Antenatal protocols: legally is fine, in practice lacks even more


The funds planned for the programs for mothers and children are not enough, and it is also concerning that sometimes the planned funds are not realized, which happens in most of the cases.


In the Strategy for safe motherhood from 2010 to 2015, it was confirmed that the national clinical guidelines and protocols for prenatal care are old and should be revised. In the Strategy for sexual and reproductive health 2010 – 2020, it is stated that previously Macedonia had no prenatal protocols. The prenatal care in Macedonia was regulated in 2010 for the first time. The Ministry for Health brought a Manual for the way of performing the health activities for prenatal controls during pregnancy. This is what the regulative for prenatal care shows, and which brought in the last few years.

The legal analysis in the legislative of this area shows that there isn’t a particular disagreement between the laws’ and bylaws’ acts which refer to the prenatal care. But, in the Law for protection of the rights of the patients it is foreseen to form local commissions for promoting the rights of the patients, and that every municipality should have this commission. Few years after the establishment of the Law, only the City of Skopje and the Municipality of Ohrid have formed these commissions. protocol

Usually there are bigger disagreements when it comes to practical work. For example, the compensation by the Fund for health insurance of Macedonia for pregnant women who are employed, is five – six months late, and usually in the period when they are most vulnerable and in need of finances.


Bigger control

It is inevitable to ask the question: where do we need to change the regulative when it comes to prenatal health services?

Therefore, in the part of the monitoring and evaluation of the Programs for active protection of mothers and children, where a separate part is planned for prenatal care. These programs are brought by the Macedonian Ministry for Health. Besides the Ministry for health, an additional independent body is needed, organ or commission, comprised by representatives of the non-government sector which deal with this problematic. This organ, no matter the needs, will prepare an annual report for realization of the planned funds and implementation of the planned measurements and activities. In that way, the realization of the programs will be more transparent and the eventual weaknesses will be easier to identify and then removed, depending on the level of realization.

From a legal point of view, this material is covered, i.e. there are significant numbers of laws’ and bylaws’ acts, regulations, manuals which regulate the prenatal protection and care. Then, where does the problem occur and is there a problem at all?

The answer of this question is positive. The physical infrastructure and medical equipment should be updated or renewed so that they could respond to the real needs. The system of the health statistic and information is not computerized or integrated enough. This makes it significantly difficult to monitor of specific indicators, run certain data needed for prenatal care and decreases the ability to analyze the problems in order to plan the adequate activities for dealing with the negative tendencies in this area. The exchange of information on different levels of protection is also difficult. The funds planned for the programs for mothers and children are not enough, and it is also concerning that sometimes the planned funds are not realized, which happens in most of the cases. The transparency of the programs for mothers and children is weak. Inappropriately allocated personnel, as well as a need for further education are the basic needs which should start in the next period.

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