The importance of international experience, capacity building activities and consistent environment and leadership for a critical policy decision and successful process of Family Medicine specialization and reeducation initiation in Macedonia Katerina Venovska MSPH, FM Spec. MD 3-4 September 2012 IV Biannual Conference Gothenburg on the Future of Primary Health Care in Europe IV: "Crossing Borders in Primary Care“ 24/05/2015Republic of Macedonia1

PROJECT COORDINATION UNIT Ministry of Health of Republic of Macedonia Health Sector Management Project (HSMP) - Loan by the WB (2004 – 2010) Provided financial & technical support and consistent environment & leadership Component 1: Health Policy Formulation & Component 3: Service Delivery Improvement Coordinator: Katerina Venovska, MSPH, FM Spec. MD 24/05/2015Republic of Macedonia2

HEALTH SECTOR MANAGEMENT PROJECT Health Strategy Development Process International Health Policy Consultant engaged (2005) Health Strategy Working Group established (2005) Health Situation analyses & needs assessment carried out Broad discussion & negotiations with stakeholders Transparent process involving profession and the public International experience reflected (WHO, WB...) Health Strategy 2020 developed & enforced by the Government (2006) 24/05/2015Republic of Macedonia3

FAMILY MEDICINE (FM) IMPLEMENTATION Training & International Experience - Strategic Planning HARVDARD SCHOOL OF PUBLIC HEALTH Strengthening Human Resources in Health SOUTHEMPTON CONFERENCE Future of Primary Care in Europe II Visit to St Mary’s Surgery 24/05/2015Republic of Macedonia4

FAMILY MEDICINE IMPLEMENTATION Public Relations & Communication (PRC) support Adequate communication of Health Reform goals & activities Increased cooperation with journalists (opponents to FM) Public Relations Working Group established within HSMP Technical support to PRC activities provided (2007) PRC Strategy developed (2008) Study Tour of Journalists in Netherlands organized (2009) Joint PRC on FM implementation with main stakeholders 24/05/2015Republic of Macedonia5

JOURNALIST STUDY VISIT TO NETHERLAND (2009) Ministry of Health, Welfare and Sport – Den Haag Domus Medicus - Utrecht Family Practice - Den HaagNIVEL 24/05/2015Republic of Macedonia6

FAMILY MEDICINE IMPLEMENTATION FM Strategy Development & Implementation Technical support & cooperation with Slovenian Family Medicine Department (Medical Faculty - Ljubljana) - HSMP Family Medicine Working Group established within HSMP FM Strategy and Implementation Plan developed (2009) Memorandum of Cooperation in FM implementation signed (Ministry of Health & Medical Faculty Skopje) - May FM Educators / Mentors (skilled CME educators) were engaged through HSMP and trained (2009/2010) FM Educational Board nominated at Skopje Medical Faculty 24/05/2015Republic of Macedonia7

FAMILY MEDICINE IMPLEMENTATION FM Capacity Building Activities Training of Core group of 24 FM Educators (2009, Ohrid) 6 day training curricula developed 50 FM Educators trained - Prilep Educational Centre (2010) Visit to FM Educators practices FM Continuous Medical Education program initiated Close cooperation with Association of GP/FD in Macedonia Training of additional groups of FM educators ( ) Study visits to Slovenia (Ljubljana & Bled) ( ) 24/05/2015Republic of Macedonia8

FAMILY MEDICINE CAPACITY BUILDING 24/05/2015Republic of Macedonia9 Training of FM educators – Cooperation with Slovenian FM Department Professors Training of additional groups of FM Educators by the Core Group of FM Educators

FAMILY MEDICINE CAPACITY BUILDING 24/05/2015Republic of Macedonia10 Debriefing of FM Educators after the trainingGroup of Certified FM Educators and teachers

FAMILY MEDICINE IMPLEMENTATION FM Department establishment at the Medical Faculty Family Medicine Educational Board operational FM specialization curricula revised and teaching program developed Family Medicine Specialization initiated (October 2009) First year of study - financial support provided to first 10 trainees Educational Centers in Veles, Gostivar & Strumica visited to plan their use for FM purposes Family Medicine Educational Centre in Skopje established & fully equipped with HSMP support (2010) 24/05/2015Republic of Macedonia11

FAMILY MEDICINE IMPLEMENTATION FM Specialization Initiation 24/05/2015Republic of Macedonia12 MEMORANDUM OF COOPERATION (FM) SIGNED - May 2009 Ministry of Health & Medical Faculty Skopje (Deputy Minister, Minister, & the Dean) FAMILY MEDICINE SPECIALIZATION LAUNCH - October 2009 Medical Faculty Skopje & MOH/PCU (Vice-Dean, Dean, MOH/PCU FM Coordinator, Medical Faculty FM Coordinator)

FAMILY MEDICINE EDUCATIONAL CENTER – SKOPJE Reconstruction, Equipping & Launch 24/05/2015Republic of Macedonia13 Acceptance of renovated & fully equipped premises Ministry of Health / PCU Family Medicine Educational Centre - Skopje Launch

FAMILY MEDICINE EDUCATIONAL CENTER International Experience & Cooperation Memorandum for Cooperation in the field of FM between Medical Faculty Skopje & Ljubljana signed (2010) Study visit to Slovenia & maintaining close cooperation with the GP/FM Associations & FM University Departments in Croatia, Montenegro, Slovenia, Serbia, Bulgaria, Turkey… Study visit to Nijmegen University, FM Department, Netherland and relevant institutions & Family Doctors Study visit to Imperial College, London, United Kingdom Bilateral Cooperation in FM between Macedonia & Turkey Contact established with FM Association in Canada Cooperation with Austrian FM University Dep. (CME Course) 24/05/2015)Republic of Macedonia14

FM INTERNATIONAL EXPERIENCE & COOPERATION 24/05/2015Republic of Macedonia15 Study visit to Imperial College, London, UK Study visit to Bled, Slovenia

FM INTERNATIONAL EXPERIENCE & COOPERATION 24/05/2015Republic of Macedonia16 Study visit to Domus Medicus, Utrecht, NetherlandStudy visit to Nijmegen, Netherland

FM INTERNATIONAL EXPERIENCE & COOPERATION 24/05/2015Republic of Macedonia17 Study visit to Family Practice near Nijmegen, Netherland

FM INTERNATIONAL EXPERIENCE & COOPERATION Bilateral Cooperation in FM with MOH / Turkey 24/05/2015Republic of Macedonia18

IMPROVED COLLABORATION IN FM IMPLEMENTATION 24/05/2015Republic of Macedonia19 Established & maintained good cooperation between the key players: Ministry of Health, Health Insurance Fund, Medical Faculty Skopje, Slovenian FM Department experts Macedonian Doctors Chamber Association of GP/FM Doctors in Macedonia

FAMILY MEDICINE EDUCATIONAL CENTER Retraining of GPs to become FM Specialists FM retraining curricula & teaching program developed Bylaw for Specializations referring to FM Specialization & Retraining of doctors working in GP practices adopted Specialization & Retraining Fees agreed between MOH, Medical Faculty Skopje & the Macedonian Doctors Chamber Web Site for FM specialization & FM activities created & regularly updated Second Group of FM specialization started in October 2010 Retraining of GPs in FM Specialists started in February 2011 in Prilep and Skopje FM Educational Centers 24/05/2015Republic of Macedonia20

SKOPJE FAMILY MEDICINE EDUCATIONAL CENTER Retraining of General Practitioners to FM Specialists 24/05/2015Republic of Macedonia21 Regular Training Sessions in the FM Educational Center Within FM Retraining activities Established Teacher exchange program with Ljubljana FM University Department based on the signed Agreement for Cooperation

TRAINING OF MEDICAL FACULTY PROFESSORS Family Medicine Specialist Exam – Examiners Preparation Appropriate FM Specialist Exam materials and program were developed The Medical Faculty nominated professors from various related fields to take part in the team of examiners for the FM Specialist Exam Orientation Training for the professors for the implementation of FM Specialist Exam was carried out by the Slovenian FM University Department Professors The first FM Specialist Exam was organized in May 2011 and managed by the Ljubljana University FM Department Professors in collaboration with trained Skopje Medical Faculty Professors First 24 FM Specialists in Macedonia certified in May 2011 Since then number of FM Specialists is growing - over 50 (2012) 24/05/2015Republic of Macedonia22

TRAINING OF MEDICAL FACULTY PROFESSORS Family Medicine Specialist Exam – Examiners Preparation 24/05/2015Republic of Macedonia23

FIRST GROUP OF FAMILY MEDICINE SPECIALISTS Certified by Slovenian Professors & Medical Faculty Skopje May /05/2015Republic of Macedonia24

THANK YOU 24/05/2015Republic of Macedonia25

ANY QUESTIONS? 24/05/2015Republic of Macedonia26