Bringing care where it’s needed most: the impact of North Macedonia’s Mobile Gynaecological Clinics
In this member spotlight, the Macedonian Association of Gynecology and Obstetrics shares the extraordinary impact of their Mobile Gynaecological Clinics – a ground breaking initiative that has brought quality care to women and girls in rural, remote and underserved areas.
When the COVID-19 pandemic hit, it didn’t just disrupt our health systems – it laid bare the inequalities that already existed within them. For many women and girls in North Macedonia, especially those in remote or marginalised communities, access to essential reproductive and gynaecological care became even more difficult and in some cases, completely out of reach.
In response, a bold and compassionate initiative was born. In December 2021, the Mobile Gynaecological Clinics were launched as part of the Safe and Innovative Services During COVID-19 project, supported by the Ministry of Health of the Republic of North Macedonia, the Macedonian Medical Association and UNFPA. What began as an emergency response has since evolved into a critical component of our national strategy to ensure no woman is left behind.
The programme was built on existing resources, including mobile clinics, technical expertise, training materials and e-health platforms. A rapid assessment at the project’s outset enabled the creation of roadmaps and functional mappings of health facilities to optimise service delivery.
Through UNFPA support, mobile units were upgraded with new ultrasound machines and small-scale equipment to enhance service quality. Reproductive health kits, personal protective equipment and medical supplies were also procured to maintain service delivery under strict COVID-19 protocols.
Vehicles were fully serviced and repaired to ensure field-readiness. Each mobile clinic is adapted with a gynaecological chair, ultrasound (ECHO) device, medicines, consumables and private space for consultation. Services include Pap smears, pregnancy planning, maternal health education and gender-based violence support, all based on clear protocols.
To support digital integration, IT equipment was provided and linked to the national e-health platform Moj Termin, allowing data collection, coordination and referrals between primary and secondary care. Standardised reporting forms were integrated for monitoring activity outcomes by age, gender and other determinants.
Reaching the unreachable
These clinics target women and girls in rural, remote and underserved areas, including:
- Macedonian Brod, Bogdanci, Delchevo, Lipkovo and over 30 other hard-to-reach municipalities.
- Vulnerable populations: incarcerated women (via KP"Idrizovo"), Roma women, drug users, sex workers, migrants, asylum seekers and women working in the textile sector.
- Psychiatric hospital patients and communities without registered gynaecologists.
- Women who are blind or have other visual impairments, ensuring they too have equal access to essential reproductive health services.
Making women visible
This initiative has made an extraordinary impact. More than 350 field activities have been carried out, with 3,326 women and girls examined. The programme collaborates with NGOs including HOPS, La Strada, Roma Resource Center, Roma Perspective and Voice of Textile Workers to reach hidden communities.
The results are striking:
- 68 women (average age: 42) were found with mild cervical intraepithelial neoplasia (CIN1) associated with HPV.
- One woman (age 34) was diagnosed with CIN3, a high-grade precancerous lesion.
- The highest participation rate (30%) came from women aged 51 to 60, while only 5% were from the 21–30 age group, indicating a gap in outreach to younger women.
A model for the future
Since October 2022, the mobile clinics have been included in the national programme for early detection of malignant diseases, continuing through 2023 and 2024. The Ministry of Health has committed funds from the National Cancer Prevention Programme to support ongoing cervical cancer screening.
The project is coordinated by the University Clinic for Gynecology and Obstetrics in cooperation with the Macedonian Medical Association, the Macedonian Association of Gynecologists and Obstetricians (MAGO) and the Red Cross. The Mobile Gynaecological clinics of North Macedonia represent more than a service, they are a commitment to equity and dignity in health care. They show that with the right partnerships, infrastructure and compassion, we can reach every woman and girl—no matter where they live.
This is not just a response to a crisis, it’s a foundation for a stronger, more inclusive future.