables provide allocations or unit costs, but some omit currency and dates. Apart from the approved 2021 state-budget allocation and invoice-and-report-based payment mechanism, the material does not specify external funding sources, funding gaps, resource-mobilisation arrangements, or economic assumptions.[20][23][5]