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VISION H.E.R.A. will work towards the establishment of a world in which sexual and reproductive rights are guaranteed and a world in which all men, women and young people are healthy and free, celebrating their sexuality and diversity as a basic principle of their way of living. VALUES m H.E.R.A. believes that the sexual and reproductive rights are inseparable from
any of the human rights and that each individual must enjoy the right of his/her sexual liberty, identity and right to have access to SRHR information and services. m H.E.R.A. believes that the right of making free choices is a legitimate need of each individual to make free choices about his/her body, life and sexual and reproductive health. m H.E.R.A. believes that sexual and reproductive rights are necessary for the enjoyment of high standards of mental, physical and social welfare. m H.E.R.A. fully recognizes and respects the needs and concerns of the young, the vulnerable and marginalized groups, including those of the people who live with HIV, concerning their SRHR and commits itself towards their implementation. m H.E.R.A. is an organization of volunteers which stimulates youth participation in the implementation of its mission and its objectives. m H.E.R.A. believes that enhancement of sexual and reproductive health and rights is possible only through co-operation and mutual commitment on the part of each of the significant stakeholders in the country, such as governmental and nongovernmental organizations, civil society organizations or institutions. MISSION H.E.R.A. is inclined towards achieving enjoyment of basic human rights of women, men and the young who must be correctly informed and have appropriate access to high quality confidential services in order to make their informed choice regarding issues such as their sexuality, as well as the prevention, care and treatment of sexually transmittable infections and HIV, including achievement of full protection of the rights of people who live with HIV/AIDS and their close families, contraception, access to safe and legal abortion and exercise of sexual and reproductive rights.
ANNUAL REPORT INTRODUCTION It's my pleasure to present to you H.E.R.A. Annual Report for 2009 that summarize our achievements during this year. I can outline 2009 as very intensive and fortunately successful year of H.E.R.A. that enabled us to continue and improve our ongoing activities and programmes, especially in the field of service provision and access to sexuality education. Moreover 2009 is the year where H.E.R.A. positioned itself not just as a service-based NGO but also as organization that has capacities and strongly advocates to and support for SRH and sexual rights. To improve association transparency and the programme management lots of efforts has been done in building Management and Governance capacities. In this regards H.E.R.A. adopted its First written Strategic Framework (2009 – 2013) and developed several very important human resource polices, including HIV/AIDS Workplace policy which is the first of its kind in Macedonia demonstrating H.E.R.A.'s commitment to greatly support and encourage PLWHA to enjoy their fundamental right of employment alike all others and not only within the association but broadly. Therefore H.E.R.A. will commit itself to promote this policy and to be acknowledged broadly among CSOs, private sector and the Government institutions. 2009 is also the year when we are celebrating the 15th anniversary of the International Conference for Population and Development (ICPD, Cairo, 1994) a crucial event for recognition and advancement of the sexual and reproductive health and rights. To bring ICPD at national level H.E.R.A. was involved in various advocacy activities with NGOs, Government officials and police makers to make additional efforts to improved access to sexual and reproductive health information and services, particularly to young people. In this regard in June a youth conference has been organized bringing 30 youth participants from over 20 NGOs, youth branches of political parties and media who created the Declaration titled “Take part: Sexual Rights for All”, a document which calls on Government of Republic of Macedonia to meet their commitments on sexual and reproductive health and rights derived from the ratified international agreements and national legislation which recognize sexual and reproductive rights and needs of the young people. In addition the first Parliamentary Hearing for Sexual and Reproductive Health of Young People in collaboration with the Parliamentary Commission for Equal Opportunities for Women And Men has been organized whereas the MPs has concluded that the efforts for introducing sexuality education in schools and better access to youth friendly services has to be prioritized in the development polices. More important H.E.R.A. for the first time carried out the need-assessment on introducing sexuality education and the desk review on SRH topics that enabled to have better overview of the knowledge and attitudes of all actors relevant for introducing a discipline of sexuality education in schools. The survey showed that there is a positive view for introducing sexuality education in schools from all actors. The results of the survey will be used as a tool in 2010 to advocate for integration of the sexuality education in the school curricula based on the human rights approach. H.E.R.A. has taken the lead role to create strong CSO platform and oppose anti-abortion movement in Macedonia.
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The Abortion Declaration signed by 41 associations at the time of Conference organized by H.E.R.A. and 4 other NGOs in Macedonia demonstrate strong civil society support toward protection of the women's right to freely decide for her live, health and physical integrity. Bearing the fact the strong NGO movement in period of 6 months (January - June 2009) the Govt. has slow-down the antiabortion activities and draw out the bit for issuing media camping to teach women of the harmful consequences of the abortion. Very important event in 2009 is the translation and printing of IPPF Sexual Rights Declaration with which for the first time is defining the sexual rights in a broader concept of human rights. This publication appeared in a very important momentum for Macedonia society, in the year when the one-side discussion for the sexual rights was opened and when the conservative believes of the right-wing oriented Government party and general public prejudices came into sight. Therefore H.E.R.A. found out that this document is very relevant and broad for its further advocacy actions for sexual rights and human rights in general. In the field of HIV one of the major achievements is the established first informal group of 10 PLWHA followed with the capacity building of the group on community mobilization. Moreover the collaboration and the trust between H.E.R.A. staff and PLWHA have been strengthen since earlier H.E.R.A. hadn't initiated any structured activity that would more stimulate PLHIV clients of H.E.R.A. services to link and act as community. Prior to the formation of the group H.E.R.A. conducted a needs assessment among users of the services at the HIV counseling centre to identify how to improve the overall social and health status of PLHIV and to ensure a better quality of life. Need assessment has also showed that the largest part of PLHIV demonstrated affirmative attitude regarding further communication with other PLHIV, as well as for involvement in different types of activism. Last but not the least we are very proud that H.E.R.A. has been accredited as Full Member of IPPF this year. This is both, a great success and responsibility for H.E.R.A. to continue its hard work and ensure quality and commitment in the field of improving SRH to all people, especially to those who are most vulnerable and the young people. I would like to thank our volunteers, staff, donors and all our supporters for the hard work and confidence paid in us and looking forward to another successful year. Bojan Jovanovski Executive Director
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I YOUTH AND ADOLESECENTS Goal: All adolescents and the youth are aware of their sexual and reproductive rights to enable them to make free and informed choices and actively exercise these rights
One of the major achievements is the launch of the programme for boys SRH. An intensive 3 months course of 2 groups of young people, boys in schools and youth Roma enabled 15 young people to get knowledge and skills on SRH, how to improve the attitudes and practices toward gender roles and the risk for contracting STI's. The programme included different aspects of boys SRH and has been designed using best practices tools developed by IPPF and Promundo. The experiences gained during implementation of this programme showed that the male SRH is neglected and that there is a need to work harder to equip boys with skills essential to make informed choices regarding their sexuality and promote gender-based approach. In addition 10 workshops with boys, especially those coming from sub-urban or rural areas, were organized reaching around 130 boys where participants were provided with the basic information on contraception and abortion rights and were also engaged in value clarification sessions. Openness from boys to discuss these topics during the workshops, especially for abortion, was demonstrated. The workshops evaluation findings suggested that the knowledge about contraception is missing but on the other hand boys showed they are sensitized when it comes to use of contraception and do not have misconception about abortion rights, especially the right of the women to choose terminate her pregnancy. H.E.R.A. has also conducted a survey among young girls who are using SRH/HIV services to get better overview of the knowledge attitudes and practices on contraception and abortion and that will help H.E.R.A. how to extend its interventions within existing training programmes to best suit young girls needs. The findings of the survey showed that young girls are insufficiently informed about abortion legislation, do not understand the concept of dual protection and emergency contraception and there are still significant myths and misinformation on abortion and modern contraceptives use among young girls. More important young girls are not always aware of their sexual rights and are not empowered to practice it. H.E.R.A. has successfully implemented a small grant from UNDP in the occasion of 50th University of UN Declaration of Human Rights where around 500 youth Roma people received education on human rights and UN declaration, with focus to sexual and reproductive rights (SRR). The project has also built capacities on human rights agenda and SRR of teachers working in schools with concentrated Roma people as well as on working in partnership with young people where teachers together with the Roma students were initially trained and further involved in organizing workshops with Roma on different topics related to human rights and SRH In the framework of the Global Fund project H.E.R.A. has trained 40 new peer educators on HIV/SRH and Tuberculosis prevention and care followed with the peer education workshops where around 2600 young around Macedonia, especially in the rural parts received education on HIV/SRH and Tuberculosis. The peer education activities have been also supported and logistically assisted by the volunteers from the Peace Corps in Skopje. In addition with the support of the Center for Public Health – Skopje and financed by Ministry of Health H.E.R.A. has organized the 6th Y-PEER National Training of trainers on sexual and reproductive health where 22 young people have been certified as
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I YOUTH AND ADOLESECENTS youth peer trainers. This training enabled to build capacities of the local NGOs dealing in the field of health and human rights and to continue expanding the network of young volunteers involved in sexuality education. Moreover in the occasion of 1st of December H.E.R.A., supported by the MoH, H.E.R.A. organized a series of peer education workshops in 5 cities, including Skopje, Stip, Kocani, Bitola and Kumanovo reaching around 2000 young people. The workshops were facilitated by H.E.R.A. peer education team and Y-PEER focal points. HERA paid also attention of training teachers on HIV and Tuberculosis, especially reaching those parts of Macedonia where the Tuberculosis prevalence rate is bigger and particularly the rural parts. During 2009 a total of 86 teachers have received basic knowledge and skills on TB and HIV prevention. Moreover each of the trained participants has developed an individual action plan that during 2009 has been implemented with the technical support of HERA. Thus around 55 different educative events (informal lectures, photo exhibition, movie presentation, poster presentation) were organized by the teachers in almost 40 schools in Macedonia whereas around 2300 pupils who attended these events received basic information on HIV and Tuberculosis. 100 teachers and 100 parents have also taken part at the workshops and prevention events organized in schools. H.E.R.A. youth volunteers were involved in the consultation of the development of IPPF EN youth training modules and further trained how to use them in their work. At the end of June the trained facilitators of H.E.R.A. has conducted an 5 days training for 20 H.E.R.A. youth volunteers to test the implementation of the modules and to enhance their capacities to broader issues of volunteerism and sexual and reproductive rights. At the end of the training, using the knowledge and skills gained from the training course, the youth volunteers have developed an action plan to work on 4 selected areas: volunteerism, advocacy, IEC materials and social marketing. Each of the action plans uses creative approaches to address different issues of youth SRH and youth volunteerism and will be implemented in the first 4 months of 2010 with the financial support of IPPF EN. H.E.R.A. in collaboration with UNFPA Country Office host the National Y-PEER Coordinator for 7 months June – December 2010 in order to ensure smooth functioning of Y-PEER network and better promotion of Y-PEER in the country as well as to learn from the experiences of H.E.R.A. in the field of sexual and reproductive health. Furthermore by the end of 2010 H.E.R.A. has been also accredited by the European Commission Programme - European Voluntary Service (EVS) that will enable H.E.R.A. to send and host EVS volunteers, according to their needs and interest, and ensure sharing experiences within European Union youth volunteers in the area of sexual and reproductive health and rights.
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II HIV/AIDS Goal: To maintain low prevalence of HIV/AIDS and provision of full protection of the rights of the people infected or affected from HIV/AIDS
The major achievement in 2009 was the “Care, support and capacity building for PLHIV� project where H.E.R.A. established the first informal group of PLHIV and made initial steps by building their capacities on community mobilization. Moreover the collaboration and the trust between H.E.R.A. staff and PLHIV have been strengthen since earlier than this project H.E.R.A. hadn't initiated any structured activity that would more stimulate PLHIV clients to link and act as community. Prior to the formation of the group H.E.R.A. conducted a needs assessment among users of the services at the HIV counseling centre to identify how to improve the overall social and health status of PLHIV and to ensure a better quality of life. Need assessment has also showed that the largest part of PLHIV demonstrated affirmative attitude regarding further communication with other PLHIV, as well as for involvement in different types of activism: participation on trainings/seminars, taking part in informal group of PLHIV, member of civil society organization of PLHIV or to be involved within current programs for HIV/AIDS within H.E.R.A.. The findings clearly showed that half of the interviewed HIV users are in favor to be further involved in different activities associated with HIV and therefore 2 capacity building trainings (on topics related to HIV/AIDS, Community-based activism and HIV, electronic health card and data protection, Sexual health - as per the findings of the assessment) and 2 peer support meetings were organized in the last quarter in 2009 gathering a total of 10 participants who will at the end of December establish the first informal group. Starting 2010 the group agreed to create their own programme of action, ground rules and code of confidentiality. The project strongly emphasized the PLHIV involvement in all stages of the project development, including design, performance and evaluation. In particular, 3 PLHIV volunteer members of H.E.R.A. were involved in the process of design and testing the need-assessment questionnaire. Additionally, at the first orientation meeting one PLHIV conducted mapping of the topics that should be covered during the following capacity building seminars and educational meetings. It's also worth to mention the success of the group to remove the HIV status under the General Clients Information in the draft electronic health card. The group of PLHIV with the technical assistance of H.E.R.A. has sent the letter to Directorate for Personal Data Protection to ensure full protection of the data related to the HIV status in the electronic health card and remove the HIV status as Chronicle Diseases thus to restrict access to health data of the patients. The Directorate for Personal Data Protection further informed the group and H.E.R.A. that the Chronicle Diseases will be removed from the General Information of the patients and HIV status will not be mention in the General data section. During the course of the year H.E.R.A. along with 3 PLHIV volunteers developed the HIV/AIDS workplace policy that was adopted by GA. The process was initiated by a PLHIV volunteer that took part in IPPF+ Management Meeting in May 2009. Since the prevalence in Macedonia is still low our policy is more specific and is targeting both volunteers and employs. However the volunteers and the staff are now more aware about the rights of the colleagues living with HIV. Is worth mentioning that after putting the policy in practice and starting the mobilisation of the PLHIV it became evident how much this document was needed. H.E.R.A. is one of the first organisations in the field that
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II HIV/AIDS adopted and is implementing this kind of a policy. Although having policies on the most important issues that you are dealing with is not a common practice in Macedonian state or civil organisations, H.E.R.A. already started with dissemination of it's own policy and raising the awareness of it's importance among the HIV/AIDS NGOs. In 2009 a total of 2208 clients have been tested for HIV within the Outreach Mobil Clinic. Comparing to 2008 an increase over 130% of performed HIV tests are recorded, mainly due to expansion of the Mobile VCT in 10 other cities around Macedonia and well-established partnership with 14 NGOs, Institute for Public Health and 10 Local Centres for Public Health. They were involved in all stages of activity performance (NGO – recruiting clients and providing counseling, whenever Local Center for Public Health in charge for taking blood examples) For the purpose of the Outreach VCT a mobile clinic to operate out of Skopje has been purchased by the Global Fund. In addition the Mobile VCT clinic has been expanded to 3 other prisons (out of Capital) in Macedonia that resulted in reaching new prisoners clients who received HIV testing. Around 70% of tested people belong to most-at-risk groups, including MSM, SW, prisoners and ID users. Furthermore 309 people received pre and post counseling and testing for Hepatitis C as the result of integrating HCV testing within VCT mobile clinic from April 2009. According to service statistics 93% of the beneficiaries of the Mobile VCT clinic are new clients. In 2009 the HIV counseling centre associate clinic between H.E.R.A. and Clinic of Infective Diseases has provided a total of 229 HIV testing. In 2009 H.E.R.A. in the framework of the Mobile VCT clinics and associated HIV counseling centre has performed 64% of the total HIV tests in the country and position itself as leading country service provider on HIV Testing and Counseling. Moreover 37.7% of the newly detected HIV positive cases were diagnosed through the Outreach VCT Clinics, all among MSM community. The associate HIV counseling centre as the only referent health institution dealing with PLHIV has recorded a total of 1890 services provided to 36 PLHIV and those affected, in which around 500 psycho-social services and around 1000 medical services, mainly related to treatment and surveillance. Moreover H.E.R.A. within IPPF AIDS project 10 out of 36 HIV+ clients- users of services at the HIV counseling centre regularly received a monthly social aid packages (hygiene and food) according to their income and social status. The results of the need assessment among the PLHIV users in the Counseling Centre helped H.E.R.A. together with the social worker in the HIV/AIDS counseling centre to develop a protocol that defines the criteria how people can access and benefit the social aid packages of H.E.R.A.. The funding for the provision of the psycho-social support is part of the National AIDS programme from 2009 as result of H.E.R.A.'s successful advocacy in 2008 enabling these services to be part of the Government funding. At the South-Eastern Regional Conference of GFATM the mobile VCT project has been recognized as one of the best practices tolls on HIV prevention among vulnerable and marginalized groups. The VCT project coordinator of H.E.R.A. has been asked to do a presentation of the VCT programme and facilitates the plenary discussion on VCT. Moreover at the IPPF competencies workshop on HIV, H.E.R.A. as focal point on HIV in European Network took participation in the HIV/AIDS competency workshop held in Mumbai from 7-10 July. As fresh member of the IPPF family this was a good opportunity to better understand the process of building capacities and creating stronger and unite voice on HIV/AIDS within the Federation. During the Press conference on linkages H.E.R.A.
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II HIV/AIDS presented the story named “Linking HIV and SRH at service level. First steps towards full recognition of sexuality�. Together with the other MAs H.E.R.A. developed an HIV Operational Plan for 2009 2010 as result of the capacities and knowledge build during the workshop, mainly focused on positive prevention and capacity building of PLHIV and members of CCM on SRHR.
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III ACCESS Goal: All people, especially youth and vulnerable groups have access to comprehensive and quality information, education and SRH services, including family planning services, based on the concept of sexual and reproductive rights In 2009 a total of 4535 clients have been registered as beneficiaries of HIV/SRH services provided within 4 service delivery points of H.E.R.A., including 2 youth clinics, mobile VCT clinic and HIV counseling center as part of the Clinic of Infective Diseases. In addition around 10.000 services have been provided, including HIV testing, contraception, gynecological care (including ultrasound examinations, PAP smear), STI testing & counseling, dermatological care (including Cryo-therapy ), immunization, psycho-social services for PLWHA , Roma women and girls as well as for victims of domestic violence (36 clients received psycho-social support and referrals to other services as result of domestic-violence suffered). In 2009 an increase over 120% in the number of clients using services of H.E.R.A. have been recorded whereas 82% belong to poor, vulnerable and marginalized groups. If we compare the statistics from 2008 the percentage of vulnerable and poor groups that received services in H.E.R.A.'s service delivery points has been increased for 13%. The main factor contributing to this large increase of number of clients reached is due to expanding mobile VCT services in 10 other cities in Macedonia, where more than 80% of those who received VCT belong to MSM, ID users and sex workers. The considerable growing in visit numbers in 2009 is also caused in introducing new, particularly medical services in the youth clinics, including ultrasound check-ups, Cryo-therapy and HIV testing. The purchase of all the equipment needed to provide these services have been done through the SALIN project (ultrasound and Cryospray) and Global Fund project (rapid HIV tests). In particular the introducing of the ultrasound check-ups have enormously increased the number of gynecological visits at the mainstream youth clinic in Skopje as most asked in the last couple of years from this target group. On the other hand the introducing of dermatologist and Cryo-therapy services has increased up to 600% numbers of visits in the both clinics, especially among MSM population (Cryo-therapy is especially used for burning Condiloma) and since Roma youth centre is the only service delivery point offering dermatological and STI services for around 25,000 habitants in this Roma community. It is worth to mention the improved collaboration with the local school and action plan developed with 5 schools, neighboring mainstream youth clinic in Skopje, and increased number of visits of young people attended informal SRH lectures in the youth friendly service premises. If we compare the numbers in 2008, when only 518 visits have been registered in the mainstream youth clinic “Sakam da znam – Vodno”, an increase over 130% in 2009 are recorded. A total of 8 peer educators in the both youth clinic were actively involved in providing peer educations for young people within school and youth clinics as part of the activities of the youth friendly services “Sakam da znam” reaching. Moreover the peer educators from Sakam da znam – Vodno were involved in outreach promotional activities in schools by distributing leaflets, IEC materials and condoms. The service provision in the youth friendly clinic in 2009 has been supported by different partners and donors, mainly Norwegian Church AID, through the Roma Resource Centre project, IPPF and Global Fund. With the technical support of the Netherlands NGO SOAIDS, H.E.R.A. in June has organized the first peer training for HIV and sexual health for sex workers in order to mobilize sex workers as active players in provision of information and education among their peers. The trainings has also built
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III ACCESS capacities of NGO HOPS which primarily target are sex worker to further incorporate this programme within association objectives. Participants were been recruited by the partner organization HOPS. The agenda has been facilitated by the trainer from SOAIDS, including two local trainer form H.E.R.A. and HOPS who have previously passed international UNFPA training on peer education & sex work. A total of 15 sex workers have been trained and further involved in 6 follow-up peer education sessions reaching around 25 sex workers around country. One of the achievements of this project is that this training was first of its kind in Macedonia targeting sex worker on HIV and sexual health. Moreover the training and the follow up activities build up a supportive environment between sex workers to act together in order to know/how to protect themselves for STI/HIV and unplanned pregnancy and to be aware of their rights, although there was a fear that participants coming from different area and involved to different scope of sex work, i.e. street sex work and high class sex work, could provoke internal discrimination between themselves. One of the main achievements within the Roma Resource Center that ended in may 2010 were the conflict resolution workshops were around 15 young Roma were involved in the design of the theater play addressing cultural and traditional believes and traditional taboo among Roma related to gender, gender identity, stigma and discrimination related to sex and sexuality. For the period of 3 months the Roma theater director, Ms. Sanela Emin, worked with the group of young Roma, some of them peer educators of the youth friendly service Sakam da znam, on the theater ply titled “I walk with false face”. The theater workshops and the play itself has increased the empathy between your Roma themselves and motivated them to think differently about those people who are stigmatized, socially excluded and discriminated on different grounds (gender, sexuality orientation, use of drugs e.t.c.). The premiere of the theater plat was hosted by the Faculty of Art Theater whereas 150 attended the event. Although the play was performed on Roma language the use of symbols and body language managed the audience to clearly receive its messages. More important is that the afterwards the theater play “I walk with false face” was invited to take part at the Amateur Theater Festival since the selector of the festival has attended the performance and was in much satisfied of the scenario and the role of the young actors. From the period of 26 – 29 May the “I walk with false face” has been performed at the Amateur Theater Festival held in Kocani together with 20 other selected theater plays around Macedonia. Although the play was not awarded still it will be something to remember and will be a motivation for our actors in further projects. Through the Roma Resource Center project H.E.R.A. has organized a 3 days capacity building training for Roma grassroots NGOs on SRH and project management. 20 participants gained knowledge and skills in writing projects on SRH and Roma and were more familiar of the concept on SRH and sexual rights. The training gave also a possibility of the participants all around Macedonia to visit the Roma youth clinic. With the support of the City Of Skopje project titled “Increasing access to social and health services for most poor and socially excluded Roma people” for the period September – December 2009, a total of 103 visits to Roma families. During the home-based visits the service providers from Roma youth Centre together with outreach workers of 2 Roma grass root organizations provided various
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III ACCESS
cinformation and counseling for SRH and rights, including menstrual cycle, HIV/STIs, family planning and contraception, pregnancy, immunization reaching 275 Roma in total. Moreover during the home visits the representatives of the Roma families were motivated to use the medical service in the Roma youth clinic, especially to those who most needed. As a result of this in addition a total of 44 Roma women received gynecological care services at the Roma clinic, 14 people have received HIV test and to 15 people were offered a psycho-social services related to domestic violence and behavior change. Along with the outreach work H.E.R.A. in collaboration with the Ministry of Social Affairs has conducted an assessment among beneficiaries of the project and the service provided at the Roma clinic about barriers that most poor Roma in Skopje are facing in regards to access to social and health services. The assessment find out that 83% of targeted population do not posses health insurance. Moreover Roma consider Centers for social work as not very accessible and do not respond to the needs of the poorest Roma families, especially when it comes to family planning service. Around 52% of the responders pointed the need of the creation of non-institutionalized forms of protection (i.e. center for daily abode) at the local level. The conclusions from the assessment will be carefully taken into consideration by the officials of the Ministry of Social Affairs in further planning of their social programmes for most vulnerable and poor people, especially for Roma. 2 staff representatives from H.E.R.A. has build their capacities on Sexuality and learning Disabilities as H.E.R.A. was invited to take part at the training held in Latvia, facilitated by MA of United Kingdom. During the training H.E.R.A. participants gained new knowledge and skills and worked on the development of action plan at national level that will be implemented in 2010 with financial supported by IPPF EN. At the Meeting on Youth Health Friendly Services in European region organized by WHO in Edinburgh H.E.R.A. presented its best practices on youth sexual and reproductive health services, facilitated by the Executive Director. Moreover H.E.R.A. worked on design of the case study “I want to know – best practices on YFS in Macedonia� that will be also published in the publication of the WHO on youth finely services to be printed beginning of 2010.
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IV ABORTION Goal: A guarantee of women's right to choose and access to safe and legal abortion as well as increased rate of contraceptive use H.E.R.A. has taken the lead role to create strong CSO platform and oppose anti-abortion movement in Macedonia. The Abortion Declaration signed (please visit www.H.E.R.A..org.mk) by 41 associations at the time of Conference organized by H.E.R.A. and 4 other NGOs in Macedonia demonstrate strong civil society support toward protection of the women's right to freely decide for her live, health and physical integrity. Bearing the fact the strong NGO movement in period of 6 months (January - June 2009) lead by several human and gender rights CSOs, including H.E.R.A., ESE, Akcija Zdruzenska, Lenka, SOZM and others the Govt. has slow-down the anti-abortion activities and draw out the bit for issuing media camping to teach women of the harmful consequences of the abortion. In some sense it could be concluded that the NGOs has played a significant role in fighting abortion and SRH oppositionist, especially Govt. to further continued its anti-abortion activities. From the period of October – December a total of 10 workshops on modern contraceptives and safe abortion with women living in rural areas, particularly in villages in the Eastern and Western part of Macedonia and with dominant Muslim population, have been carried out reaching a total of 123 participants (44 Macedonian, 60 Albanian and 19 Roma), aged 25 – 55. The workshops have been logistically supported by HERA's partners at local level, including NGO Puls, Roma NGO Lil and Union of women of Saint Nikole and took place at the local community premises and elementary schools. The topics such as basic information of sexual and reproductive health, female reproductive system, modern contraceptives with focus to condom and pills and safe abortion were part of the workshop agenda. The main achievement of these workshops is that they enabled to reach women having less access to information to SRH, especially when it comes to contraception use and abortion. The value clarification training facilitated by IPPF EN that took place in Skopje, between 18 - 20 December, under GCACP project helped H.E.R.A. staff and volunteers, especially youth volunteers, to enhance their skills to undertake activities and to respond in a professional and individual consistent manner to anti-abortion movement in Macedonia and to better strategize their actions to protect women's right to choose for abortion. The workshop is especially important since for the first time has brought staff and volunteers at one place to discuss this sensitive and imperative issue and to share their thoughts and values. As outcomes of the workshop participants has agreed to work on the following issues in future: £ Develop fact sheets on abortion to better combat SRH/abortion opposition £ Integrate abortion-related topics within the training curricula of peer educators £ Need-assessment of medical abortion among gynecologists and women associations £ Review of the current abortion policy of H.E.R.A. to better respond ongoing SRH opposition in a manner consistent to Macedonian context H.E.R.A. has been nominated by the MoH to take part in the expert group for developing Safe Abortion Standards. Main focus H.E.R.A. gave for introducing medical abortion as part of safe abortion standards and replacing "sharp curettage" with MVA in the first trimester. The Abortion Standards are in draft and include Medical Abortion as part of abortion procedures in the hospital settings.
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V ADVOCACY Goal: Significant commitment of all relevant factors in the country for strong public, political and financial support to sexual and reproductive health and rights The main focus of H.E.R.A. advocacy work in 2010 has been given for the introduction of the sexuality education in schools. Thus the need-assessment among pupils, teachers and parents has been conducted together with the desk review of the existing school curricula on topics related to sexuality and SRH. In general in Macedonia there is a need for introducing sexuality education in schools. The finding is a result of a research determining the needs of the parents, teachers and students, and reviewing the current school curricula. The research has also pointed to the following conclusions: 1. Both parents and teachers agree on the introduction of sexuality education as a regular subject in schools. Such subject, among others, must develop the practical skills for protection from risks related to sexual activity. Besides the fact that both parents and teachers are insufficiently informed about each of the areas which should form part of a comprehensive sexuality education, both seem open to introduction of a model which will promote sexual diversity. Teachers feel unprepared to teach a number of comprehensive sexuality education topics and fail to recognize each of the aspects of sexual privacy of students. 2. Students think that a comprehensive sexuality education in schools should form part of the official state school curricula. At present, they are not recognizing schools as institutions where responds to their questions and to sexuality related information in general, could be provided. Moreover, it was discovered that students have no positive attitude and values with regard to sexuality and that they, quite readily, adopt current prejudices and stereotypes. Nevertheless, while taught in school they fail to develop skills in order to make informed decisions regarding their sexual challenges. They are not informed about their right to sexual privacy and there are some indications that this right of theirs is often denied to them. 3. This insight into the curricula, i.e. the textbooks, shows that the Macedonian education system lacks professional and harmonized view of policy for provision of sexuality information, i.e. information on sexual and reproductive health and rights. There is no information on a number of topics which form integral part of a comprehensive sexuality education (condom use, living with HIV, sexual and reproductive health services, legal protection, masturbation, violence, rights and pleasure). Information related to topics above, which are occasionally covered, are often scarce, insufficient and sometimes, false. In addition to this, the bulk of such information are not comprehensive and greater attention is directed to bio-medicinal aspects of sexual and reproductive health, lacking or completely failing to cover psychosocial aspects of sexuality. While, there is no harmonized approach on how to serve information for a particular topic in a particular curriculum, often times such a topic maybe setting double standards for example, in one and the same textbook. Some of the training materials promote stereotypes (for e.g. about sexual diversity, hormonal contraception, etc.) and negative attitudes about love and sexuality. The state-ran school curricula fail to provide acquisition of true knowledge and development of tolerant attitudes, as well as practicing safe sex, i.e. protection of one's sexual health and sexual rights. Following the research there were also activities to raise public awareness on sexuality education in schools. A press conference and the TV show on sexuality education has been organized and
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V ADVOCACY positive reaction from the general public was recorded since the general public is ready to open the discussion for this topic and moreover more than 90% are in favor of the initiative of introducing SE in schools. However these facts has to be accepted with sort of limits bearing the fact that the main debates for the topics of the SE are still not touch upon, especially when it comes to sexual diversity. Maybe one of the most important advocacy achievements of H.E.R.A. in 2009 working with the MPs are the conclusions of the Parliamentary hearing of the Equal opportunities commission (organized within the ICPD+15 project) where the introduction of SE is stated as one of the recommendations. H.E.R.A. can also point the achievements within the Count me in – Sexual rights for all project, initiative to celebrate 15 years of ICPD where we were was successful to mobilize young people in advocacy for sexual and reproductive rights. In this regard in June a youth conference has been organized bringing 30 youth participants from over 20 NGOs, youth branches of political parties and media to work on development of youth declaration and to articulate the youth voice of Macedonia for improved SRH as well as increased participation of young people in all stages of policy development, including design, implementation and evaluation. The Declaration titled “Take part: Sexual Rights for All” is a document which calls on Government of Republic of Macedonia to meet their commitments on sexual and reproductive health and rights derived from the ratified international agreements and national legislation which recognize sexual and reproductive rights and needs. The Declaration refers to three areas of priority defined during the course of the Youth Conference “Take part: Sexual Rights for All: 1. Youth participation and lobbying, 2.Access to sexual and reproductive health education and services 3. Sexual rights (For English version of the declaration please visits www.H.E.R.A..org.mk). In addition a series of round-tables with young people, service providers and decision makers from the Local and Central Government has been organized to promote the declaration and the needs of the young people towards their sexual and reproductive health and to open a floor of the importance of youth participation in policy making. Around 750 people have attended the round table discussion and some of them were hosted by the Municipality Majors that gives a credit to H.E.R.A. work and commitment to SRH for the young people. More important at the end of December H.E.R.A. together with the Parliamentary Commission for Equal Opportunity of Woman and Man facilitated the first public hearing in the Parliament for young people and their SRH. The MPs commit themselves that will work on improved institutional and financial support for the youth SRH and introducing a sexuality education as the main conclusions of the event. H.E.R.A. has been very successful in promoting the petition for “Count me in - Sexual right during the period of 5 months (June – October 2010) and has collected around 800 signatories from young people within their service delivery points, peer education workshops and networks of human rights, youth and health organizations. Also one of the achievements in 2009 was the development of the first written midterm Advocacy Strategy of H.E.R.A. 2009 - 2011, approved at the AGM in May 2009 which clearly strategizes H.E.R.A.'s actions on each of the 5As in the next coming 3 years. The Declaration “Abortion is right of choose and reproductive right of every women” sent a strong message by joined NGO initiative to prevent the process of Govt. and media manipulation and misinformation to the general public that had the purpose to remove the right of choice and
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V ADVOCACY women rights from the topic of abortion and to create ideological and dogmatic believe of the right of life. Very important event in 2009 is the translation and printing of IPPF Sexual Rights Declaration with which for the first time the document defining the sexual rights in a broader concept of human rights has been presented on Macedonian language. This publication appeared in a very important momentum for Macedonia society, in the year when the one-side discussion for the sexual rights was opened and when the conservative believes of the right-wing oriented Government party and general public prejudices came into sight. Therefore H.E.R.A. found out that this document is very relevant and broad for its further advocacy actions for sexual rights and human rights in general. The SRID has been distributed to all responsible institutions in 2009 following a round-table discussion in November with the speakers from the UN agencies and human rights experts. In the period of October – December the Institute for Public Health has selected H.E.R.A. to promote the Draft National Strategy for SRH at local level thus several round-tables in 6 cities around Skopje were held to hear the opinions of local stakeholders to ensure local Governments needs are appropriately addressed in the Strategy document and are in line with the process of decentralization in the primary health care. The conclusions from the round-tables were distributed to National SRH strategy expert group of MoH to be taken into account when preparing the final Draft. One of the main conclusions is how to ensure effective implementation of the strategic plan at local level and the financial commitment that has to allocate from the Central Government to Local level. In 2009 H.E.R.A. continued its active and joint involvement within the Coalition for promotion and prevention of the sexual and human rights of the marginalized groups. Together with the Coalition a round-table discussion on Health and Sexual Rights of PLWHA has been organized where the findings of the need-assessment report has been presented. Moreover the coalition members were also involved in the desk review of the school curricula on sexuality education. The leaflet for the Human Right of PLWH has been designed and printed with the support of the Coalition and other continued actions, joint press conference, writing article in media... H.E.R.A. has been also involved in collecting case studies among its clients of the service delivery points to document cases of violation of the human rights, especial among PLWHA and Roma women as most vulnerable. Around 10 cases were collected and further published in the Coalition Annual report. For 2010 the Coalition will look for resources for free legal aid in order to assist those to whom the rights were violated to appeal to the Macedonian courts. In this report it is also worth to mention the establishment of the informal group of the PLWHA. Immediately after the formation, although the group was very diverse and not yet structured, the first successful advocate steps were made. In particular the PLWHA group has send the letter to the Direction for protection of the personal data to call upon of the protection of the data related to the HIV status in the electronic health card that the MoH intend to issue in the forthcoming period. The reaction was positive bearing in mind that the Direction for protection of the personal data has stand up to PLWHA side and give notice that will protect the interests and the rights of the PLWHA in the process of the creation and finalization of the e-health card.
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VI ACCREDITATION AND GOVERNANCE At the Governing Council of IPPF in November, H.E.R.A. has been accredited as Full Member of IPPF. In February H.E.R.A. with the IPPF technical assistance has organized a 5 days workshop to assist volunteers and staff to develop a draft Strategic Plan in line with the IPPF Global Framework and based on local SRHR analysis and on an inventory of existing policies. For the period of 3 months (April - June 2009) H.E.R.A. worked on the design of the new strategic development policies as well as other management and human resource polices in order to meet the standards and Responsibilities of IPPF Membership and get accredited for full membership. At the Annual General Meeting H.E.R.A. adopted its first written Strategic Framework 2009 – 2013 together with the Advocacy Strategy 2009 – 2011 and Resource Mobilization Strategy 2009 – 2011. In addition AGM has also adopted a full range of management and human resource polices (Workplace policy, HIV/AIDS policy, and Financial Regulation policy, Staff-Appraisal Policy, Risk-Assessment Policy and Contingency Plan) in order to comply with all 65 IPPF Membership standards as set within Accreditation Review Visit that took place in 2008. H.E.R.A.'s extended its membership with 30 new volunteers The Executive Board has proposed around 30 candidates at the AGM to be approved for new volunteers of H.E.R.A.. This resulted with increased number of H.E.R.A.'s volunteer members to 78. More important H.E.R.A. has improved past practices not only to involve youth volunteers but also to engage senior members (especially medical doctors) with well-known background and supporters to the vision and principles of H.E.R.A.. H.E.R.A. adopted an HIV/AIDS workplace policy This year H.E.R.A., for the first time, initiated and in collaboration with the PLHA member volunteers have developed the HIV/AIDS workplace policy. In the development process H.E.R.A. uses the already existing IPPF policy as well as experience gained from of one of our volunteer during his attendance at the IPPF+ meeting in London. This policy as the first of its kind in Macedonia demonstrates H.E.R.A.'s commitment to greatly support PLWHA to enjoy their fundamental right of employment like all other people and not only within our association but country-widely. Therefore H.E.R.A. will commit itself to promote this policy and to be acknowledged broadly among CSOPs, private sector and Government institutions. The HIV working policy consists of following issues: 1. Introduction - Why this document is important for the association? 2. Purpose 3. For whom the policy apply 4. Confidentiality and disclosing HIV status 5. Stigmatization and discrimination 6. Training of volunteers and staff 7. VCT and treatment 8. Care and support of PLHA staff or those affected by HIV 9. Submitting appeal 10. Safety of the workplace 11. Policy review
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VI ACCREDITATION AND GOVERNANCE New Executive Board appointed At the AGM a new Executive Board has been selected and d-r Milena Stevanovik was once more appointed as President of H.E.R.A. with 2 years mandate.  H.E.R.A. adopted an Abortion policy At the AGM H.E.R.A. has also adopted its first written Abortion Policy as guarantee of women's right to choose terminate the pregnancy and also demonstrated association efforts for increased access to modern contraceptives. The policy document also demonstrate H.E.R.A.'s dedication as proactive organization to oppose any initiative that will undervalue women's right of choice and that will lead to any restrictive policies towards abortion legislation.
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VII RESOURCE MOBILIZATION H.E.R.A. managed to increase the Government funding within National AIDS Programme and has been granted from 5 Local State Centers for Public Health (Skopje, Kocani, Bitola, Kumanovo, and Stip) to implement youth HIV/SRH peer education activities. It was for the first time H.E.R.A. to get funded by the Govt. budget as a result of last year successful advocacy to introduce separate budget line for CSO's under National AIDS programme. A total of 10.000 EUR have been approved by the Govt. budget to H.E.R.A. for youth peer education activities in 2009. In line with Government funding, H.E.R.A. has also received a small grant from the Municipality of Skopje aimed to increase access to SRH services among most poor and sexually-excluded Roma women and girls living in the Roma community of Suto Orizari. H.E.R.A. has also received a one-year grant (November 2009 – November 2010) from the Norwegian Ministry of Foreign Affairs through the Norwegian NGO partner – Norwegian Church Aid for introducing the model of Roma Health Mediators and increase the access of Roma to health, social, educational and legal services through the developed innovative, state-recognized and sustainable model of Health mediation and ensure better representation of the Roma people in the State Health System. H.E.R.A. has also applied for three years RHM programme 2011 – 2013. Foundation Open Society Institute Skopje also supported H.E.R.A.'s project to provide technical and expertise support of the project implementation as well as to cover particular activity costs for the RHFs within this project, including development of the RHF training curricula by the Public medicine School and study visit for the members of the expert group on RHF in Romania or Bulgaria on sharing best practices. H.E.R.A. has already signed an agreement with OSI Skopje to jointly implement and support the RHF programme. 15.000 EUR for 2010 will be allocated by OSI Skopje side and further commitments are given for more matching funds in the coming years to ensure programme improvement and sustainability. H.E.R.A. has been also granted by UNFPA (5.000 $) to support youth advocacy activities in the framework of the ICPD@15 and 15andcounting campaign.
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VIII CAPACITY BUILDING Adolescents In April 2009 IPPF EN invited 2 H.E.R.A. representatives to attend 5 days training on youth training modules aimed at training young volunteers within IPPF. Further to the training H.E.R.A. has translated the ToT training module and conducts the training for around 20 youth volunteers followed with the development of action plan to ensure practical implementation of the training modules and facilitate H.E.R.A. volunteers active involvement in IEC activities and SRHR among young people. The action plan covered issues such as sexual rights, sexuality and pleasure, advocacy and communication skills, risky behavior using creative strategies, including photography, theater based education, social media such as facebook, twitter, and blogging. Part of ToT training modules, especially Volunteers, Abortion and Sexual Rights have been also incorporated within the peer education training curricula of H.E.R.A.. HIV/AIDS H.E.R.A. as IPPF EN focal point for HIV/AIDS has attended the HIV/AIDS competencies workshop in Mumbai, India and focused on the review of the IPPF strategy on HIV over the last 5 years and reflect on how best IPPF MA's can use their evidence to maximum effect of their work in regards to prevention, treatment and care, linking HIV and SRH and dealing with key populations. After the workshop H.E.R.A. participants (Programme Director) together with H.E.R.A. staff has developed the HIV operational plan for 2010 using the knowledge base and shared experiences from the workshop. Two representatives form H.E.R.A. has attended an EATG training course to assist in capacity building skills in HIV Treatment Literacy and Advocacy and contribute to the improved communication and the delivery of psycho-social support and legal services to the People Living with HIV and their families. H.E.R.A. produced a needs assessment report among users of the services at the HIV centre to identify how to improve the overall social and health status of PLHIV and to ensure a better quality of life. The needs assessment worked with 'The People Living with HIV Stigma Index' to better understand the internalized stigma experienced by PLHIV. The report will assist H.E.R.A. to further improve their actions and services in order to meet their needs, especially to treatment and SRH as well as to ensure that PLWH are actively involved in Association Governance and programmes and have skills to better advocate for their rights. Access H.E.R.A. has received training course on learning disabilities and SRH facilitated by IPPF and MA of UK, which took place in Latvia. 2 staff from H.E.R.A. has received information and skills on Sexuality and Relationships Work with people with learning disabilities. As a result of the capacity building training an operative plan for 2010 was developed to launch this initiative in Macedonia and to further work on strengthening and sustaining capacities of the association. In the framework of the ICPD@15 and 15andcounting H.E.R.A. produced a toolkit “Read it before start lobby� which provides advocacy strategies and advices how young people, especial youth MA volunteers, can stand and lobby for their sexual and reproductive health and rights and how to support sexuality education.
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VIII CAPACITY BUILDING
Проценка на потребата и на достапноста на информациите од областа на сексуалното образование во Македонија
H.E.R.A. has also published a report on sexuality education titled “Love only after classes” that asses the needs of the young people, parents and teachers on introducing sexuality education in schools as well as provides broad desk research analyses of the content, the quality and the rightbased approach of the SRH topics within the school-curricula in the elementary and high school. The finding from the research will help H.E.R.A. to better strategize their advocacy steps for introducing sexuality education in schools. Abortion In December 2009 IPPF EN facilitated a value clarification workshop on abortion for staff and volunteers of H.E.R.A.. Participants received up-date information and knowledge base on Abortion and Contraception worldwide, How to deal with Abortion Opposition, Medical Abortion, Abortion and Media. Furthermore the workshop helped staff and volunteers of MAs to enhance their skills to undertake activities for the reduction of barriers to safe abortion services in a manner consistent with their personal and professional values. Advocacy H.E.R.A. has translated and published Macedonian version of the IPPF Declaration for Sexual Rights and conducted several events: workshops and round-tables to bring the SR declaration to the policy makers and CSOs. The SRID has been integrated as a main advocacy tool of the Coalition for Sexual and Health Rights for Marginalized Groups In occasion of ICPD@15 H.E.R.A. organized an youth conference in Ohrid whereas young people coming from 28 organizations, NGOs, political parties and media has adopted a Youth SRH Declaration “Take part: Sexual Rights for All” which calls on Government of Republic of Macedonia to meet their commitments on sexual and reproductive health and rights derived from the ratified international agreements and national legislation to SRHR. The Declaration will assist organizations to improve their SRH advocacy efforts for the young people. Strategy Development H.E.R.A. has developed its first Strategic Framework 2009 – 2013 together with 2 other strategy documents: Resource Mobilization Strategy and Advocacy Strategy. IPPF has facilitated the process of strategic documents development and build capacities of the volunteer and H.E.R.A. staff. The strategic document clearly states the objectives and mission of H.E.R.A. to more effectively strategies their actions in the coming years to improved SRHR in the country.
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IX FINACIAL STATEMENTS
 The financial statements provide a summary of the 2008 income and expenditure of H.E.R.A. In 2009 H.E.R.A. income amounted to 354.908 US$ an increase over 41,50% from 2008. Most H.E.R.A. resources have come through the Global Fund Project and IPPF, which greatly contributed to the increasing of 41,50%. Income received from Government resources increased to 3% of the total income in 2009 an increase over 300% from 2008.
Incoming resources Grants from International Foundations and Non-Governmental Organizations
International Parenthood Planned Federation (IPPF)
$US 119.636,00
Norwegian Church Aid
59.504,00
Global Fund to fight HIV/AIDS and Tuberculosis and Malaria
134.111,00
SubTotal
313.251,00
Grants from Government and Government Agencies City of Skopje
6.269,00
Institute for Public Health
5.807,00
SubTotal
12.076,00 Grants from UN agencies
United Nation Population Fund (UNFPA)
21.165,00
United Nations Development Programmes (UNDP)
1.015,00
SubTotal
22.180,00
Membership
6.137,00
Interest income
1.264,00
TOTAL
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354.908,00
ANNUAL REPORT
IX FINACIAL STATEMENTS 
Expenditure H.E.R.A. activities by Strategic Priorities and Supporting strategies can be broken down as follows:
Management and administration 29%
Abortion 3% 9.816,00$
93.337,00$ Access to HIV/SRH services 40% 129.289,00$
Capacity Building 4% 14.364,00$
Advocacy 7% 24.209,00$
Young people 11% 37.536,00$
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H.E.R.A Executive Committee Members Milena Stevanovik, President Daniel Kalajdjieski, Secretary Aleksandra Vuckovska Zaklina Sopova Zoran Jordanov Stefan Stojanovik
H.E.R.A. Office Staff Bojan Jovanovski Executive Director Drasko Kostovski Programme Director Mila Carovska Programme Coordinator Youth Friendly Services Iva Mihajlovska Social worker – Youth center “Sakam da znam”, Suto Orizari Vesna Turmakovska Psychologist - Youth center “Sakam da znam”, Suto Orizari Marija Dragojlovik Host – Youth Centar “Sakam da znam”, Vodno Elizabeta Bozinoska Programme Coordinator HIV/AIDS Aleksandra Vuckovska Youth and Peer Education Coordinator Katerina Spasovska Project Coordinator Tuberculosis Milos Stojanovik Director of Finance and Administration Damjan Nikolov Administrative Assistant Lozan Kirandgiski Driver Miroslav Jelik Driver