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Countries prepared for health emergencies

[COUNTRY STORY]

Strengthening the monitoring of and response to health emergencies in North Macedonia: establishing a Public Health Emergency Operation Center

North Macedonia

Photo: WHO Epidemiologists work at North Macedonia’s Public Health Emergency Operation Center (PHEOC) in Skopje.

Public Health Emergency Operation Center for rapid emergency response

In the early phases of the COVID-19 pandemic, the epidemiological and information landscape evolved rapidly. North Macedonia’s Ministry of Health (MoH) recognized that there was a need for stronger coordination among health institutions to ensure a timely and efficient response. Joining forces with North Macedonia’s Institute of Public Health (IPH), WHO North Macedonia, Robert Koch Institute (RKI), and USAID North Macedonia, the MoH launched a Joint Action Project and created a Public Health Emergency Operation Center (PHEOC) in August 2020. Serving as an advisory body to the MoH, the PHEOC has enabled rapid sharing of information across a nationwide network of 10 Emergency Operation Centres (EOCs) in Regional Centers for Public Health (RCPHs). By strengthening the monitoring of and response to health emergencies, the PHEOC has enabled North Macedonia to better meet the 2005 International Health Regulations (IHR) and save lives.

Key WHO Contributions

Conduct of technical workshops to identify response capacity gaps
Leverage WHO tools to establish PHEOC
Provision of technical guidance on institutionalization of PHEOC
Procurement of ICT materials for the functioning of PHEOC and EOCs
Conduct training of disciplines on PHEOC operations.

How did North Macedonia, with the support of the WHO Secretariat, achieve this?

In July 2021, WHO conducted two workshops with 32 participants from the MoH, IPH, RCPHs, the eHealth directorate, and the Institute of Epidemiology. These workshops were designed to gain a better understanding of existing capacities, gaps, and needs, and were guided by WHO’s PHEOC Framework. Participants discussed planning and operational processes, physical infrastructure, information and communication technology infrastructure, human resources, and data analysis standards. The RKI, the United States Centers for Disease Control and Prevention (USCDC), plus a representative from the MoH of Israel presented PHEOC models from other countries; and a data collection tool was developed to enable capacity assessment. The tool was then deployed by WHO and other members of the joint action project team during a series of field visits to the PHEOC and EOCs. WHO supported the analysis of information from the workshops and assessments, and a 3-day workshop was held to develop a detailed action plan for the operationalization of the PHEOC.

“At the very beginning of the pandemic, coordination was a big challenge. New information was constantly released and the situation was changing rapidly. The founding of this centre, enabled ongoing real-time monitoring of events in all regions of the country and continuous and fast information exchange.”

- Dr Shaban Memeti, Director of the Institute of Public Health, North Macedonia

The joint action team, which included WHO, presented the action plan to decision-makers in the MOH. The IPH approved the plans and the United States Agency for International Development (USAID) provided additional funding. Subsequently, a PHEOC coordinator and 10 EOC focal points were officially nominated, an Emergency-Steering committee was appointed, and plans and procedures were developed. Following an in-depth analysis of existing public health laws in North Macedonia, a legal framework was developed for the institutionalization of the PHEOC. Technical inputs for both activities were provided by WHO North Macedonia and WHO Regional Office. The government subsequently endorsed the legal framework following a workshop to discuss the framework.

WHO procured basic equipment and tools to improve the information and communication technology (ICT) infrastructure for the PHEOC and EOCs and provided technical support to conduct trainings. The PHEOC core team has 14 full-time employees, of which five are epidemiologists, three medical doctors, three medical analysts and three medical technicians. A 3-day workshop on PHEOC functions was held during which the core team developed standard operating procedures for the PHEOC. Six epidemiologists who were selected as facilitators attended an Epiconcept [1] Field Epidemiology Training and then conducted a 5-day training in Basic Field Epidemiology for IPH and RCPH epidemiologists. The ten newly appointed EOC focal points in the RCPHs were trained on the use of digital tools and capacity building. To facilitate knowledge exchange, a 3-day visit to the RKI was organized for the joint action team in July 2022 as North Macedonia had chosen to deploy a model similar to that of the RKI.

^{North Macedonia’s Public Health Emergency Operation Center (PHEOC) staff analyze real-time epidemiological data and discuss response strategies.}Photo credit: WHO.

Since its inauguration in August 2020, the PHEOC has carried out a range of activities to coordinate and support the RCPHs; it has collected and processed surveillance data and prepared and disseminated reports both nationally and internationally (e.g., TESSy [3]). In order to continually build capacity, the PHEOC carries out emergency preparedness reviews, simulation exercises and trainings, develops health strategic plans and checklists, and advises on plans for repurposing of staff at the regional level, task sheets and deliverables. It also monitors and strengthens the public health emergency system by conducting periodic evaluations and documenting good practices to enable evidence-informed decision-making. Furthermore, the PHEOC holds regular coordination meetings with EOC focal points and the MoH as well as the Commission for Infectious Diseases to ensure strong information flows across the network.

“Timely information sharing, strategic coordination, and efficient management of resources are all critical elements for an effective response to public health emergencies such as COVID-19. Having a central hub for collecting information, making decisions on priorities, and coordinating action and communication can help countries to better direct emergency operations and save lives”

- Dr Anne Johansen, WHO Special Representative to North Macedonia and Head of Office a.i., WHO North Macedonia

The PHEOC in North Macedonia is a pioneering example of how WHO can partner with national authorities to extend public health intelligence to help countries address both the current COVID-19 pandemic and future emergencies. This initiative is unique in the involvement of a broad range of stakeholders and the emphasis on creating the conditions needed to institutionalize the operation of the PHEOC and the RCPHs and ensure that North Macedonia is well equipped to address future pandemics.