First national declaration for liver cancer in North Macedonia

By Milan Mishkovikj, Hepar Centar Bitola

Hepar Centar-Bitola was established to help raise awareness of liver viruses and non-communicable liver diseases, especially hepatitis, non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver disease (NAFLD), obesity, alcohol and liver cancer. Hepar Centar-Bitola aims to educate and prevent hepatitis transmission in youths, risk groups and the general population; offer testing, screening and counselling; promote new solutions and approaches for treatment of patients who suffer from hepatitis and non-communicable liver diseases and other transmitted infectious viruses; protect patients’ rights, and combat discrimination, marginalisation and stigmatisation.

The campaign

Organising campaigns was a challenge this year due to the global pandemic, but our main goal was clear: to place a special emphasis on uniting all parties and stakeholders to showcase the link between hepatitis and liver cancer.

Liver cancer is the third deadliest cancer in the world, and chronic hepatitis B and C contributed to more than 60% of liver cancer cases in North Macedonia. Using this information, we decided to change our approach this year by focusing on the link between hepatitis B and C with liver cancer. We found that by connecting hepatitis B and C with liver cancer many people were more empathetic to the cause and wanted to listen and help, more so than when hepatitis was linked with tuberculosis or HIV. As a conclusion from the numerous virtual conferences, discussions and technical consultations, all participants from the Republic of North Macedonia published the first National Declaration for the Fight Against Cancer. The declaration focuses on liver cancer and the individual approach in its prevention, as well as diagnosis and treatment of chronic hepatitis B and C, alcohol abuse, NASH/NAFLD and cirrhosis. The declaration was launched on World Hepatitis Day.

The declaration calls on the government of the Republic of North Macedonia, the Ministry of Health, the Health Insurance Fund and all the affected parties to develop a fully funded national programme. This will be implemented through partnerships between all relevant entities and affected parties, both in health care and the wider social context aided by the European Parliament’s development legislation and its health programme. Dealing with serious health threats and improvements in the fast recovery of the health system, the declaration showcases the role of screening and early diagnosis for the detection of hepatocellular carcinoma and the early stages of cirrhosis. This will result in better treatment outcomes and quality of life for patients. We achieved this by highlighting the direct link between late diagnosis of hepatitis B and C and liver cirrhosis with the help of the Oncology Clinic, Center for Interventional Radiology of the Liver, Digestive Clinic, Clinic for Gastroenterohepatology and the infectious disease clinic after collecting all the information and number of patients in our country. We managed to assemble a coordination body with all these stakeholders together with the Ministry of Health for the first time in the history of our country. There were roughly 40 meetings with different stakeholders over the course of 3 months in order to make the declaration a reality, with all those involved dedicating hours outside their designated work hours to meet, which really showcased their belief and dedication to the cause.

With the success of the declaration, we are currently in the process of opening a special centre for liver disease which will be an integrated multidisciplinary centre for patients particularly patients with hepatitis, NASH, alcohol abuse and other liver diseases. This will reduce stigma as the centre encompasses all liver disease as opposed to being connected to one disease in particular. The centre will also improve efficiency, as patient’s medical history will be on one shared database as they go through treatment and will not need to be delayed due to the transfer of documents.

We utilised social media for the campaign, using Facebook, Instagram and Twitter as a marketing tool. We used Facebook for the first part of the campaign, by encouraging Facebook friends, patients, experts and some of the policy makers to change their profile picture frames, posting videos and posts. After the campaign we continued to utilise Instagram and Twitter to spread awareness.

Top tips for success

  • The success of Hepar Centar-Bitola belongs to the visibility of our awareness campaign, this success opens doors for us with every important health stakeholder in our country.
  • Working closely with different departments and stakeholders is critical, as we found that their eagerness to get involved resulted in different options of therapy being offered at the clinic for Gastroenterohepatology (after 3 months of intensive negotiations)
  • Public support from celebrities such as the front man of the rock group “Nokaut”- Nikola Perevski Pere and pop singer Elena Ristevska helped reach more people with the campaign, especially younger audiences.
  • Despite the COVID-19 pandemic, we ensured continued momentum by putting on some amazing events in 2021. Our job was difficult because we were preparing the campaign for more than 3 months.
  • The announcement of animated character Heparko proved to be very successful as we created an identifiable figure that was recognised by all demographics. The materials and events for campaign are published on Facebook, Instagram, Twitter and using hashtag #Heparko, #LiverCancer #EUCancerPlan #Nohep #EndHep.

Achievements to date

  • Preparation, launch and signing of the first national liver cancer declaration with an emphasis on the elimination of hepatitis c and reduction on Hepatitis B
  • Social media campaign
  • Music and animation events
  • Involving celebrities for support
  • Indoor soccer tournaments

Key learnings

All parties involved need to see each other as equals and everyone needs to feel as though their input is necessary for the declaration


  • The most difficult part was procuring funds for the program especially with the ongoing COVID-19 pandemic
  • The project/programme activities were carried out mainly according to the project plan, with minimal modifications to ensure the highest degree of efficiency.

For more information please contact Hepar Centar-Bitola at