It all began when a concerned doctor, Professor Mirjana Kocova wrote a letter to the Macedonian Ministry of Health. She wanted to replace the run-down equipment in her hospital in Skopje and improve intensive care for babies. Her inquiry led to a review of all aspects of perinatal care by the Ministry of Health. It then turned to the World Bank to launch a nationwide project to upgrade training and care for newborn babies.
The World Bank helps doctors and nurses receive specialized training
The aim was to decrease Macedonia’s high perinatal mortality rate and bring it close to European norms. As part of the program, a group of Macedonian pediatricians spent four months at the Royal Prince Alfred Hospital in Sydney, Australia in 2000. They returned and successfully spread their new skills. Today, 50 percent of doctors and 25 percent of nurses providing care for newborns have received specialized individual training.
Mortality among newborns drops significantly
The project helped decrease mortality among newborns by 36 percent for 25,000 infants born annually.This means that 108 babies are saved each year. A 28 percent decrease in stillbirths saved another 168 babies in 2000-2001. The statistics are based on careful data collection from 16 hospitals where more than 93 percent of births in Macedonia occur.The objective now is to decrease perinatal mortality to less than 10 deaths per 1000 births by 2005.
These perinatal support services began in 1999 as a component of a larger Health Sector Transition Project financed by US$16.9 million credit from the International Development Association (IDA), part of the World Bank Group. Some 21 pediatric clinics have received US$3.5 million for new medical equipment. Some 28 of Macedonia’s 29 neonatal departments are now considered “baby-friendly.” The program improved the knowledge and skills of doctors and nurses, and introduced evidence-based clinical guidelines. Changes in care practices and availability of state-of-the-art equipment contributed to the dramatic reduction in mortality of newborns.
Overcoming problems
The project has not been trouble-free. High turn-over of senior staff was a problem. The civil war in 2001 slowed implementation in the western region of Macedonia. And skepticism from neonatologists who did not participate in training and felt intimidated by their colleagues’ new professional skills also hindered smooth implementation.
Education and training make the difference
“These outstanding results are attributed primarily to educational intervention during a period of political and civil disruption,” said Jean J. De St. Antoine, the project’s task manager. Macedonian pediatricians are now pushing for legislative reforms to ensure the long-term sustainability of the project.
It all began when a concerned doctor, Professor Mirjana Kocova wrote a letter to the Macedonian Ministry of Health. She wanted to replace the run-down equipment in her hospital in Skopje and improve intensive care for babies. Her inquiry led to a review of all aspects of perinatal care by the Ministry of Health. It then turned to the World Bank to launch a nationwide project to upgrade training and care for newborn babies. 
The aim was to decrease Macedonia’s high perinatal mortality rate and bring it close to European norms. As part of the program, a group of Macedonian pediatricians spent four months at the Royal Prince Alfred Hospital in Sydney, Australia in 2000. They returned and successfully spread their new skills. Today, 50 percent of doctors and 25 percent of nurses providing care for newborns have received specialized individual training. 
The project helped decrease mortality among newborns by 36 percent for 25,000 infants born annually.This means that 108 babies are saved each year. A 28 percent decrease in stillbirths saved another 168 babies in 2000-2001. The statistics are based on careful data collection from 16 hospitals where more than 93 percent of births in Macedonia occur.The objective now is to decrease perinatal mortality to less than 10 deaths per 1000 births by 2005.
The project has not been trouble-free. High turn-over of senior staff was a problem. The civil war in 2001 slowed implementation in the western region of Macedonia. And skepticism from neonatologists who did not participate in training and felt intimidated by their colleagues’ new professional skills also hindered smooth implementation. 
“These outstanding results are attributed primarily to educational intervention during a period of political and civil disruption,” said Jean J. De St. Antoine, the project’s task manager. Macedonian pediatricians are now pushing for legislative reforms to ensure the long-term sustainability of the project.
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