In an effort to advance health equity in North Macedonia, WHO/Europe recently conducted an assessment to identify equity gaps and find ways to promote people’s access to quality and equitable health services.
WHO/Europe’s “Health inequity assessment” has focused on data collection and analysis, which are playing a key role in guiding policy-making and closing equity gaps.
“We need a multisectoral approach to advance gender equality, equity and human rights in health. WHO has played a leading role in building sustainable partnerships and generating data and evidence to uncover gaps and initiate health policy dialogues to drive change and spark more investments into health equity monitoring,” said Dr Anne Johansen, WHO Special Representative and Head of the Country Office in North Macedonia.
Investing in better data
The health inequity assessment, funded by the Government of Canada, has catalysed the development of a national health equity monitoring system to improve data collection and disaggregation, which is essential for tracking and addressing health inequities. Health inequities are unfair and avoidable differences in people’s health status, such as lower life expectancy or barriers in accessing health services that are affected by factors such as socioeconomic status, ethnicity, gender identity or place of residence.
Although North Macedonia has a robust health data collection system, data is often not disaggregated. Thus there is need for more nuanced data disaggregation by sex and age, and also for collecting and analysing data by geographic locations to uncover and tackle health service barriers and gaps. Better data on people living with disabilities is also crucial to advance health equity.
“The WHO-supported health inequity assessment is an important step towards improving country capacity to collect more nuanced and detailed data, to set up monitoring systems and to elevate gender, equity and rights considerations – not only within the health sector but also in broader national development strategies and interventions,” noted Dr Johansen.
With funding from the United States Agency for International Development (USAID), WHO has recently completed a barriers assessment to gather more evidence on issues impacting equitable health-care access in North Macedonia.
“We need data to take action. We are focused on a sustainable approach and building national capacity in data collection and analysis at the health facility and national level, and strengthening the embedding of health equity in broader national frameworks to ensure nobody is left behind,” Dr Johansen added.
Addressing health inequities to leave no one behind
In North Macedonia and globally, health inequities are driven by weak health systems, financial insecurity, poor living conditions, gender inequality, lack of social and human capital, and non-secure employment and work. This makes it hard for individuals and families, especially in rural and disadvantaged areas, to escape health inequities.
Almost 40% of the people in North Macedonia were at risk of poverty or severe material deprivation in 2019 and over 43% of children were at risk of poverty or social exclusion. COVID-19 further exacerbated existing inequities and challenges.
The pandemic rolled back gains on equality by weakening financial and social protection systems, also leading to serious mental health challenges.
“But the pandemic has also allowed us to raise health equity to a higher level on the political agenda,” said Dr Johansen.
The pandemic also provided an opportunity to accelerate equity efforts by increasing health-care coverage and reach, especially of immunization services. Integrating gender, equity and human rights into national COVID-19 recovery plans and strategies is critical.
High out-of-pocket expenditure on health-care costs and inequitable access to health services, especially in rural and remote areas, are challenges WHO continues to tackle with partners on the ground. Improved access to medication, especially for chronic conditions and for people living in remote areas, is required.
“We are working closely with United Nations partners and the government to set up the health equity monitoring system and support its functioning while also improving protection and employment conditions for health workers, the majority of whom are women,” Dr Johansen said. “WHO remains committed to building a fair and healthy society and health systems that leave no one behind, and pave the way for a more equitable future for all in North Macedonia.”