Forthcoming Policy Developments

The deinstitutionalisation process in North Macedonia has been implemented since 2018 within the framework of the National Strategy for Deinstitutionalisation 2018–2027 and broader social protection reforms. A significant milestone was reached in 2023, when the Government formally confirmed the closure of large residential institutions for children without parental care and the transfer of children under the age of 18 to small group homes or family-based care arrangements. The reform process is coordinated by the Ministry of Social Policy, Demography and Youth in cooperation with relevant state institutions and international partners.

The current reform phase (2025–2027) therefore focuses on completing the transition of these groups to appropriate family-based or community-based alternatives, where feasible, while ensuring adequate professional care.

Ongoing measures include expanding foster care capacity, strengthening specialised family-based care services, and improving coordination between Centres for Social Work, healthcare institutions and local self-government units. Particular emphasis is placed on preventive services designed to reduce the risk of new institutional placements.

Reform efforts are supported by UNICEF, which continues to collaborate with the Government on strengthening the national child protection system. Cooperation includes improvements to the legal framework for child protection, enhancement of monitoring and case-management systems, development of early intervention services, and alignment with the European Child Guarantee framework.

Further policy development is expected in the period 2025–2027, particularly regarding:

• expansion of community-based social services at municipal level;
• increased financial and professional support for foster families;
• development of structured after-care programmes for young people leaving alternative care;
• strengthening inter-sectoral coordination mechanisms.
   

Financial assistance schemes and employment incentives remain available for young adults who have aged out of care. These measures include transitional financial benefits and active labour market measures coordinated with the Employment Agency of the Republic of North Macedonia.

Ongoing Debates

Despite substantial structural progress, several policy debates remain active among public authorities, civil society organisations and international partners.

A central debate concerns the sustainability and quality of deinstitutionalisation. While the closure of large institutions has been widely recognised as a major achievement, experts and non-governmental organisations have raised concerns regarding the adequacy of specialised services for children with disabilities, differences in quality standards among small group homes, and the long-term financial sustainability of community-based services. Stakeholders emphasise that deinstitutionalisation should not be understood solely as physical relocation, but as a comprehensive transformation ensuring improved developmental outcomes and social inclusion.

Another significant area of discussion relates to support for care leavers aged 18 and above. Although legal provisions guarantee certain financial assistance and employment support measures, implementation challenges persist in securing stable housing, long-term employment opportunities, psychosocial support and protection from poverty. Civil society representatives advocate for structured after-care programmes extending beyond the age of 18, targeted housing schemes and stronger coordination between social protection services and labour market institutions.

Preventing re-institutionalisation remains an additional policy concern. Particular attention is given to children with disabilities and children from families affected by poverty or social exclusion. International organisations, including UNICEF, stress the importance of increased investment in early childhood intervention, inclusive education and family support services as preventive mechanisms.

Finally, debate continues regarding the strengthening of inspection and monitoring mechanisms for small group homes, the improvement of national data collection systems, and the development of measurable outcome indicators for deinstitutionalisation reforms. While the structural phase of reform is largely completed, the current policy focus has shifted toward quality assurance, accountability, evidence-based monitoring and long-term social integration outcomes for children and young people without parental care.