“Suspicion towards vaccines diminishes when faced with facts. The communities I work with trust me because they know I’m going to show up and always fight for the people,” explains Fatma Bajram Azemovska, a community leader in Bitola, North Macedonia.
The COVID-19 pandemic expanded existing pockets of mistrust and suspicion related to vaccines in North Macedonia, especially within marginalized groups such as Roma communities. It also made a lasting impact on mental health, including among children and adolescents.
In response, the WHO Country Office in North Macedonia has engaged trusted nongovernmental organizations and influential women community leaders in country-wide efforts to correct misinformation, bust myths, and increase dialogue around immunization and mental health.
Increasing awareness about immunization
Between 2022 and 2024, the WHO Country Office engaged a Skopje-based nonprofit, the Association for Sustainable Development (BIOM), to train and mobilize a cadre of 15 passionate women consisting of educators, parents, municipal leaders and professionals, to lead grassroots education campaigns on the value of vaccines to public health.
In each municipality, the women – including Fatma, a local activist who has been working for Roma rights for over 25 years – organized community events such as panel-style question-and-answer sessions about immunization to foster engagement and informed discussions.
“In the Roma community especially, trust is a key ingredient to success,” Fatma points out. Seen as a compassionate voice of reason among the communities in which she works, she has succeeded in building lasting relationships steeped in mutual respect.
Over time, knowledge about immunization has increased in the engaged communities, along with uptake of vaccinations, particularly against human papillomavirus (HPV); measles, mumps and rubella; and SARS-CoV-2, the virus that causes COVID-19.
Tackling mental health stigma
WHO and BIOM also launched a campaign to educate influential female community leaders to recognize and respond to young people with mental health problems and encourage open discussions about mental health. It aimed to normalize seeking mental health and psychosocial support, which is still taboo for many people in North Macedonia. Making mental health a normal part of health-care discussions is helping to change this.
Since the COVID-19 pandemic, levels of depression and anxiety among children and adolescents in North Macedonia have risen, outbursts of violence have increased in schools, self-harm incidents among children have become more frequent, and social media bullying has become more prevalent.
Many parents are also struggling to navigate new behavioural issues arising in their children, and this has been linked to a rise in violence against children. There is an overall lack of support services at the community level across the country, and a lack of capacity among parents, teachers and professional staff at schools to respond.
“Women often make decisions relating to the health of their children and families, yet feel that their voices are not heard within the health-care sector,” explains Zurija Memedova, President of BIOM. “We mobilized strong, passionate women leaders who listened to mothers, young people, teachers and professionals in communities and created communication bridges between communities and local government institutions to help in coming up with appropriate responses to health issues.”
Supporting parents
Marija Raleva, a child and adolescent psychiatrist supporting the Alternativa Center of Excellency in Parenting in Skopje, designed and delivered 2 workshops with women leaders in the community to increase awareness of the importance of the mental health of children and adolescents. She invited the women to take the lead on sensitizing the community to this issue. This work led to the creation of a new parental support centre, which opened its doors on 7 October 2024.
The workshops focused on:
- defining good mental health;
- identifying how parents influence the mental development of their children;
- calling out misperceptions and their root causes;
- defining risk factors contributing to mental health challenges, including individual, family, community and societal factors;
- recognizing the symptoms of deteriorating mental health among children and adolescents;
- clarifying how to respond to deteriorating mental health; and
- designing community responses.
“It’s really empowering to see these trainings being put into practice. The women leaders initiated this process, and parents and school staff became so involved in working to improve things for our country’s children,” shares Marija.
WHO relies on its existing relationships with local nongovernmental and nonprofit organizations. These partners, broadly called non-State actors, form a crucial network throughout the WHO European Region and further afield, lending trusted influence to local communities on key health topics.