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1. Policy framework

2. Stakeholders

3. Guidance to stakeholders

4. Target groups

5. Funding

Policy framework

The health and youth policy framework continues to recognize the importance of early identification and support for young people at risk. The key strategic documents — the Health Strategy 2021–2030, the National Youth Strategy 2023–2027, and the Law on Mental Health — all foresee prevention, early detection and improved access to mental-health services for children and youth. Despite these commitments, practice remains dominated by institutional treatment, while community- and school-based mental-health services are still underdeveloped.

Positive prospects lie in the current Health Strategy, which emphasizes strengthening health education in schools, including healthy lifestyles, substance-abuse prevention, sexual and reproductive health education, and early support for mental-health challenges. Still, primary health-care services lack resources, training, and specialized staff to adequately respond to the mental-health needs of young people.

A significant development is the 2025 Programme for Systematic Medical Examinations of Students in the Republic of North Macedonia, which mandates regular health screenings for pupils in the 1st, 3rd, 5th, 7th and 9th grade, for secondary school students in the 1st and 4th year, and for university students in their first year. Alongside general physical health checks, the programme explicitly includes screening for risky behaviours, substance use, sexual health, bullying, and early signs of depression and other mental-health disorders, with referrals to specialist services where needed. The programme also prioritizes the detection of children outside the education system — particularly from Roma communities — and provides mechanisms for their inclusion in preventive health care.

However, implementation challenges persist. Although systematic check-ups are formally required, their quality and consistency vary due to limited staffing, lack of standardized mental-health screening tools, and uneven cooperation between schools and health institutions. As a result, a comprehensive and accessible network of counselling and psychosocial support services for children and adolescents remains underdeveloped, leaving many young people without adequate early intervention and follow-up.

Stakeholders

The leading institutions designated to support young people at risk are the Ministry of Health and the Ministry of Education and Science, supported by bodies such as the national mental-health committee and the national mental-health coordinator. The Ministry of Health is responsible for monitoring the implementation of the mental-health legal and strategic framework, while the Ministry of Education and Science oversees the delivery of programmes in primary and secondary schools.

Despite this structure, there remains no fully institutionalised capacity-building programme for all relevant stakeholders (schools, health centres, youth workers) to detect and support youth mental-health needs in a coordinated way.

Guidance to stakeholders

Specific programs for sensitization of stakeholders are not in place, except work of some civil society organizations and international organizations  working on substance abuse (Healthy Options Project Skopje - HOPS), sexual and reproductive health (United Nations Population Fund - UNFPA and Health, Education and Research Association – HERA), in collaboration with the institutions. Through peer-education programmes, counselling, and school-based workshops, they provide practical guidance to professionals and raise awareness among young people, often filling institutional gaps. Collaboration with institutions exists, but remains project-based and time-limited, which affects the long-term sustainability and nationwide coverage of such interventions.

Target groups

The Ministry of Health continues to implement annual public-health programmes targeting different categories of citizens living with specific diseases or risk factors. In the context of youth, these programmes cover prevention, vaccination, screening and health promotion. However, general health policies are implemented for all young people equally, in line with the principle of non-discrimination and equal access to services. This means that while certain population groups—such as young people with chronic illnesses, Roma youth, or those living in rural and economically disadvantaged areas—may face additional barriers, there are no dedicated national programmes specifically tailored to their mental-health needs. Consequently, early identification and support for the most vulnerable young people often relies on individual institutions, donor-funded projects, or CSO initiatives rather than a coherent nationwide approach.

Funding

According to the Law on Public Health (Article 34), public-health financing is secured from:

1. the Budget of the Republic of North Macedonia;

2. municipal budgets;

3. own revenue sources;

4. donations; and

5. other sources defined by law.
   
    

The Ministry of Health has seen a gradual increase in public spending over the past years. The total budget grew from 12,246,000,000 MKD in 2020 to 21,707,000,000 MKD in 2025. Although the overall allocation for health continues to rise, mental health remains only one of many areas competing for funding, and there is no publicly available data on how much of the budget is specifically dedicated to youth mental health.

Health financing also relies on the Health Insurance Fund (HIF), which purchases health services, including those in mental health. Ambulatory services are reimbursed through global budgets and a capped fee-for-service model, while primary care providers are paid using a mix of capitation and performance-based preventive targets.

However, despite growing budget allocations, the lack of designated funding streams for youth-focused mental-health programmes remains a challenge. Civil-society organisations continue to rely heavily on donor funding, making many prevention and counselling programmes dependent on external support, and limiting sustainability, continuity, and national coverage.