The vital role of patronage services: reaching every child amid growing challenges
Home visiting helps close inequality gaps and support children to achieve their full potential
- English
- Македонски
- Shqip
In a Roma neighborhood in the village of Algunja, North Macedonia, around 20 kilometers north of Kumanovo, 26-year-old Marijana and her husband Stefan, parents of 8-year-old Teo and two-month-old Jakov welcome the patronage nurse in their home. Sladjana, a nurse from the Kumanovo health center, provides polyvalent home visiting services to pregnant women, young mothers, newborns, infants, and children. She also supports other family members, particularly the elderly and those with chronic conditions.
During the visit, Sladjana checks the baby’s immunization calendar—he has already received the BCG and hepatitis B vaccines. She reminds the mother that next on the schedule are the Rota and pneumococcal vaccines.
As they talk about breastfeeding, the baby’s development and Marijana’s concerns about anemia, Sladjana introduces the Bebbo application. Together, they explore a leaflet outlining the app’s features.
Despite living in a remote village with scarce resources, Marijana is digitally connected and curious, so she downloads the app easily. The patronage nurse explains that Bebbo - developed by UNICEF Europe and Central Asia - offers expert parenting advice on child health and development, including nutrition, breastfeeding, early learning, responsive parenting, and parental well-being.
Before leaving, Sladjana checks the grandmother’s blood pressure and offers tips on balanced meals. Her visit leaves the family feeling cared for and empowered.
When back at the health center, Sladjana will record the visit in the Moj Termin (My Appointment) system, including important information about the family’s health and living conditions, as part of the national record for home visits. While the recording system is digitalized and integrated into the e-health platform, only about 60% of patronage nurses use it—often due to a lack of IT resources. According to 2022 UNICEF-supported functional assessment of home visiting, the quality of patronage services and the way they operate varies significantly among communities and health centers across the country.
Challenges of the profession and ways forward
During the COVID-19 pandemic, when basic services like home visits were interrupted, both families and nurses looked for resourceful ways to continue their communication. They began with phone calls, then transitioned to Viber, sharing photos and videos.
“I have received many pictures of newborn navels; we had video calls to help find the best position for breastfeeding and overcome the fear of not doing it right or not being able to get enough breastmilk…” says Sladjana. In many cases, this remote communication has continued even after the pandemic, unfortunately sometimes replacing physical visits altogether.
She admits the visits are less frequent than before and things are changing. UNICEF evidence shows that the workforce is aging and after retirement are usually not replaced; the remaining patronage nurses are reassigned to hospital tasks; there is a lack of standardized practices and regulatory frameworks; insufficient funding and resources such as transport, mobile phones and internet access, and lack of incentives and recognition.
Sladjana has served as a patronage nurse for 35 years. She, along with two colleagues from the Kumanovo health center will retire this year. Currently, most patronage nurses in North Macedonia are aged between 50 and 60, meaning a large portion will retire in the next 2–7 years. Without significant efforts to attract and retain new staff, the sustainability of the service is at risk.
Patronage nurses are often the first - and sometimes the only - professionals to enter a family's home, placing them in a unique position to identify, observe and report on wide range of issues, from violent discipline to developmental delays. However, the availability of these services is not consistent across the country. This uneven distribution disproportionately affects rural areas and vulnerable communities, such as Roma families, who often need this support the most.
In partnership with the Ministry of Health, WHO and the Association of Nurses and Midwives UNICEF is helping to further strengthen the system of home visiting nurses by intensifying support for the most vulnerable newborns and their parents and upgrading the home visiting package to cover emerging developmental, health, environmental and nutrition risks.
Proper care in the first phase of a child’s life is both life-saving and life-shaping. This is why motivated, trained, and well-supported patronage nurses like Sladjana are essential in helping families thrive—not only by monitoring the health and growth of infants like Jakov, but also by building trust, sharing knowledge, and empowering families to raise the next generation with strength and care.
