HIV/AIDS and Young People's Health

ISSUES
The country is on track to achieve the MDGs in regard to health. The under five mortality rate (U5MR) was 17 per 1,000 live births in 2006 and the maternal mortality rate was 13.3 per 100,000 live births in 2005 while the adult HIV prevalence rate remains below 0.1 per cent.

However, disparities in access to basic primary health care services remain wide between urban and rural areas and among different socio-economic and ethnic groups, with very limited access among the Roma population. Also, the quality of services is generally very low.

Overview of key health indicators concerning mother and child health

• The country has the highest perinatal mortality* in Europe, with 16,8 per 1,000 births against the European Union average of six (*perinatal mortality includes still births and newborn deaths occurring within first 7 days after delivery);
• Trends in differences of immunization coverage exist on ethnical basis, Macedonian/Roma=19 per cent;
• Macedonian/Albanian=7.5 per cent;
• Approximately 17 per cent of all children are not covered under the public Health Insurance Scheme;
• In the poorest quintiles, 25 per cent of children aged 18-29 months have missed out on at least one out of eight recommended vaccinations (these children come predominantly from rural areas and from Roma and Albanian ethnic communities);
• The three poorest quintiles have 1.5 times higher probability of dying before the age of five compared to the national average;
• In rural areas the under five mortality rate is 2.6 times higher than in urban areas;
• Decline of exclusive breastfeeding rates since 2001 – from 65% to 16%; 
• Double burden of malnutrition with stunted (8,6 per cent) and overweight (10,7 per cent) children where significant differences exist based on maternal education, wealth status and ethnicity
  Sources: Multiple Indicators Cluster Survey (State Statistical Office), 2005/2006; UNICEF Child Poverty Study, 2007

ACTION

UNICEF HIV/AIDS Prevention and Young People’s Health programme aims at contributing to national reforms in the health sector by supporting interventions to increase access to and quality of basic primary health care services for children. More specifically, through this programme, UNICEF:

• Supports the Ministry of Health and other relevant health institutions in the development of integrated mother and child health care policies and services, especially in the areas of immunization and perinatal and newborn care. These actions are being developed within the context of the ongoing primary health sector reforms and decentralisation of primary health care services. 
• Supports capacity development of health professionals in planning, budgeting and decentralization of preventive health programmes in the area of mother and child health, including by strengthening national systems to regularly monitor the health status of women and children. 
• Supports the setting up of an adolescent health surveillance system to regularly monitor prevalence of risk behaviors among adolescents in the country, including in the area of HIV-AIDS.

• UNICEF is supporting the Ministry of Health in strengthening the national health monitoring system. A new Law on Health Statistics, aligned with EU criteria, is expected to be approved by end of 2008, while the setting up of an Adolescent Health Information System (ongoing) under the responsibility of the Republic Institute for Health Protection will support accurate and systematic monitoring of health risk behaviors among adolescents. 
• Interventions reaching out to adolescents and young people most-at-risk of HIV infection have been included in the National AIDS Strategy (2007-2011) through UNICEF advocacy work. To download version of the strategy in Macedonian language click here Национална стратегија за ХИВ/СИДА (2007-2011)
• UNICEF provided technical support to the Republic Institute for Health Protection for the development of a second generation HIV/AIDS surveillance system, through the creation and installation of seven databases for most-at-risk to HIV target groups. As a result, the first national behavioral and serological study on HIV/AIDS was completed and presented in 2006, setting the baseline data that determined priority interventions in the new National AIDS strategy (2007-2011). Furthermore, a qualitative research study on Most-at-Risk Adolescents (MARA) was finalized in 2007. The study provides knowledge on lifestyles, social networks, relationships and perceptions and these findings will inform the development of targeted polices and out-reach services for most-at-risk adolescents.
•  In 2007, UNICEF supported the Ministry of Health in a campaign to improve access to services for most-at-risk adolescents (MARA). The campaign included the production and dissemination of a documentary and TV spots on both national and regional television stations. The campaign generated dialogue at both national and local community levels to support the process of identifying community responses and increased the general awareness of MARA as well as an understanding of the scale of MARA in the country. The documentary motivated round table discussions among local decision makers and service providers in six major cities and informed the development of local action plans.
• A National Assessment of Youth Friendly Services was conducted in 2006 which informed the development of the National Adolescent Health Strategy (2008-2015), currently being finalised by the Ministry of Health with UNICEF technical support. The strategy addresses the inequalities in access to health services and health promotion programmes.
•  In 2006 and 2007, UNICEF supported the Ministry of Health in setting up two Youth Friendly Health Centers in Skopje which serve as good practice models for integrated health and social services and in developing standards and protocols for stationery and outreach youth friendly health services. By the end of September 2007, 6,635 clients (over 80% young people) were covered by various types of services in the centres. Some 3,692 received special medical services with regards to their sexual and reproductive health, while 4,559 were reached through different educational activities. Both centres are operated by medical professionals from the preventive health teams while out-reach activities and community mobilization are being provided by local NGOs.
• In 2007, UNICEF supported the Ministry of Health in establishing in-patient and out-patient departments within the clinic for infectious diseases in Skopje.