HERA 2017 Annual Report

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doslednost (consistency) [noun] – keeping the opinion held and the promise made, persisting on the given word

The institutions once deaf have now regained their hearing, uncertainty and awaiting have now given their way to the expectation that, with the political crisis over, things will change for the better, and that promises will be honoured. Instead of involving themselves in protests, civil society organisations have finally been involved in the decision-making processes; however, they remain loud criticisers of the new government, which is yet to justify the confidence that citizens had invested. The Government’s consistency (shall) mean the courage to uphold what they had signed, to respect what they had said, to persist until what has been set – what has been promised – is finally achieved. Ours, on the other hand, (shall) mean to continue protecting the sexual and reproductive rights even more committedly, and to strive without faltering for greater quality, more availability and better accessibility of sexual and reproductive health services for all. We sincerely hope that their consistency will outshine ours.


DEAR FRIENDS, 2017 will be remembers as the year of great political changes in the country. The new coalition, headed by the Social-Democratic Union of Macedonia, brought along the promises and commitments on restoration of democratic processes in the society and on greater transparency and accountability in policy making. Governmental institutions have now slightly opened their doors for cooperation, and the work of the civil society sector has again become acknowledged as an important factor of democratic change. Particularly important for us was the comeback of sexual and reproductive health on the advocacy agenda with governmental institutions. In less than six months, drastic shifts have been made towards improving the situation of sexual and reproductive rights, which had been delegitimised and held back before. The Ministry of Health has now established a multisectoral working group charged with the task to make an expert analysis of and propose amendments to the restrictive law, which will facilitate women’s access to safe abortion and will protect the human rights in compliance with international conventions. For the first time ever, a public call for funding has been issued for civil society organisations working on HIV prevention among marginalised communities, and in this way the state has fully taken over the responsibility to fund the services that had endured for more than 15 years thanks to the support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. We also take pride in the setting up of the Balkan’s first ever informal parliamentary group for the protection of LGBTI community rights, together with a number of civil society organisations. In addition to advocacy, as one of the key activities of HERA, 2017 was also marked by the growing number of young and of persons coming from marginalised communities who were educated or received services through our service providers. In just one year, the number of young people who completed the full curriculum of our informal comprehensive sexuality education increased by 30%. More than 6600 clients used our services provided through the stationary and mobile clinics for sexual and reproductive health and gender-based violence. In order to bolster the inclusion of Roma women on the labour market and to create social profit that could contribute to the financial sustainability of HERA’s services, in September we established the social enterprise “Nega Plus” which provides homebased eldercare. We have trained 15 Roma women to work as caregivers, and in less than few months we have managed to register our first six clients. In 2017 we started the preparations for our organisation’s new strategic framework, to cover the 2018-2022 period. We have set clear priorities for our future development so as to extend our influence in the accomplishment of long-term and sustainable changes in the area of sexual and reproductive rights and gender equality in Macedonia, and also in the region and in Europe. We will strive to “mobilise a comprehensive civil action to achieve sexual rights and ensure improved sexual and reproductive health education and services, in particular for the marginalised communities”. To all our organisation’s staff, volunteers and members, 2017 was the year of positive transition in our constant efforts to promote sexual and reproductive rights. We wish to thank them for their commitment and support. However, our critical thinking of the government must further persist. We will keep overseeing our government and the new administration, watchfully and critically, and we will keep reminding them of their promises: consistency, cooperation and a guarantee for the promotion of human rights and democratic processes in the country. The fight must go on. Enjoy your reading!

Bojan Jovanovski Executive Director

Iva Mihajlovska President


TABLE of CONTENT

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HERA ID

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ADVOCACY

26

INFORMATION AND EDUCATION

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SERVICES

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PUBLIC AWARENESS ABOUT SRH - MEDIA CAMPAIGNS

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MOBILISATION OF RESOURCES

74

RESEARCH

82

PUBLICATIONS

87

TESTIMONIALS / CASE STUDIES

93

MANAGEMENT BOARD AND EXECUTIVE OFFICE


I D CA R D

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STRATEGIC

FRAMEWORK

VISION:

HERA

ALL PEOPLE ENJOY THEIR SEXUALITY FREELY AND IN SOCIAL WELL-BEING

2022 2018

OUR VALUES EQUALITY EQUITY SOCIAL JUSTICE EMPOWERMENT

MISSION:: H.E.R.A. LEADS A CITIZENACTION AND ENCOURAGES SOCIAL CHANGETO ENSURE SEXUAL RIGHTS FOR ALL AND TO ENABLE IMPROVED SEXUAL AND REPRODUCTIVE HEALTH EDUCATION AND SERVICES, ESPECIALLY FOR THE MARGINALIZED

YOUTH PARTICIPATION DIVERSITY FREEDOM OF CHOICE FEMINISM

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State institutions are working in accordance with democratic principles towards protection and improvement of sexual and reproductive rights and gender equality

Everyone is aware of and exercises their social, sexual and reproductive rights

Equal access to quality services for sexual and reproductive health, HIV and gender-based violence

Improving laws, policies and practices related to HIV, sexual and reproductive health and gender equality

Empowering women from marginalized communities, especially Roma women to exercise their sexual, reproductive, economic and social rights

Providing services for sexual and reproductive health and gender-based violence, especially for young people and marginalized communities

Building and maintaining partnerships with CSOs at local, national and international levels

Providing comprehensive sexuality education for young people

Developing professional skills and knowledge of service providers about sexual and reproductive health and gender-related aspects

Collaboration and strengthening the capacities of institutions at local and national levels

Raising public awareness about sexual and reproductive health and sexual rights

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H.E.R.A. is a sustainable and professional civil society organization

Strengthening activism and volunteer engagement within the organization Ensuring continuous and up-to-date expertise, professionalism and accountability Ensuring financial sustainability and stability


MEMBERSHIP AND NETWORKS @national level • Coalition “Margins” • Gender Equality Platform • “Voice against Violence” – National Network to End Violence against Women and Domestic Violence • National Youth Council • Network for Protection against Discrimination • Macedonian Anti-Poverty Platform • Y-PEER Macedonia • National Network against Homophobia and Transphobia • HIV Prevention and Support Programmes Sustainability Platform @international level • International Planned Parenthood Federation (IPPF) • ASTRA Network • Women’s Global Network for Reproductive Rights • International Campaign for Women’s Rights to Safe Abortion • Y-SAFE • Y-PEER • COPASAH – Community of Practitioners on Accountability and Social Action in Health • ERA – LGBTI Equal Rights Association for Western Balkans and Turkey • Cobatest Network • The European HIV Legal Forum (AIDS Action Europe) • Fundamental Rights Platform Host-organisation to: • The Secretariat of the HIV Platform • The Secretariat of the National Coordinating Mechanism • The Secretariat of the Regional Coordinating Mechanism • The Secretariat of the All-Party Parliamentary Group on HIV MORE ON HERA AT Web-page www.hera.org.mk FACEBOOK www.facebook.com/hera.macedonia TWITTER www.twitter.com/hera_mkd YouTube www.youtube.com/HERAMacedonia Address & Telephone ul. Franklin Ruzvelt br. 51а/26, 1000 Skopje, +389 2 3290 295

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OUR SERVICES Youth Centres for Sexual and Reproductive Health “I Want To Know” * Vodno Outpatient Clinic, ul. Elisie Popovski br. 2, tel. +389 2 3176 950 * Šuto Orizari Outpatient Clinic, Šuto Orizari bb, tel. +389 2 2651 955 contact@sakamdaznam.org.mk Mobile Outpatient Clinic for HIV Counselling and Testing hera@hera.org.mk The First Family Centre of the City of Skopje against Domestic Violence tel. +389 2 3215 905, infopsc@hera.org.mk Counselling Service for HIV/AIDS and Support to Persons Living with HIV In cooperation with the Clinic for Infectious Disease and Febrile Conditions, tel. +389 2 3147 752 Mobile Gynaecology Outpatient Clinic hera@hera.org.mk ADVOCACY HERA works on advocating the interests and needs of all people in sexual and reproductive health by creating new policies and changing the old ones, with the purpose of improving the legal framework, the rights, the available services and, ultimately, the wellbeing of all citizens. EDUCATION AND SERVICES Access to the relevant information, including available healthcare and social services supported by the latest social and medical research in the key fields of operation of HERA: HIV/AIDS, contraception, sexually transmitted infections, abortion, gender­based violence, gender identity. The commitment to introduce a comprehensive sexuality education in schools, and to improve the availability of SRH services for all citizens, and especially for the socially excluded and marginalised groups of citizens, is still one of the highest work priorities for HERA DEVELOPMENT AND RESEARCH Continuous and systemic development and research with the purpose of offering information and services grounded in evidence-based medicine and in the latest achievements and practices around sexual and reproductive health remains one of the top commitments for HERA. Keeping up with the variable social, economic and political contexts, HERA is always basing its policies, commitments, advocacy and services on the current, relevant and quality information and research. FUNDRAISING Securing the financial sustainability for the organisation and for the services we provide is one of the priorities, and challenges, too, that we are facing. We are particularly committed to lobbying for an increased support from national funding mechanisms for the services we are providing and to identifying innovative models of funding, especially through the development of social entrepreneurship.

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ADVOCACY

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THE STATE FULLY TOOK OVER THE FUNDING OF HIV PREVENTION

Representatives of the HIV Platform at a meeting with the President of the Government of the Republic of Macedonia discussing the sustainability arrangements for HIV programmes for the key populations affected by HIV (30 August 2017)

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In December 2017, the Global Fund “left” the country after 15 years of continuous funding of HIV prevention and support programmes, in particular for the marginalised communities. Macedonia can remain the regional leader with the lowest HIV infection rate only if the developed HIV services continue by receiving funding from the state budget. In September 2017, the Ministry of Health issued its first ever public call for awarding of funds in the total amount of 14.7 million denars to civil society organisations that work on HIV prevention and protection of marginalised communities. The HIV Programmes Sustainability Platform, comprising 16 organisations, implemented a number of activities for mutual coordination and joint advocacy for integrating these programmes within the state-run programmes and budgets: a three-year advocacy plan was developed, 5 meetings of the coordination committee were organised, as well as 16 direct meetings with the decision-makers; the Platform participated in the national HIV bodies and took part in the consultation process for the development of the 2018 HIV Programme. Four member-organisations of the platform – HERA, HOPS, “Stronger Together” and EGAL – were involved in the working group that drafted the 2017-2022 National HIV Strategy, which is expected to be adopted in the course of next year. Moreover, three public policy making publications were released: “How to Successfully Control the HIV Epidemic in Macedonia – a Brief for the Decision Makers”; “Considerations on Sustainability with Opportunities and Proposals” for ensuring sustainability of activities that were supported by the Global Fund; and an “Analysis of the Transition Process” concerning the process of transition from the donor support towards the national funding of HIV protection programmes. Joint efforts and consultation processes resulted in the piloting of a funding system for associations in September 2017, whereby 13 non-governmental organisations entered into contract with the Ministry of Health. Moreover, the Ministry of Health allocated a total of 47 million denars to 2018 HIV programmes to be implemented by associations, which, after the withdrawal of the Global Fund, is the first ever case of a substantial governmental support to HIV programmes in the region. In the course of 2018, the HIV Platform will remain the key partner in responding to HIV and, through the national HIV bodies, will get involved in setting the standards for HIV services, in developing long-term and stable state funding mechanism for such programmes, as well as in strengthening the oversight of HIV programmes on the national level.

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AN ALL-PARTY PARLIAMENTARY GROUP ON HIV SET UP IN THE PARLIAMENT OF THE REPUBLIC OF MACEDONIA FOR THE THIRD TIME

A visit to the National Gay and Lesbians Centre, Association EGAL

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The Parliament of the Republic of Macedonia has had an All-Party Parliamentary Group on HIV ever since 2012. So far, the Parliamentary Group has organised three public parliamentary discussions on increasing the HIV treatment funds, and its members have also been involved in the awareness raising campaigns for HIV testing and for reducing the HIV-related stigma. The Parliamentary Group has also made a genuine contribution to the planning of the transition from international to national HIV funding through direct recommendations to the Government and the Ministry of Health on sustainability arrangements for HIV programmes. In May 2017, the All-Party Parliamentary Group on HIV was re-established for the third time, now reflecting the new parliamentary composition, with a total of six women MPs, one independent and five representing the following political parties: DOM (Democratic Renewal of Macedonia), SDSM (Social Democratic Union of Macedonia), LP (Liberal Party), DUI (Democratic Union for Integration) and LDP (Liberal Democratic Party). In May, the Parliamentary Group’s representatives together with representatives from the Ministry of Health, Ministry of Labour and Social Policy and healthcare institutions visited the HIV services provided by civil society organisations in the field, dedicated to people who inject drugs and men who have sex with men. During the year, representatives of the All-Party Parliamentary Group on HIV, who are also a member of the European Parliamentary Forum on Population and Development, were involved in international initiatives and events related to the promotion of sexual and reproductive health, including the attendance at the International Parliamentarians’ Consultation on ending Female Genital Mutilation & Child Marriage, which was held in Morocco. In February 2017, two women MPs joined the international initiative signed by 375 MPs from all over the world against the decision of the new US administration to reintroduce the Mexico City Policy (Global Gag Rule) which bans the funding of organisations which are involved in any form of activities related to public information and education about safe abortion. In October 2017, the Parliamentary Group endorsed the initiative against the Lithuanian Parliament’s motion to adopt a rather restrictive law on pregnancy termination. In the capacity of the Secretariat of the All-Party Parliamentary Group on HIV, HERA will continue to cooperate closely with the group so as to ensure its involvement in the HIV oversight, both in terms of the adoption of legal procedures concerning the HIV programmes sustainability and in other activities concerning the promotion of sexual and reproductive health, such as the access to contraception and safe abortion for all women on the national and international level.

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WORKING GROUP ESTABLISHED FOR EXPERT ANALYSIS AND AMENDMENT TO THE ABORTION LAW Representatives from competent institutions gave their word to involve the non-governmental organisations in the process of drafting the amendments to the Pregnancy Termination Law

REQUESTS TO THE GOVERNMENT OF THE REPUBLIC OF MACEDONIA AND THE MINISTRY OF HEALTH IN REGARD TO AMENDMENTS OF THE LAW ON TERMINATION OF PREGNANCY

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THE MINISTRY OF HEALTH SHOULD, AS SOON AS POSSIBLE, FORM AN EXPERT WORKGROUP TASKED TO WORK ON AMENDMENTS OF THE EXISTING LAW ON TERMINATION OF PREGNANCY OR ADOPTING A NEW LAW ENTIRELY. SIMULTANEOUSLY, 50% OF THE WORKGROUP PARTICIPANTS SHOULD BE CIVIL SECTOR REPRESENTATIVES IN THE FIELD OF LAW AND GENDER-RELATED RIGHTS, AS WELL AS REPRESENTATIVES OF THE PROFESSIONAL ASSOCIATION OF GYNECOLOGISTS AND OBSTETRICIANS.

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THE MINISTRY OF HEALTH SHOULD ENABLE THE WORLD HEALTH ORGANIZATION TO PERFORM AN EXPERT REVISION OF THE DECISIONS FOR AMENDING LEGAL REGULATIONS, IN ORDER FOR THE CHANGES TO REFLECT THE TECHNICAL RECOMMENDATIONS OF THIS ORGANIZATION IN FAVOR OF A SAFE AND LEGAL ABORTION.

III

THE MINISTRY OF HEALTH SHOULD ADOPT AN URGENT DECISION TO WITHDRAW THE RULEBOOK ON THE CONTENT AND MANNER OF COUNSELING PREGNANT WOMEN PRIOR TO TERMINATION OF PREGNANCY, WHICH WAS ADOPTED IN OCTOBER 2014 AND INFORM THE HOSPITALS ON THE TERMINATION OF ITS USE WITHIN THE SCOPE OF SAFE ABORTION CARE. UNTIL THE ADOPTION OF A NEW RULEBOOK ON THE GROUNDS OF A NEW LAW ON TERMINATION OF PREGNANCY, THE DIRECTIONS ON SAFE AND LEGAL ABORTION BY THE WORLD HEALTH ORGANIZATION (WHO) SHOULD BE OBSERVED.

IV

THE GOVERNMENT SHOULD ADOPT A DECISION ON PERMANENT PROHIBITION OF ANY OF THE VIDEOS PERTAINING TO THE ANTI-ABORTION MEDIA CAMPAIGN "YOU HAVE A CHOICE. CHOOSE LIFE" AND INFORM THE MACEDONIAN RADIO TELEVISION AND THE AGENCY OF AUDIO AND AUDIOVISUAL MEDIA SERVICES IN WRITTEN THEREOF.

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THE MINISTRY OF HEALTH SHOULD COOPERATE WITH CIVIL SOCIETY ORGANIZATIONS AND IMPLEMENT AN AWARENESS-RAISING CAMPAIGN ON THE USE OF MODERN CONTRACEPTIVE MEASURES IN ORDER TO REDUCE THE HARM ON THE PUBLIC OPINION DEALT BY THE YEARS-LONG NEGATIVE GOVERNMENT CAMPAIGN AGAINST ABORTION.


Four years after the adoption of the Law on Abortion, women in Macedonia are still facing many administrative barriers that prevent them from using their right to terminate their pregnancy freely and at their own will. In spite of many remarks made by international human rights committees and the civil society, we are still one of the countries where women’s reproductive rights have been restricted. However, the change of political power in 2017 opened up the opportunity for cooperation with the Government around amendments to the legal framework, which was one of the promises given by the now ruling political parties during the last parliamentary elections. Together with the Gender Equality Platform, on 28th September, on the occasion of the Global Day of Action for Access to Safe and Legal Abortion, we organised a panel discussion under the title “Abortion Is Not Safe When It Is a Hurdle Race�. In addition to twenty or so representatives from gynaecology clinics and activists, the discussion was attended also by high representatives of governmental institutions and from the Parliament. During the discussion, the Platform proclaimed its demands from the new Government, stressing the urgency of the need for a multisectoral working group to be formed that will make an expert analysis and revision of the law. The Health Advisor from the Cabinet of the President of the Government of the Republic of Macedonia and the Deputy Minister for Health gave their word to act upon these demands, thereby making clear that they fully support the need to amend the law. Moreover, the Centre for Reproductive Rights presented the findings from the research they had carried out among 15 women, who had shared their abortion experiences and challenges with the provisions concerning the mandatory and biased counselling that was imposed by the new law. We organised a press conference together with the Professional Association of Gynaecologists where we publicly reiterated our demands and emphasised the impact the restrictive legal provisions are having on women seeking abortion. In December, the Ministry of Health set up the working group consisting of members from civil society organisations, including HERA, jurists, specialising gynaecologists and social workers with a mandate to make an expert analysis of the effects of the current law and propose amendments to it. In the course of 2018 we will participate actively in preparing the expert analysis and drafting the amendments to the legal framework in a way that we will offer our expertise and support to the Ministry of Health. We will be zealous proponents of a new and modern law on termination of pregnancy, expected to be adopted by the end of the year, a law that will safeguard full protection of both the health and the rights of women in compliance with international human rights conventions and public health standards.

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WOMEN FROM ŠUTO ORIZARI FINALLY GOT A GENERAL GYNAECOLOGIST

Activists of the Šuto Orizari Women’s Initiative stand tireless in their fight for Roma women’s reproductive rights

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There has not been a single general gynaecologist in the Municipality of Šuto Orizari for almost a decade. Reproductive health promotion was inaccessible to 8000 women in their reproductive stage. In spite of many efforts put in by the Ministry of Health to provide temporary gynaecological services by transferring some of the staff from other healthcare institutions, the issue remained unresolved on the long run. Throughout 2017, the Šuto Orizari Women’s Initiative continued to alarm the public about them not having a general gynaecologist through participation in TV shows, making statements for the media, and issuing of press releases, as their way to react to the Municipality priorities, in particular against the local authorities’ decision to build a swimming pool in Šuto Orizari in a situation when the women’s health was grossly neglected, “More than 600000 euro allocated to a swimming pool construction, and only 4000 euro a year for a gynaecologist in Šuto Orizari”. Šuto Orizari Women’s Initiative, as a group of women activist fighting for Roma women’s reproductive health and rights, participated in the work meeting seeking solutions for the promotion of reproductive health, which was also attended by the Minister for Health, Minister for Labour and Social Policy, Minister without Portfolio in charge of Roma issues, the President of the Association of General Gynaecologists and representatives from the partner organisation “Ambrela”. After this meeting, the Ministry of Health launched the gynaecological office in Šuto Orizari, where a new general gynaecologist started their practice as of September 2017. HERA and the Šuto Orizari Women’s Initiative will focus their activities in 2018 on strengthening the cooperation with the new gynaecologist in Šuto Orizari through meetings and referral of clients, but also on monitoring of the quality of services that citizens receive in the new gynaecological practice.

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SEXUAL AND REPRODUCTIVE HEALTH ARE STRATEGIC PRIORITIES IN THE NATIONAL PLAN FOR PREPARATION AND RESPONSE OF THE HEALTHCARE SYSTEM IN CRISIS AND DISASTER SITUATIONS

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The latest National Plan for Preparation and Response of the Healthcare System in Crisis and Disaster Situations, adopted in 2009, failed to include the sexual and reproductive health (SRH) as an urgent healthcare issue when planning the healthcare measures in crisis situations. As of 2014, supported by UNFPA, HERA has been working on the recognition of SRH within the healthcare policies dedicated to humanitarian crisis and natural disaster management. In February 2017, the Government adopted the new National Plan for Preparation and Response of the Healthcare System in Crisis and Disaster Situations, where SRH was acknowledged and integrated as a separate strategic objective. This resulted from the many activities that had been implemented and from the technical assistance that had been provided to the relevant governmental institutions over the years. As early as in 2015, a working group was formed together with UNFPA, Public Health Institute, Prevention Unit of the Ministry of Health and the Crisis Management Centre in order to address SRH as part of national policies and to strengthen the capacities of all stakeholders. The working group has made a number of assessments of the existing healthcare capacities, it has developed annual action plans for preparation and response under migrant crisis and organised many trainings on the concept of Minimum Initial Service Package for SRH in humanitarian crisis situations. HERA coordinated the activities of this working group and provided expertise on SRH-related issues. We were also a part of the national body drafting the National Plan for Preparation and Response of the Healthcare System in Crisis and Disaster Situations, under the management of WHO and the Ministry of Health, where we lobbied for SRH to be included in the new package of activities and measures. In this line, a special strategic chapter was developed for SRH in crisis situations, along with many accompanying documents on intersectoral coordination, standard operating procedures for genderbased violence management and a gynaecological service provision protocol. All these documents have been integrated in the plan that was endorsed by the Government, and they are the result of the four years of lobbying the healthcare authorities to consider SRH management in crises situations. In 2018 we will keep building the capacities of governmental institutions around the importance of addressing SRH and providing corresponding services to persons affected by crises. We will continue the practice of developing annual action plans for preparation and response of SRH in crisis situations, and we will develop a dedicated web platform with information materials that will be beneficial both to the governmental institutions and to the general public.

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MINISTRY OF EDUCATION MADE EFFORTS TO PROMOTE COMPREHENSIVE SEXUALITY EDUCATION

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Formal education provides limited, partial and inaccurate information about sexual and reproductive health and sexual rights. In its comprehensive 2018-2025 National Strategy for the Development of Education, the Ministry of Education (MoE) determines that the Life Skills subject has failed to be efficiently implemented in schools. This only reaffirmed our findings that school pupils have no access to topics from comprehensive sexuality education (CSE), even though the previous government reassured us that such topics have been covered by the Life Skills school subject. During the early parliamentary elections in 2016, SDSM, together with 9 other pollical parties, committed to undertake measures to enhance the curriculum with information concerning SRH. With the change of political power, MoE announced its intentions to reform the education and presented the comprehensive national education strategy to the public, thereby inviting comments and proposals. HERA and the Coalition “Margins”1 forwarded their proposal to MoE on how to improve the strategy from three aspects, including a piloting of comprehensive sexuality education in several schools. HERA also attended the consideration of the strategy by the Parliamentary Commission on Education, where once again we reiterated our arguments and proposals. 2017 was a year also marked by the signing of Memorandum for Cooperation between HERA and MoE on the promotion of sexual and reproductive health education and comprehensive sexuality education. Moreover, the Youth Platform for CSE, comprising 7 member-organisations (HERA, HOPS, MOF, Y-PEER, “Youth Can”, “Shadows and Clouds” and NYCM), designed New Year cards with messages about comprehensive sexuality education. The messages were addressed to institutions, parents and the young people, wishing them all a comprehensive sexuality education in the New Year 2018. In accordance with the signed Memorandum for Cooperation, in 2018 HERA will make efforts to establish a working group within MoE and the Education Development Bureau, with a task to expand the education reforms package with draft models for piloting CSE in primary and secondary schools.

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Coalition “Margins” is the new name of the Coalition “Sexual and Health Rights of Marginalised Communities” (SHRMC).

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PREPARATIONS KICKED OFF FOR THE ESTABLISHMENT OF AN ALL-PARTY PARLIAMENTARY GROUP ON THE PROMOTION OF LGBTI PEOPLE’S RIGHTS

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The Law on Prevention and Protection against Discrimination fails to explicitly list sexual orientation and gender identity as grounds for discrimination. On the other hand, LGBTI people in Macedonia face discrimination and violence on daily basis, and the unprocessed cases only reinforce the stigma and the distrust in institutions, especially in smaller towns. Moreover, over the last years, the Parliament of the Republic of Macedonia has been a source of hate speech against LGBTI community, where sexual orientation and gender identity have been used as derogatory attributes for political opponents. In 2017, together with the Coalition “Margins”, HERA continued developing the capacities of the established local coordinating bodies for protection against discrimination in Strumica, Štip and Kumanovo. Early in 2017, the Councils of these Municipalities adopted the Protocol of Action in Discrimination Cases, including the discrimination against LGBT people. With the change of the local authorities in 2017, we met with the new Mayors of these towns with the intention to inform them about the work of these bodies and their plans for the forthcoming year, above all, ensuring continuity of capacity building and development of annual action plans. Furthermore, together with the Coalition “Margins” and the Helsinki Committee for Human Rights we launched the initiative to set up an All-Party Parliamentary Group for the Promotion of LGBTI People’s Rights. We met with the MPs, both men and women, who showed interest to contribute for the promotion of LGBTI rights in the Republic of Macedonia. In this process, 7 MPs joined the initiative, as follows: Liljana Popovska and Maja Moračanin from the Democratic Renewal of Macedonia (DOM); Pavle Bogoevski, Ivana Tufegdžić and Irena Stefoska as independent MPs; Julijana Nikolova from Liberal Democratic Party (LDP) and Branko Manoilovski from the Democratic Union for Integration (DUI). We expect all interested MPs to join the constitutional meeting in the Parliament early in 2018, and to officially establish the All-Party Parliamentary Group for the Promotion of LGBTI People’s Rights in Macedonia. The role of HERA and its partners will consist in providing continuous support to the Parliamentary Group in organising their activities and operations, especially in the process of amending the Law on Prevention and Protection against Discrimination. We will also cooperate with the local coordinating bodies for protection against discrimination in the development of annual plans and implementation of activities throughout 2018.

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NATIONAL COORDINATING MECHANISM OF MACEDONIA – LEADERS IN THE REGIONAL INITIATIVE FOR HIV PROGRAMMES SUSTAINABILITY

Through regional cooperation to sustainability of HIV prevention programmes in SEE countries

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The withdrawal of the Global Fund to Fight HIV, Tuberculosis and Malaria, as the sole donor for HIV prevention services in South-Eastern Europe, and the absence of national investments in the prevention, have raised the HIV rate among marginalised groups in some of the countries in the region, in particular in Serbia and Romania. In December 2016, upon initiative from the Secretariat of the National Coordinating Mechanism (NCM), HERA and “Stronger Together� organised a regional conference where a regional coordinating mechanism was formed from 8 South-Eastern European countries, with the purpose of greater regional coordination and lobbying for HIV programmes sustainability. In May 2017, the second regional meeting was organised to define the three-year objectives of regional advocacy for increased national investments in the South-Eastern European countries and for the implementation of national funding mechanism for HIV prevention services. An annual plan was adopted for advocacy and fundraising for prevention services in countries where such services have been closed down or are at risk from closing due to the absence of national funding systems. The meeting also defined the three-year objectives relevant for applying to the regional call of the Global Fund exclusively dedicated to the countries from Eastern Europe and Central Asia, for issues concerning the sustainability of HIV interventions among key populations. In December 2017, we started organising the regional dialogue between civil society organisations working on HIV-related issues in South-Eastern European countries and the potential external donors who would invest in bridging the gap and in sustaining the prevention services until national funding systems are put into place. The meeting in Belgrade was attended by 26 participants from non-governmental organisations that implement prevention activities in South-Eastern European countries and 8 representatives from potential donors. The meeting reached the conclusion that external funding is still required, especially for the South-Eastern European countries, which have no national investment and funding systems that could ensure the sustainability of prevention services for key populations. In addition to this, countries should work more intensely for increasing the national funding of HIV programmes sustainability, which can be achieved through regional coordination and joint advocacy. The third meeting of the Regional Coordinating Mechanism of South-Eastern European countries is scheduled for February 2018, where the regional application to Global Fund will be developed aiming at increased investments in the HIV treatment, care, support and prevention services that are to be implemented by civil society organisations. Regional advocacy activities have also been planned for the general meeting of the Global Fund’s Management Board scheduled for May 2018 in Macedonia.

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INFORMATION AND EDUCATION

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CSE IS GATHERING MOMENTUM! KEEP UP THE GOOD WORK, HERA YOUTH!

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For more than three years, our informal curriculum for comprehensive sexuality education has been bridging the gap from the lack of information about sexual and reproductive health and rights that young people were receiving in formal education. HERA Youth group works daily on public awareness raising and greater information of youth in Macedonia through peer education both inside and outside of schools, radio shows and activism. During 2017, 206 young people from Skopje completed the training in comprehensive sexuality education. Another 140 young persons, including persons with disabilities, were involved in a number of workshops as part of the CSE curriculum. The trainings were implemented in schools and through weekendmodules in the Youth Education Centre (or “Centarče” (tiny centre), as we prefer to call it) as part of the “I Want To Know”Youth Centre located at Vodno, which was opened in September with the support from International Planned Parenthood Federation and an institutional grant from Civica Mobilitas. Throughout the year we worked together with the following schools: “Braќa Ramiz i Hamid”, “Orce Nikolov”, “Braќa Miladinovci”, “NOVA” and “Goce Delčev”. Another 21 CSE peer educators were trained during the Mavrovo Summer School. HERA Youth were also active internationally: in November 2017, two of the more experienced HERA Youth volunteers became part of the trainers’ team for the regional CSE training that was organised in Brussels by Y-SAFE, a network of young volunteers of IPPF Europe and Central Asia. 18 radio shows tackling various CSE topics were aired as part of the “Sexy Neighbourhood” programme that is broadcast every other Wednesday on Radio MOF. HERA made sure that the young journalists and activities of the “Sexy Neighbourhood” participate in two workshops delivered by the prominent journalists and writers, Ana Jovkovska and Toni Dimkov, thus giving them the opportunity to learn a lot about journalism, gender inequality in the media and the media ethics. HERA Youth marked the 26th September, the World Contraception Day, with a panel discussion under the title “Young People Demand What Is Due to Them – Access to Sexual and Reproductive Health Services”. The panel discussion provided an opportunity for the young people to ask questions to the representatives of the competent institutions and to the decision-makers, and the availability of modern contraceptive methods in Macedonia was a major topic of discussion. The Deputy Minister for Health, Goce Čakarovski, made a promise to those attending, including more than 50 young persons among them, to secure the budget for modern contraceptive methods as part of the next year’s prevention programmes. In 2017, we opened the HERA Youth Instagram Profile so as to increase the level of information, accessibility, visibility, communication, and entertainment among the young people. In 2018 we will expand the coverage of young persons with CSE education, we will organise trainings for new peer educators, not only in Skopje, as was the practice over the last three years, but also in another 4 towns. In addition to education, the “Sexy Neighbourhood” radio shows will continue to air. Our volunteers will organise an exhibition, produce videos, write columns and screen films, with a single purpose in mind – to make the CSE story reach as far as possible.

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ROMA HEALTH MEDIATORS FACILITATING THE ACCESS OF ROMA (WOMEN) TO HEALTHCARE SERVICES

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For seven years now, Roma Health Mediators have been facilitating the access of Roma population to healthcare services and have contributed to building their confidence in healthcare institutions and in healthcare staff, at the same time helping them build their habit to look after their own health. Initiated by HERA, this model has been continuously supported by the Ministry of Health since 2011, because they have acknowledged the importance of building the mediators’ capacities and have ensured the sustainability of this programme though the state-run public healthcare system. During 2017, we worked on strengthening the capacities of the ten mediators on issues related to discrimination and child marriages. In cooperation with the Ombudsman Office, we organised 8 educational panels in the municipalities of Šuto Orizari, Kočani, Gostivar and Štip to raise the awareness of the Roma population about child marriage prevention, about the importance of preventive healthcare, and about the importance of obtaining health insurance. In addition to this, we worked on strengthening the multisectoral cooperation on the local level and, in line with this, we conducted a needs assessment and capacity assessment of the local institutions (in cooperation with CRPRC “Studiorum”) and we organised working meetings with local institutions in these municipalities. Our objective was to identify, on the local level, sustainable models of supporting and employing the health mediators. Both UNICEF and the Ministry of Health were actively involved in all these processes. Annual reporting figures show that, in the course of 2017, the ten mediators who were acting as part of the Ministry of Health’s programme, have provided a total of 19035 services, of which 80.7% were in the area of healthcare, 12.4% were concerning the provision of personal documentation, and 6.9% were related so social welfare. Next year, too, we will continue to seek sustainable solutions for full employment of Roma Health Mediators and we will continue to provide technical assistance to the mediators’ work in line with the needs and plans of the Ministry of Health.

31


FROM AN IMPROVED COMMUNICATION WITH DOCTORS TO BETTER HEALTHCARE SERVICES FOR THE ROMA COMMUNITY

A scene of the forum theatre performance “New Stories from the Waiting Room”

32


Roma (women) are still not in the position to fully enjoy their healthcare rights, which is owing to the discrimination, but also to communication barriers that arise from language and cultural differences between the Roma people and the healthcare workers. For two years now, with the support from FOSM, HERA has been using creative tools and approaches to improve the cooperation and communication between healthcare workers and patients from the Roma community. The forum theatre performance “New Stories from the Waiting Room” was one of the project activities implemented last year. We turned the theatre stages in Skopje, Delčevo and Tetovo into big waiting rooms where, through discussion and acting, and together with the audience, we attempted to find solutions to the problems that Roma patients are facing in healthcare institutions, at the same time trying to encourage proactiveness among citizens. In cooperation with the Family Medicine Centre of the Medical Faculty in Skopje, we organised two workshops, in Skopje and in Delčevo, to improve the communication skills of 40 healthcare workers and make them more sensitive to the Roma culture. Various forms of communication materials were used as part of the project (videos, articles, comics, photo stories), which are available on the web page and the Facebook page of the “New Stories from the Outpatient Clinic”. On Facebook, more than 5700 users are already a part of creating new practices in the healthcare provision. The making of new, positive narratives for the Roma in the healthcare system will continue in the next year, too. Besides the preparation of a new forum theatre performance and the on-going communication on internet platforms, next year, together with the Family Medicine Centre, we intend to further raise the level of education of the healthcare workers through the delivery of an even greater number of accredited trainings in even more towns in Macedonia.

33


THROUGH AWARENESS RAISING TO AN IMPROVED PREVENTION – BUILDING THE HEALTHCARE WORKERS’ SKILLS AROUND CONTRACEPTION, REPRODUCTIVE HEALTH IN CRISIS SITUATIONS AND GENDER-BASED VIOLENCE

34


Over the past years, HERA has been working continuously on expanding the knowledge and perfecting the skills of healthcare staff and healthcare associates on various topics in the area of sexual and reproductive health and gender issues. Reasons are manifold: only 13% of women in Macedonia use modern contraceptive methods; in situations of humanitarian crises, women and girls, and especially pregnant women become particularly vulnerable, and the healthcare system fails to acknowledge SRH as an important healthcare intervention; there is no uniform healthcare provision in the healthcare sector that can ensure comprehensive care and support to the victims of genderbased violence. In 2017, in cooperation with the Family Medicine Centre and the Healthcare Institute for Mothers and Children, we delivered family planning trainings to 20 freshly enrolled family medicine doctors, with a further attendance of 5 nurses from family doctors’ offices and 71 community nurses. In order to better sensitise them about the importance of SRH care and comprehensive response in humanitarian crises and of the clinical treatment of sexual abuse victims, we trained 44 healthcare workers and associates, including doctors, specialising gynaecologists, nurses, psychologists, social workers, forensic medicine specialists, and also representatives from civil society organisations that provide services in crises situations. In cooperation with the Ministry of Health and the Family Medicine Centre, HERA produced its first ever package of training materials in the area of gender-based violence dedicated exclusively to healthcare workers. Two trainings were organised for healthcare workers, including 34 family doctors, 22 nurses and 2 representatives from civil society associations, from all over Macedonia. The trainings have revealed that majority of healthcare workers share the same convictions and fears as the general society: that domestic violence is a private matter that should not be interfered with unless specifically asked from them. As it happens, victims of violence frequently visit their general practitioner complaining about various symptoms that are not necessarily of medical nature, just so to attract the attention of their doctors. The ability of the doctor to identify one such instance, like frequent headache complaints, a black eye or bruises all over the body, can mean an open case or a helping hand. This is exactly why next year we will continue with additional trainings for gender-based violence and for the importance of SRH in crises situations and of clinical management of sexual abuse victims. The cooperation with the Family Medicine Centre as our partner is of exceptional importance because it enables us to reach out to many more healthcare workers from the primary healthcare sector. Promoting the general practitioners as family planning service providers is used as a preventive strategy by healthcare workers to reduce the number of unwanted pregnancies and to combat sexually transmitted infections. Therefore, family planning remains our top priority as far as the strengthening of healthcare capacities is concerned.

35


THROUGH COOPERATION WITH HIGH SCHOOLS TO AN IMPROVED PREVENTION OF DRUG USE AMONG YOUNG PEOPLE

36


For more than 5 years now, with the support from the City of Skopje, HERA has been working on the promotion of cooperation and capacity building of high school staff around improving the prevention of drug use among young people. Despite the fact that the number of young people who use drugs is constantly growing, prevention services are still lacking, and there is also a need for continuous capacity building of specialised support personnel in schools so as to prevent drug use among high school population. In 2017, an educational workshop was organised with representatives from 18 high schools where teachers were thoroughly introduced to the services provided by the “I Want To Know� Youth Centres and the First Family Centre, as well as to the referral mechanisms and ways to obtain services from the centres. Moreover, topics were defined for the training delivered to 19 representatives of specialised support personnel from 22 highs schools in Skopje, with a focus on new psychotropic substances and violence against children in schools. In 2017, we launched the new Facebook page of the Drug Use Prevention Counselling Service from where young people, but also teachers and parents, can obtain information about the services provided by the Centre and receive answers to their questions and concerns. In 2018 we will continue training the high school teachers about intervention and early detection of drug use, about the new psychotropic substances, and on building interpersonal skills for drug use prevention. The services provided by the Counselling Centre will be promoted with printed posters, flyers and through social networks, which will contribute for a greater visibility and an increased number of clients.

37


BUILDING THE INTERSECTORAL RESPONSE FOR PREVENTION OF VIOLENCE AGAINST CHILDREN IS A PREREQUISITE

38


There is no coordinated approach in Macedonia for protection of children against violence. Institutions from different sector act independently, with an existing cooperation only between social services, the police and the prosecution office, in rather small percentage (9.5%). Violence against children is typically reported by parents, family members or the victims themselves, to the social work centres or to the police. There is no evidence of any case of violence against children to have been identified and reported by the healthcare or education system. In September 2016, in partnership with UNICEF, HERA launched an innovative project for setting up local intersectoral teams that will act in cases of violence against children in order to reinforce a coordinated approach. Initially we developed a trainer toolkit and then we did a training of trainers; with the completion of the training, 14 professionals from various sectors (including the social work sector, education, healthcare, police, public prosecution and the civil society sector) were awarded certificates for national trainers, meaning that they can train intersectoral teams who can act in cases when children are the victims of violence. Protocol of action for intersectoral teams was developed, and practical guidelines were prepared for professionals from the education and healthcare systems, so as to improve their skills and knowledge around identification of violence against children and the referral procedure in such cases. In 2017, 4 local multisectoral teams were established in Skopje, Gostivar, Ĺ tip and Bitola. The teams comprise professionals from the local social work centres, police stations, basic prosecution office, gynaecologists, paediatrics, as well as representatives from the Education Development Bureau and the civil society organisations. A total of 65 professionals from six sectors were trained. Next year we will deliver trainings for an additional strengthening of the teams, and we will set up further 4 multisectoral teams in other towns so as to ensure better treatment of children in cases when they are the victims of violence. We will finalise the practical guidelines for the Ministry of Health and for the Ministry of Education and Science, which will then be distributed to healthcare workers and the teaching staff in schools.

39


SUPPORTING THE NGOs TO DEVELOP BUSINESS PLANS FOR STARTING SOCIAL ENTERPRISES THAT WILL EMPLOY ROMA (WOMEN)

Business plan development training for non-governmental organisations

40


The long-term unemployment and the limited participation of Roma women in the labour market is a challenge that civil society organisations have been dealing with for a long time in their attempts to enable the social inclusion of the Roma population in the society. However, social entrepreneurship as a form of Roma inclusion in the labour market has not been given proper acknowledgment in our society because this is an innovative model, and it is only recently becoming more and more applied around the world as an employment model for categories of people with restricted employability. The project “Empowering Roma Women through Social Enterprise Creation”, funded from the EU Instrument for Pre-accession Assistance (IPA), presented the concept of social entrepreneurship throughout 2017 to around 60 representatives from the non-governmental sector. Together with the SOS Group from France, HERA worked with the most interested organisations on developing 20 business plans for the social inclusion and integration of Roma (women) on the labour market. Then followed a marked research into the most successful business ideas, so that we finally ended up with 10 developed social start-ups, predominantly in the food processing industry and service provision. A social entrepreneurship manual was also developed, “Development of Social Enterprises for Creating Inclusive Communities”, which provides information about the legal framework, models of social enterprises, as well as guidelines for designing a successful business plan. The manual will be useful for the organisations, but also to individuals who may wish to start up a social enterprise. Next year, with the support from IPA programme, HERA will continue to work on the social entrepreneurship development and will further strengthen the advocacy capacities of the interested civil society organisations on the territory of the City of Skopje. Together with the City of Skopje, we will develop a local social entrepreneurship strategy with an action plan for the employment of Roma (women). At the same time, we will create funding opportunities for the civil society organisations who may wish to start up social enterprises, which will allow us to analyse the efficiency of the local policies that we will have developed in cooperation with the City of Skopje.

41


SERVICES

42


In 2017, a total of 6635 clients used the services of HERA concerning sexual and reproductive health, HIV and gender-based violence. As many as 91% of the clients came from one of the marginalised or vulnerable groups of citizens, including the Roma population, LGBTI persons, women sex workers, women and children victims of violence, people who use drugs, women from rural areas, persons living with HIV or the disabled persons.

Service

Number of clients in 2017

Youth Centre for Sexual and Reproductive Health “I Want To Know” – Vodno

831

Youth Centre for Sexual and Reproductive Health “I Want To Know” – Šuto Orizari

1655

Mobile Gynaecology Outpatient Clinic

646

First Family Centre

208

Mobile Clinic for HIV Counselling and Testing

2919

Counselling Service for HIV/AIDS (in cooperation with the Clinic for Infectious Diseases and Febrile Conditions)

376

% of women/girls

46.9%

% of men/boys

52.9%

% of transgender persons

0.2%

% of young people aged 10-24

41.4%

% of clients provided with services during humanitarian crisis

1%

% of persons from marginalised communities

91%

43


“I WANT TO KNOW” YOUTH CENTRES – NONPAREIL AND OURS!

44


In the course of 2017, the “I Want To Know” Youth Centres located at Vodno and in Šuto Orizari registered a total of 3772 visits by 2526 clients, and they provided a total of 8736 healthcare services and counselling sessions on sexual and reproductive health. A total of 652 STD tests were administered, including for chlamydia, gonorrhoea, syphilis, trichomonas and candida, and further 461 HIV tests. 147 oral contraceptive kits were distributed and 8 intrauterine contraceptive devices were inserted as methods of protection against unplanned pregnancy. 114 Pap smear tests were administered free of charge to women who were most in need. Through the Youth Centres, 454 young persons received education on some of the SRH topics, which was delivered by a pedagogue, a psychologist and peer educators trained to work with children, young people at risk, and persons with disabilities. In 2017, the work of the Youth Centres was for the first time supported by the Municipality of Centar (60000 denars) and Komercijalna Banka (40000 denars), whereas the continuation and consistency of services independently of international donors was secured through the HIV Prevention Programme of the Ministry of Health, which fully took over the funding responsibility after the withdrawal of the Global Fund. It bears mentioning that by the end of 2017, the “I Want To Know” Youth Centres have become fully funded solely from domestic sources, be it from the local or central government, or donations from the private sector. We will stay committed to securing the future funding of our services predominantly from state institutions, which is a practice followed in many European countries where civil society organisations receive state support to contribute for social welfare and healthcare of citizens.

45


MOBILE GYNAECOLOGY OUTPATIENT CLINIC: FIELD PRESENCE FOR THOSE WHO REQUIRE OUR SERVICES THE MOST MOBILE HIV CLINICS: PROVIDING CONTINUOUS HIV TESTING FOR THE KEY POPULATIONS

46


In the course of 2017, in cooperation with 7 civil society organisations, the mobile gynaecology outpatient clinic operated in the field in a number of towns across the country: Kumanovo, Tetovo, Gostivar, Prilep, Bitola, Strumica, Ohrid, Struga and Demir Kapija. They have covered women from the communities of women sex workers and persons who inject drugs, and 520 Pap smear tests and 7 chlamydia tests were administered. The mobile gynaecology outpatient clinic provided its services also in migrant and refugee transit centres at Tabanovce and Vinojug, where gynaecological examinations were carried out to 92 women, and further 12 pregnant women received antenatal care, including ultrasonography, food supplements, and safe pregnancy counselling. Gynaecological examinations were provided to 108 women from the rural areas of Lojane and Vaksince. At the request from the Ministry of Justice, the mobile outpatient clinic worked with women from the “Idrizovo� penal & correctional facility, where 17 women convicts were provided with Pap smear screening, gynaecological examinations and ultrasonography. Our service providers have also visited the Demir Kapija Special Institution for Persons with Intellectual Disabilities, where 8 women were examined and 4 Pap smear tests were administered. The Mobile Gynaecology Outpatient Clinic for women from marginalised communities and rural areas has been recognised programme-wise and funding-wise within the National 2018 HIV/AIDS Prevention Programme; this will secure the continuation of our services beyond the withdrawal of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), who have originally supporting this service since 2013.

In addition to the Global Fund, HIV field testing in 2017 was supported by ViiV Healthcare UK Limited with activities exclusively aiming at the HIV prevention among men who have sex with men (MSM) and members of the LGBTI community. In 2017, the mobile HIV service providers administered a total of 2910 HIV tests, 91% of which were among MSM, persons who inject drugs, women sex workers and convicts. Moreover, 821 HCV tests were administered. In cooperation with the Public Health Institute we organised a two-day training for voluntary counselling and testing which was delivered to the counselling services of the public healthcare centres; 21 participants refreshed their knowledge with novelties in HIV prevention, in particular, regarding the pre- and post-exposure prophylaxis and the global 90-90-90 HIV targets, and they were also made aware of the current epidemiological HIV and AIDS trends in the country. HIV prevention among MSM population was in the focus of our trainings. By the end of the year we delivered a training for HIV counsellors from the partner civil society organisations who, too, are involved in the mobile and stationary services inside and out of Skopje, in order to refresh their knowledge about HIV and to improve their counselling skills. A total of 24 persons from 12 civil society organisations were trained. As of October 2017, the funding of the mobile HIV testing service, coordinated by HERA in cooperation with 15 civil society organisations, has been ensured through the National HIV/AIDS Prevention Programme of the Ministry of Health, which will allow for continuation of our field work, which was originally funded by the Global Fund since 2004.

47


COUNSELLING SERVICE FOR DRUG USE PREVENTION AMONG YOUNG PEOPLE

FIRST FAMILY CENTRE: CLIENT SATISFACTION – A MOTIVE AND A CHALLENGE

48


The number of young people who use drugs is growing every year, and the largest share belongs to young people aged 14 and 15 who use marijuana and sedatives. Apart from them, this problem is faced also by their parents, who seek ways to prevent or manage the drug use of their children. In 2017, the Counselling Service for Drug Use Prevention among Young People operated as part of the two “I Want To Knowâ€? Youth Centres at Vodno and in Ĺ uto Orizari. A total of 207 clients were registered, including 128 young persons, but also 94 parents who sought assistance and support through direct counselling, psychological education, verbal intervention, family psychotherapy, psycho-social therapy, referral to testing and referral to treatment.

By the end of 2017, Macedonia saw an intensification of the process of institutional preparation for a more comprehensive solution to issues concerning the gender-based violence. Along these lines was the adoption of the Law on the Ratification of the Istanbul Convention. However, specialised services and support are still lacking, and the First Family Centre still remains the only centre in the country that applies a holistic approach in managing the gender-based violence, meaning that they provide services to women who are victims of violence and to the perpetrators, and also to the whole family, including the children. In the course of 2017, through individual, group and family counselling, the First Family Centre covered a total of 208 beneficiaries, including 90 women victims of domestic violence, 29 perpetrators of domestic violence, 43 minor children who were direct or indirect victims of domestic violence and 46 other family members who took part in the counselling. Compared to years before, 2017 marked a 35% increase in clients who approached the First Family Centre on their own, upon recommendation from previous or on-going beneficiaries, or after they had been referred to us by other civil society organisations. This year our services were used by foreign nationals, too, which is why the services were also made available in English. Moreover, there was an overall increase in the number of women and whole families from other towns in Macedonia, who approached our Centre requiring support. Next year we will strive to make the First Family Centre more accessible to as many beneficiaries as possible, which is why we will increase the number of work hours. The quality of services will be maintained through the expansion of the team and their capacity building through trainings; we will also enhance the visibility of our services through an intensified media promotion.

49


ROMA (WOMEN) REQUIRE PARALEGALS IN THE FIELD

50


Majority of cases of violation of human rights registered in 2017 in the municipalities of Šuto Orizari, Čair and Ǵorče Petrov (49%) were concerning the illegal charging for gynaecological services, which are otherwise supposed to be free of charge when provided by general gynaecologists. Having drawn their attention to this, 4 paralegals who were actively involved in the community, initiated and implemented 11 mediation meetings with gynaecological offices and institutions in order to ensure the smooth enforcement of patients’ rights and to establish good cooperation with service providers who are directly responsible for the implementation of reproductive rights. In one of the cases, the doctor that our paralegals met with, has completely terminated his practice of illegal charging for services. In two cases, the illegal charging was only temporarily reduced. During the year, a total of 24 individual petitions were made by Roma women to institutions competent to act on the illegal charging for healthcare services. In addition to the Municipality of Šuto Orizari, as of January this year, field activities relating to antenatal care and healthcare rights began to be implemented in the municipalities of Čair and Ǵorče Petrov. During the year, paralegals organised three civil community forums, with a total attendance of 131 persons, on the following topics: “The role of social protection in facilitating the access of Roma people from Šuto Orizari to healthcare services”, “The impact of quality antenatal care on the promotion of mothers’ and children’s health”, and “The role and the significance of community nursing services in prenatal and postnatal care”. The forums were organised with the purpose of improving the cooperation of paralegals with the polyvalent community nursing services and the Inter-Municipal Social Work Centre in Šuto Orizari in information exchange and referral of clients. In 2018, paralegals will continue to carry out their field activities and, as part of the Šuto Orizari Women’s Initiative, they will continue to monitor the situation with violation of human rights and to work actively on raising the awareness of women about their sexual and reproductive rights. Actions will be intensified for elimination of illegal charging for services, especially by bringing the issue up to date with institutions competent to make the national healthcare policies and to intervene in cases of violation of related rights.

51


PUBLIC AWARENESS ABOUT SRH / MEDIA CAMPAIGNS

52


Year

Facebook

Twitter

YouTube

2016

14,796

1,699

9,200

2017

16,463

1,840

10,810

supporters

followers

views

53


JUST BECAUSE IT’S COMMON, IT DOESN’T MAKE IT RIGHT. MEASURE TWICE, CUT ONCE, DISCRIMINATE – NEVER!

54


Encouraged by the ever-growing number of discrimination petitions, together with the Coalition “Margins”, we implemented a campaign for protection against discrimination on all grounds, including on grounds of sexual orientation and gender identity, with the purpose of reminding the public that in order to reduce the number of discrimination cases, we must identify them and report them. The slogan “Just Because It’s Common, It Doesn’t Make It Right. Measure Twice, Cut Once, Discriminate – Never!” was used in the videos we had produced in Macedonian and Albanian and which were aired on 5 local and 3 national televisions. The campaign was promoted through panel discussion in 5 towns, with the involvement of representatives from the Ombudsman Office of the Republic of Macedonia, Ministry of Justice and the Commission for Protection against Discrimination, as well as from the municipalities of Kumanovo, Štip and Strumica.

55


“NOT THAT I DISCRIMINATE, BUT…”

56


“Not that I discriminate, BUT” is a form of continuation of the online campaign “Circle 20” which helped promote the protocols for promotion of cooperation of the local mechanisms for protection against discrimination that were developed in cooperation with the Municipality of Kumanovo, Municipality of Štip and Municipality of Strumica. These protocols define the actions that are required to be taken in cases of protection against discrimination on the grounds of sexual orientation and gender identity.

57


NEW STORIES FROM THE OUTPATIENT CLINIC

58


In April, theatre stages in Skopje, DelÄ?evo and Tetovo were transformed into big waiting rooms where, through acting and discussion with the audience, we tried to resolve the problems that Roma people are facing as patients in the healthcare system. More than 300 people, including healthcare workers, watched the performances given by the Forum Theatre “Stories from the Waiting Roomâ€?, and they realised that change is possible only if from passive bystanders they become proactive citizens. Striving to raise the awareness and encourage a change in the narratives about Roma people, we produced a video serial from personal stories which, on one hand, portray the lives of Roma people with presumably insurmountable social problems, such as lack of national identification number or making a living from collecting plastic bottles, and on the other hand, demonstrate that the Roma people and the Roma women can make their dreams come true and write success life stories regardless of how rough the road has been. Communication, an essential element of interpersonal relations, including the relations between healthcare workers and Roma patients, served as inspiration for a serial of 10 comics which illustrated one rather unusual friendship in the outpatient clinic.

59


YOUNG PEOPLE DEMAND!

60


HERA youth are informed “sexy neighbours” and restless when it comes to demanding what is due to them! They produced a video to send a message to the new government that contraceptives and SRH services must be available and accessible to everyone in every neighbourhood! On the occasion of 26 September – World Contraception Day, they demanded inclusion of oral contraceptives on the positive (essential) list of medicines, access to free condoms, comprehensive sexuality education in schools and youth-friendly centres for sexual and reproductive health. Here is why:

61


28 SEPTEMBER – GLOBAL DAY OF ACTION FOR ACCESS TO SAFE AND LEGAL ABORTION

In times when sexual and reproductive rights are vastly undervalued all over the world, we had no option left than to join the global camping and remind that – though exhausting – the fight for women’s rights is a tough one, personal one and a collective one! And ours! This year, too, we observed the 28th September, ready to persist until the end – because abortion must not be a hurdled race!

62


NEGA PLUS

“Nega Plus” is HERA’s first social enterprise, established from the desire to improve the social status and access to rights of marginalised communities. Every family member counts, which is exactly why “Nega Plus” offers professional care and assistance to elderly and decrepit persons in their own homes on the territory on the Municipality of Centar and the City of Skopje. Roma women count, too, so “Nega Plus” develops the capacities of marginalised Roma women and employs them, thus providing them an opportunity to become economically independent and improve their personal wellbeing. “We don’t make profit, we invest in the community where we live” is the story briefly narrated in our videos (video 1, video 2).

63


“THE NEEDS ARE HUMAN, NOT SPECIAL… EVEN WHEN THEY ARE SEXUAL”

This is exactly why once more we talked about sexual and reproductive rights of persons with disabilities. Twenty persons with disabilities participated in the sexuality workshops that were organised in response to the self-stigma, professional prejudices and other people’s looks, and we improved the access to quality sexual and reproductive health services through free of charge gynaecological and dermatovenerological examinations in our Youth Centres. The days of SRH and of persons with disabilities were completed with the screening of the film “The Sessions” and a public discussion where we talked about the need for education about sexual and reproductive health (SRH) and the access of persons with disabilities to SRH services, and about the social barriers which prevent them from using their sexual and reproductive rights.

64


WE ALL HAVE HIV STATUS. DO YOU KNOW YOURS?

This was the message used this year to encourage everyone to get tested for HIV, and in this way, we pledged our support to the European HIV Testing Week, which took place from 17th to 24th November. We organised two creative workshops where we used recycled materials to make designed outfits and sexual aids which then served the purpose of educating 15 men and women participants about the proper use of condoms and about sexual and reproductive health. We ran a social media campaign to raise awareness about the benefits from HIV testing and inform about various options for testing, therapy, care and support. With the same goal in mind, we produced the videos “We All Have HIV Status. Do You Know Yours?”, “Where To Get Tested for HIV?”, “Seven Myths and Facts about HIV” and “When Are You Getting Tested for HIV”.

65


MARIJA THE VAGINOLOGIST Marija is a HERA volunteer who has all the “1000 becauses” to all “1000 whys” that crack young people’s brains concerning sexual and reproductive health. Her corner is completely anonymous and welcoming of all questions that, due to embarrassment or fear from judgement, have remined unanswered.

ŠUTO ORIZARI WOMEN’S INITIATIVE Aware of the barriers that women from Šuto Orizari come upon when accessing the sexual and reproductive health services, activists from the Šuto Orizari Women’s Initiative produced an informative video about the services that any women should receive from her gynaecologist during pregnancy or if planning pregnancy, reminding that “For a healthy pregnancy, information is what matters the most”.

66


2018 IS HERE AND WE ARE STILL NOT GOING TO TALK ABOUT SEX(UALITY) EDUCATION? At the end of the year we sent out New Year’s cards to the young people, to their parents and to institutions, wishing for the New Year to finally bring comprehensive sexuality education!

67


MOBILISATION OF RESOURCES

68


In 2017, a total revenue of 52,455,616.00 MKD was generated from grants and donations, which represents an increase of 9.1% compared to the year before. Similar to the previous year, approximately 95% of the revenue came from international foundations, governments of foreign countries and multilateral organisations. In 2017, our organisation received its largest revenue from state institutions, i.e. from local and central authorities, compared to the period from the very founding of the organisation onwards. State funding increased by 88% compared to the year before, and in addition to the City of Skopje, this year our organisation was also supported by the Municipality of Centar, and by the Ministry of Health through the HIV/AIDS Prevention Programme. All grants received from state institutions have been allocated to providing social and healthcare services to vulnerable and marginalised communities.

69


70

Revenues raised from donors and other sources of funding

Budget (MKD)

International Planned Parenthood Federation

6.190.254,00

The Global Fund to Fight AIDS, Tuberculosis and Malaria

6.863.439,00

European Union

11.847.113,00

Open Society Foundation Macedonia

8.037.936,00

UNICEF

2.447.010,00

UNFPA – United Nations Population Fund

4.059.268,00

AIDS Health Care Foundation

759.529,00

Ministry of Foreign Affairs of the Netherlands

6.430.240,00

Ministry of Health

1.132.950,00

City of Skopje

1.341.965,00

Municipality of Centar

50.000,00

Swiss Agency for Development and Cooperation

1.765.688,00

Centre for Reproductive Rights

458.523,00

Komercijalna Banka AD Skopje

140.000,00

Naviko Shipping

6.000,00

Eurostandard Banka AD Skopje

20.000,00

ViiV Healthcare UK Limited

746.803,00

Membership fees

26.000,00

Individual donations

16.276,00

Own income from economic activities (“Nega Plus”)

116.622,00


Revenues by forms of donations

Budget (MKD)

%

State institutions

2.524.915,00

4,81

Multilateral organisations

18.393.391,00

35,06

Foreign governments

8.195.928,00

15,62

International foundations and NGOs

23.016.484,00

43,88

Private sector

166.000,00

0,32

Membership fees

26.000,00

0,05

Individual donations and own income

132.898,00

0,25

EXPENDITURES BY STRATEGIC OBJECTIVES Organisational Capacities and Mobilisation of Resources; 8.931.974,00 ; 18% Education and Services; 14.846.116,00 ; 31%

Advocacy; 13.318.451,00 ; 28%

Community Empowerment; 10.958.686,00 ; 23%

71


“NEGA PLUS” – OUR SOCIAL ENTERPRISE Awarding of certificates to the trained Roma women

72


The high level of unemployment among Roma women, as one of the most marginalised groups in the country, was the reason behind HERA’s intention to start up a social enterprise that will employ Roma women trained to provide home-based palliative care, which was supported by the European Commission as part of our IPA-funded social inclusion project. At the same time, by generating income, the social enterprise will contribute for the sustainability of voluntary, free and confidential services in the area of sexual and reproductive health that our organisation has been offering to the citizens for many years now. Upon completion of their training as home-based palliative caregivers, 15 Roma women were awarded certificates in October, and already in November 2017 the “Nega Plus” social enterprise started to work with their first clients. This year a total of 6 clients used the services of our enterprise. People received information about “Nega Plus” from the promotion materials we had produced, as well as from the Facebook page which provides information about all service packages that were custom-made for the needs of our clients. In the following period we will focus on building the knowledge of our caregivers in the area of sexual and reproductive health and rights and gender-based violence, and at the same time we will strengthen their leadership and managerial skills, and also communication skills required for conflict management. We will work hard on promoting the services of “Nega Plus” so as to reach out to as many clients as possible. Finally, next year, the enterprise will receive expert counselling support and investments in equipment so as to be able to provide its services continuously and professionally.

73


RESEARCH

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Documenting the Effects that the Regressive Macedonian Legislation and the Restrictive Abortion Policies Have on Human Rights: Key Findings and Recommendations

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Objective: To evaluate the effect and the consequences from the 2013 adoption of the existing Law on Termination of Pregnancy, which introduced restrictive legal provisions and hampered the access to safe and legal abortion in Macedonia. Methodology: 14 interviews were conducted with the purpose of screening the positions and experiences with these new legal provisions. The interviews were carried out with seven women who have had an abortion after the introduction of the new legal requirements, two gynaecologists, one sociologist, one social worker and three representatives from non-governmental organisations. Results: The research showed that stigma surrounding abortion and the adverse gender stereotypes persist and limit the access of women to safe abortion, and the imposition of the mandatory postcounselling waiting period only delays the access to services and underestimates the women in their capacity to make decisions. “In general, I believe that we should remove all the barriers that prevent a woman from making her own decision and receiving the service within the shortest possible time period.” (woman, 31) Moreover, the biased mandatory counselling underestimates women and their capacity to make decisions, and may lead to the dissemination of incorrect and misleading information about abortion. “I didn’t like how I was treated, especially when they used the heart metaphor, and when they were telling me i.e. subtly convincing me not to go through the abortion.” (woman, 33) Women need greater availability of practical and legal evidence-based information about abortion. The increased fines and stricter sanctions for violation of the abortion provisions may discourage healthcare workers from providing this medical service, thus restricting even further the women’s right to safe abortion. Finally, the issue of unavailability of medical abortion restricts the women’s right to safe abortion. “And yes, the worst thing about this law, much worse than before, is that sanctions are much higher for gynaecologists now in case they fail to report an illegal abortion.” (gynaecologist, Skopje) Conclusions: It is necessary to revoke the legal provisions requiring from women to go through the mandatory waiting period after the counselling and to remove the biased pre-abortion counselling; Any abortion-related counselling should be voluntary, non-coercive and responsive to individual needs and wishes of each woman; Trainings should be delivered to healthcare workers in order to prevent and change the stigma and gender stereotypes related to abortion; Guarantees should be offered that healthcare workers will provide only medically accurate, evidence-based information about abortion, compliant to the World Health Organisation guidelines; All costs arising from the legal abortion should be covered by the Health Insurance Fund, including for abortion at one’s own request, as well as costs for all modern contraceptive methods.

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The full research is available at the following link.

Needs Assessment for the Development of Social Enterprises in the Republic of Macedonia

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Objective: To identify which industries require social and economic innovations, and to provide guidelines for the future social entrepreneurs and civil society organisations who wish to start up social enterprises on our territory. Methodology: A comprehensive desk research has been conducted, whereby strategic national documents in the area of economy and entrepreneurship were analysed, and publications from academic institutions, from civil society and private sectors, and from international organisations were used. A corresponding analysis was made of the current situation in Macedonia regarding the possibilities for development and implementation of sustainable innovations in the public sector, which can be provided by social enterprises. Documents discussing the practices of European countries were examined, in particular the challenges arising from the needs of the ageing population and services that can be provided through social businesses. Moreover, an analysis was made of the possible development and application of new social innovations, or replication of old social innovations from experiences exchanged with sustainable social enterprises in South-Eastern and Western Europe, in order to develop better solutions that can be used on the local level for the purposes of employing the vulnerable population. Results: There is lack of adequate marketing/market research of the local market for the potential development of social enterprises; Social enterprises lack an adequate marketing strategy; Social enterprises have no access to investment funds for capital investments; There is lack of adequate entrepreneurial staff and entrepreneurial skills in social enterprises. Conclusions: It is necessary to develop a national strategic framework that will include financial and technical assistance to social enterprises through the setting up of an official network of social enterprises and horizontal cooperation of stakeholders for the purposes of sustainable development of social enterprises, as well as a dedicated capital investment fund for the development of social enterprises in Macedonia. The full research is available at the following link.

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Availability of SRH and HIV Services for Young People from Key Populations Affected by HIV

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Objective: To document the access, as well as the barriers to sexual and reproductive health services encountered by young people from the groups at higher risk from HIV. Methodology: An overview and an analysis were made of the existing documents; 4 focus groups were organised with 32 young people aged 18 through 24, coming from the following target groups: men who have sex with men, women sex workers, persons who inject drugs, people living with HIV. Additionally, a consultative event was organised with the major stakeholders with the purpose of extending and verifying the findings. Results: Young people from the groups at higher risk from HIV believe that they are not integrated in the society because they are facing unequal treatment, stigma, and violation of their rights. There are radical examples of discrimination and violence in school, workplace and healthcare settings, and by the representatives of institutions that are supposed to protect their rights (the police). Although an extensive network for HIV services does exist under the management of civil society organisations, capacities of the primary healthcare system have not been adjusted to the specific needs for SRH, and the SRH services in the public healthcare system are inaccessible to marginalised groups. Conclusions: It is evident that it is necessary to introduce comprehensive sexuality education and to revise the curriculum for healthcare workers so as to include updated and evidence-based information about HIV and SRH, drug addiction, sexual orientation, as well as healthcare rights of groups at higher risk from HIV. HIV prevention programmes need to be extended and improved, with a special focus on SRH services for groups at higher risk from HIV, and financial sustainability needs to be ensured for the already established HIV and SRH services after the withdrawal of the Global Fund in 2017. In the future, it is necessary to initiate legal amendments and introduce effective legal mechanisms that will change the violent practices of the institutions and of the public against groups at higher risk from HIV, mechanisms that will safeguard the protection of their rights. Macedonian version of the consultation process report is available here, and the publication is available in English here.

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PUBLICATIONS

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Social Entrepreneurship Manual: Development of Social Enterprises for Creating Inclusive Communit Wishing to fac ilitate the pathway to all future social entrepreneurs, especially to nongovernmental organisations like ours, we developed a Social Entrepreneurship Manual. The manual provides guidelines how to transform the idea of social entrepreneurship into a real social business that will simultaneously work on the economic strengthening and independence of vulnerable persons and on achieving the organisation’s economic mission and sustainability.

Newsletter for Healthcare Workers No. 1 In order to change them, negative narratives need to be identified first. Not only abound patients, but abound doctors, too. This is exactly why the first issue of the Newsletter for Healthcare Workers introduces us to the cultural habits that affect the health of Roma (women) patients and refers us to the ways in which the communication and cooperation can be improved between a healthcare worker and a patient so as to promote the access to and the quality of healthcare services provided and received.

Newsletter for Healthcare Workers No. 2 The second issue of the Newsletter for Healthcare Workers presents positive examples and experiences of some of the medical staff whose approach helps create new stories in the healthcare. Communication, attitudes, conduct and quality of services build up the confidence and the respect between healthcare workers and patients, which is particularly important when the patients come from the marginalised communities. Let’s create new stories in the outpatient clinics so as to create new practices in the healthcare system!

Family Planning Newsletter No. 7 In our seventh issue of the Family Planning Newsletter we tackle the most sensitive – and therefore the exceptionally important – topics concerning sexual and reproductive health and gender equality. In our interviews with three experts and university professors we consider and give recommendations and urgent measures that MPs should undertake in relation to the Law on Termination of Pregnancy, comprehensive sexuality education and the Law on Protection against Discrimination. The Newsletter is available at the following link.

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Family Planning Newsletter No. 8 The last issue of the Family Planning Newsletter was dedicated to the paid maternity leave, hoping that the positions and considerations of the interviewed women activists and women university professors will serve as a framework for discussion about the paid maternity and parental leave and the need for their extension, and that the given recommendations will serve as an encouragement to amend the relevant laws in compliance with the European regulation so that we can finally promote the health of mothers and new-borns in our country. The Newsletter is available at the following link.

Protocol for the Promotion of Cooperation of the Local Mechanisms for Protection against Discrimination Discrimination is an omnipresent phenomenon manifested on various grounds and in various forms, and in areas that fall under the competence of both central and local authorities. Taking into considerations that petitions for protection from discrimination require an adequate legal assistance that cannot always be accessed by the victims of discrimination because of their poor economic position, in cooperation with the municipalities of Kumanovo, Ĺ tip and Strumica we developed protocols for promotion of local mechanisms for protection against discrimination so as to encourage the reporting and sanctioning of discriminatory actions.

The Protocols are available for the Municipality of Kumanovo here, for the Municipality of Ĺ tip here, and for the Municipality of Strumica here.

HIV: Opportunities and Proposals for Providing Sustainability of Activities Supported by the Global Fund in the Republic of Macedonia This analysis identified the legal grounds and the legal normative mechanisms and additions that need to be introduced so as to ensure the smooth continuation of activities, and thus, the long-term sustainability of HIV prevention programmes after the withdrawal of the Global Fund, so that the HIV rate in Macedonia can still remain the lowest in all of South-Eastern Europe. The document is available at the following link.

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How to Successfully Control the HIV Epidemics in Macedonia? Republic of Macedonia is a country with low HIV rate, which is largely owing to the HIV prevention programmes for the key populations, which were originally supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and were part of the National HIV Programme for the 2003-2017 period. Thanks to the support from the Global Fund, partnership was built between the Ministry of Health and 15 civil society organisations, which is of key importance for successfully controlling the HIV epidemic in the country. This document provides a brief overview of HIV prevention programmes until 2017, as well as of responsibilities and challenges for the national funding that can further ensure their sustainability. The document is available in Macedonian.

Newspaper of the Women from Šuto Orizari No. 1 Having identified the current positions and challenges that women from Šuto Orizari face every day when they want to access any of their reproductive rights, and especially Roma women as a vulnerable group of citizens, the Šuto Orizari Women’s Initiative issued its first Newspaper of the Women from Šuto Orizari, so as the bring these issues closer to the competent institutions and to encourage them to take measures for promotion of women’s reproductive health. The focus of the first issue is on the barriers that Roma women encounter when accessing reproductive health services, underlining the discrimination in healthcare institutions and the illegal charging for healthcare services. The first issue of the Newspaper is available at the following link.

Progress towards the National Funding of HIV Protection Programmes in the Republic of Macedonia This analysis examines the process of transition from donor support to the funding of the National HIV Programme from the budget of the Republic of Macedonia, a process that was initiated when the Global Fund to Fight AIDS, Tuberculosis and Malaria, which had provided the necessary financial support for full 13 years, announced their withdrawal. Considering the fact that the Republic of Macedonia is the regional leader with the lowest HIV rate in South-Eastern Europe, the issue of funding the key HIV prevention programmes becomes exceptionally important, which is why this analysis has formulated recommendations for urgent actions in response to the challenges ahead. The Analysis is available at the following link.

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TESTIMONIALS / CASE STUDIES

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Religion Has No Place in the Public Healthcare System According to the Law on Termination of Pregnancy, when considering an abortion within ten weeks from the day of conception, the pregnant woman is to receive counselling from the doctor who will be performing the termination of pregnancy; however, beyond the tenth week of the day of conception, the pregnant woman is to be counselled by the President of the First-Instance Commission deciding on the abortion request.2 At the beginning of 2017, many media outlets reported the news: “Within five years, 40 babies were saved from abortion thanks to the counselling from ‘Lidija – A Beating Heart’”. From the very statements given by the association “Lidija – A Beating Heart” it became evident that their mission is to “save babies” by changing the minds of pregnant women and by pointing out to the “advantages of giving a new life, and consequences from the abortion”. The association “Lidija – A Beating Heart” had concluded a Memorandum for Cooperation with the Clinical Hospital in Štip pursuant to which persons from this association visited the hospital’s Gynaecology and Obstetrics Unit once a week to provide counselling to pregnant women, thereby having the Clinical Hospital in Štip relinquish its premises and its competences. The introduction of this sort of counselling in a public healthcare institution constituted gross violation of secularity, as one of the fundamental constitutional principles, taking into consideration that the association “Lidija – A Beating Heart” promoted religious values, and the hospital, even though a part of the public healthcare system, let the association use its premises and started a form of cooperation that substituted some of the hospital’s competences. HERA, as an organisation that is actively committed to providing access to safe and legal abortion, initiated a procedure by submitting an application to the Clinical Hospital in Štip requesting access to public information, to which the hospital did confirm that the memorandum signed with the association “Lidija – A Beating Heart” referred exactly to the relinquishment of premises and competences for the purposes of counselling of pregnant women by persons who are not authorised to do so. Based on these findings, HERA filed an application to the State Sanitary and Health Inspectorate requesting an extraordinary inspection to be carried out, as well as a petition with the Ombudsman Office requesting for a violation of healthcare rights to be established. Based on our petition, the Ombudsman Office imposed on the Clinical Hospital in Štip to terminate the Memorandum for Cooperation with the association “Lidija – A Beating Heart”. The hospital acted on the notification and unilaterally terminated their memorandum with the association. HERA will continue to monitor the situation with the pregnancy termination rights on the national level and will work hard on preventing the adverse practices that degrade women’s rights. HERA will in particular monitor whether the hospitals that carry out pregnancy termination comply with the counselling obligations, so as to see whether the counselling is provided objectively, by competent persons, without the imposition of biased opinions and the involvement of incompetent bodies whose activities may only have an adverse effect on a woman’s personal decision.

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2

Law on Termination of Pregnancy, The Official Gazette of the Republic of Macedonia No. 87 of 17.06.2013, Articles 6 and 11.


Fighting for the Rights of Persons without Documents Persons without documents are invisible to the institutions, which is why they face serious barriers in accessing their rights, including the right to health as a fundamental human right. The 2017 Active Health Protection Programme for Mothers and Children in the Republic of Macedonia stipulates free of charge medical examination during pregnancy and free of charge childbirth, even for pregnant women who hold no health insurance. The purpose of this measure is to cover those women who, for various reasons, have failed to obtain health insurance, including the women who have no personal documentation. In order to protect their health and the health of their children, the Ministry of Health made sure to include the persons without documents in its Healthcare Prevention Programme. However, even though the Programme clearly obliges the public healthcare institutions to implement this measure, in reality, it never worked as envisaged. The paralegals working on field activities in Šuto Orizari were approached by a pregnant woman, N.S., who does not have any personal documentation, so, when she tried to obtain gynaecological services in a public healthcare institution, the Gynaecology and Obstetrics Clinic, she was rejected at the very reception window. The paralegals, who are part of the Šuto Orizari Women’s Initiative, raised this issue at the meeting with the Minister for Health, upon which the Ministry issued a communication to all competent healthcare institutions making it clear that the pregnancy protection measure also includes women without personal documentation, and in regard to antenatal care and childbirth they have exactly the same rights as any other citizen of the Republic of Macedonia. N.S., who was initially refused her medical examination, was not aware which stage of pregnancy she was in, because she was denied access to any healthcare institution. After the communication was issued by the Ministry of Health, when she visited the Clinic for the second time, N.S. was provided with all the necessary examinations during her pregnancy, and the paralegals even accompanied her up to the moment of her childbirth, which was successfully completed at the Gynaecology and Obstetrics Clinic.

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The Importance of Gatekeepers D.D. is a 35-year-old man from Skopje, and a member of the MSM community. His partner, of similar age, is a national of one of the neighbouring countries, so their relationship is maintained through frequent travels. Aware of his partner’s need to get tested, but also considering the fear of testing that was common among his regular Macedonian clients, the gatekeeper organised a session that was completely focused on the two of them, so that they could create an atmosphere that was comfortable for both of them. The test of the foreign national turned reactive, while the test of the Macedonian partner turned negative; however, in discussion with the counsellor it was revealed that they were practicing unprotected sex, so the partner was considered as being within the window period. The partners decided on their own to inform each other of the results, and to seek support from the counsellor. Together, they went for an appointment at the Infectious Disease Clinic the very next day, where they had been previously announced, so that the discretion of the issue could be preserved and possible unwanted reactions avoided. The foreign national tested positive for HIV, so he was immediately referred to his native country with detailed instruction which doctor to see; this person was quickly processes by his country’s healthcare system and started receiving antiretroviral therapy. The other partner (the Macedonian national) remained under observation for the next 3 months until his window period expired. During this whole period of uncertainty, he was in regular weekly communication with the counsellor, a member of HERA. After the completion of the window period, D.D. remained with a negative HIV status, and the health status of his partner stabilised very quickly after the administration of the antiretroviral therapy.

The End of the Tunnel

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A.M. is a 45-year-old man who has lived as a homeless person for more than a year. He became socially disadvantaged after his immediate family sold the apartment where he lived and left him out on the street without any means of living. He managed to survive through the solidarity of the staff working in one local hamburger restaurant, who provided him with one meal a day. A.M. was helpless, he felt guilty and ashamed, and did not know where to ask for help. He accidently learned about the “I Want To Know” Youth Centre in Šuto Orizari, and approached them for help; the staff quickly developed a plan how to help him and take him out of social risk. With our assistance, the case was reported to the Inter-Municipal Social Work Centre, where we were informed that he needs to be provided with personal documents first, so that he can be placed on the waiting list for the “Čičino Selo” shelter. At the same time, we addressed the service point for the homeless people, where we received support and assistance. The assistance consisted in covering the rent for two months for a room that A.M. would find. We helped him in the process of obtaining personal documentation. We organised a number of activities to collect food, cloths and additional money for him. We frequently met with A.M. and provided him with food, personal hygiene products, and we regularly provided psycho-social support. We monitored his progress. We motivated him to look for a job, so that he can become financially independent. With our assistance and support, A.M. was successfully employed with one company. Today, A.M. has a stable income and a secure roof over his head. “Thank you for everything you’ve done for me; how will I ever be able to repay you? You have restored my faith in people!”


A New Chance To Be Happy K.A. is 20 years old. She is in her seventh month of pregnancy, and had attempted a suicide. She was a victim of psychological and economic violence by her step-father, and her step-uncles, too; she was forced to work since she was 15-16. She lived in substandard conditions, without electricity or water supply. Her mother is an intellectually disabled person, and is herself a victim of domestic violence, so she was not in the position to protect and support her daughter; after giving birth to two more children out of the marriage with the step-father, she took greater care for her new babies. K.A. continued living and working on her own, but once she entered into intimate relationship with her partner, who is several years older than her and who practically lived on her income, he requested her to leave her job when they found she was pregnant. Once the partner learned that the baby was a girl, he left her, and she tried to commit suicide. The victim saw us when she was severely depressed, with a prevailing feeling of loneliness and hopelessness. “I don’t want to suffer any more�, she said silently. We provided her with emergency counselling and emotional support, so as to normalise her situation. After the team of experts made a risk assessment and provided us with the findings, in addition to psycho-social assistance, we referred her to a shelter centre for domestic violence victims, and also to the Inter-Municipal Social Work Centre in order to seek her social entitlements. Moreover, we provided her with psycho-therapy and counselling, we accompanied her to all institutions and organisations she had to visit, we helped her develop her parental skills and prepared her for the coming childbirth. The final outcome of our work with this domestic violence victim is evident in her empowered emotional position and strengthened personal capacities, the improved psychological condition, the increased number of social contacts and information exchange, and the provision of a mid-term solution for her accommodation and the further preparations of a plan for her childcare and future employment.

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Merely One of Many Success Stories of the Roma Health Mediators M.A. is a Roma woman born in Italy who returned to Macedonia 5 month ago, together with her family of five, because she lost her right to stay in Italy. M.A. has 3 children, two of which were born in Italy. After she returned to Macedonia, her socio-economic position deteriorated. She did not have a home of her own, her husband had no job, the entire family had no healthcare or social protection. She used the money saved in Italy to rent a house in Šuto Orizari. Aware of her situation, she sought assistance from a Roma Health Mediator in Šuto Orizari, Ljatife Šikovska. “She asked me to help her with her two children born in Italy, to have them registered in the civil register, and consequently to provide health insurance for the whole family. I told her that we will handle her case, but it will take time, because of the lengthy procedures required for making an entry into birth registers of children born abroad”, Ljatife explained. In less than two weeks, our mediator collected all the documentation required to register the two children in the birth register. In the meantime, they filed an application for obtaining the right to health insurance, for herself, for her husband, and for the two children who had proper documentation; furthermore, all children were administered with the necessary immunisation, and the children who held birth certificates were enrolled in the “Osmi April” kindergarten and the “Braќa Ramiz i Hamid” primary school in Šuto Orizari. “The registration procedure for M.A.’s two children took 3 months. Once we collected the birth certificates, we immediately applied for health insurance for the two children. I helped the whole family, by accompanying them and mediating where necessary, to select a general practitioner and to receive their welfare entitlements from the Social Work Centre in Šuto Orizari”, Ljatife added.

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MANAGEMENT BOARD Iva Mihajlovska, President Kristijan Angeleski, Secretary Despina Dimitrova, Youth Representative Katerina Spasovska, Member Dragana Drndarevska, Member

EXECUTIVE OFFICE Bojan Jovanovski, Executive Director Draško Kostovski, Programme Director (until September) Elizabeta Božinoska, Programme Director (as of October) Miloš Stojanović, Administrative & Financial Director Damjan Nikolov, Administrative Assistant Meri Bogoromova, Administrative Assistant Vesna Matevska, Programme Manager Kristina Plečić-Bećarova, Programme Manager Dragana Karovska-Čemerska, Programme Manager Jovana Ananievska, Programme Manager Aleksandar Samardžiev, Project Coordinator Svetlana Vojnovska, Project Coordinator Rosana Janevska, Legal Advisor and Project Coordinator Voislav Ivanov, Project Coordinator Maja Balšićevska, Project Coordinator Lidija Kekenovska-Pavić, Project Coordinator Nataša Dedajić, Project Coordinator Ana Filipovska, General Secretary of the National Coordinating Mechanism Meri Cvetkovska, Coordinator of the HERA Youth Group Ana Pop Stefanija, Head of Communications (until August) Andrijana Papić-Mančeva, Head of Communications (as of September) Blagica Petrova, Social Entrepreneur Vaska Cvetanoska-Panova, Project Assistant Milena Papakoč, Financial Assistant Biljana Vlastimirova, Financial Assistant / Accountant

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SERVICES Marija Dragojlović, Coordinator of the “I Want To Know” Youth Centre at Vodno Nikolina Nikolovska, Social Worker with the “I Want To Know” Youth Centre in Šuto Orizari Ana Avramovska-Nuškova, Legal Advisor with the “I Want To Know” Youth Centre in Šuto Orizari Frosina Ivanovska, Social Worker with the First Family Centre of the City of Skopje Asib Zekir, Head of Support to the Roma Health Mediators Miroslav Jelić, Driver Jordan Krstevski, Driver Lozan Karandžiski, Driver Ljupčo Sinadinovski, Driver

H.E.R.A. – Health Education and Research Association April, 2018 Editor: Bojan Jovanovski, Executive Director Graphic Design: Žarko Stojanović Translated from Macedonian: Radomir Trajković

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CIP Каталогизација во публикација Национална и универзитетска библиотека “Св. Климент Охридски”, Скопје 342.746:613.88(497.7)”2016”(047.31) ANNUAL report [Електронски извор] : 2017 / [editor Bojan Jovanovski]. Skopje : H.E.R.A. - Health education and research association, 2018 Начин на пристап (URL): http://hera.org.mk. - Текст во PDF формат, содржи 95 стр., илустр. - Наслов преземен од екранот. - Опис на изворот на ден 11.05.2018 ISBN 978-608-4598-99-2 а) Здравствени и сексуални права - Македонија - 2017 - Извештаи COBISS.MK-ID 107236106

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