Transforming Care Systems in North Macedonia: Gender, Care Needs, and Financing Pathways for an Inclusive Care Economy

Care – including childcare, support for older persons, and assistance for persons with disabilities – is essential for well-being and for the functioning of society. In North Macedonia, however, most care is still provided within families, often without adequate support. As the population ages and migration reduces the number of available caregivers, the demand for care is increasing, while existing services remain limited.

This study examines how care is organised, financed, and experienced in North Macedonia. It combines data analysis with insights from caregivers, service providers, and people with care needs to provide a comprehensive picture of current challenges. The findings show that access to care services is uneven, particularly in rural areas, and that costs can be a barrier for many households. As a result, families continue to rely heavily on unpaid care, most of which is carried out by women.

The publication highlights the economic and social importance of care and its links to employment, gender equality, and inclusive development. It identifies key gaps in services and financing, and outlines practical policy options for strengthening the care system. These include expanding home and community-based services, improving support for caregivers, and increasing public investment in care.

By presenting clear evidence and actionable recommendations, the study provides a roadmap for building a more accessible, inclusive, and sustainable care system in North Macedonia.