Innovating health and social care in rural areas

New approaches for Macedonia


Kai Leichsenring


Kai Leichsenring

Daniela Cvetanoska and Marina Tosheska, Center for Development and Education, Prilep (Macedonia)

Harald Fugger, Austrian Social Attaché


Macedonia is facing heavy challenges in establishing and restructuring the provision of user-centred social and health care services. The realisation of defined visions and aims of the national government between 2005 and 2007 has been heavily jeopardised by the global financial and economic crises. In fact, new challenges have surfaced, including political instability and the refugee crisis.


  • Capacity-building for a step-wise transformation towards user-centred health and social care services by NGOs and public authorities in rural communities in Macedonia
  • Developing innovative projects for health and social care in rural communities during a 2-day workshop in the rural municipality of Krivogaštani (6-7 June 2016)


  • Background paper (good practice)
  • Multi-stakeholder workshop


  • Policy Brief ‘Innovating health and social care in rural areas – New approaches for Macedonia' (input for workshop)
  • 2-day workshop with representatives of local NGOs, employment services, health insurance and municipal authorities


The social context of the FYR of Macedonia encompasses a number of challenges, namely relatively low income levels among a great share of its population, limited access to care services, migration coupled with high unemployment rates. These challenges are even more acute in rural areas of the country.

Workshop participants identified several key areas in which interventions and innovation would be necessary. However, 'services for children with special needs', 'social inclusion of people with disabilities' and 'improving accessibility' were identified as the most important priorities.

  • Services for children with special needs: It seems that parents are often still not aware of their children’s needs. Special institutions are missing in the rural areas and transportation possibilities are missing. Therefore a special facility would be needed to provide day care with specialised staff and transport service for about 20 children and young people with disabilities (6-26 years). Social workers, nurses, pedagogues would be needed to establish the day care centre, which would need to be funded by central government, the municipality and (potentially) EU funding. The project proposal would need to involve parents to clearly manifest their and their children’s needs.
  • Improving accessibility: There is very scarce accessibility of public buildings - not only, but particularly in rural areas. Legal regulations (including the UN Convention) would be favourable, but implementation is lacking. It would be necessary to introduce sanctions for not respecting the law: improve access, raise awareness, introduce personal assistants. Apart from people with disabilities themselves, all citizens, police and architects should be addressed by this project in Krivogaštani.
  • Social inclusion of people with disabilities: Vulnerable groups are currently not included in any activities. People with disabilities (about 8,000 registered, another 8,000 not registered) are suffering a clearly medical approach to needs assessment. Furthermore, there are no data about employed people with disabilities. Further networking between business, social workers and (organisations of) target groups to promote awareness raising, training and education as well as next steps were planned.

Participants were relatively optimistic about the feasibility of these projects, although funding will be needed (proposals will be made to various funding bodies) and sustainability will remain a challenge. In Macedonia, this can mean for successful bottom-up projects to be taken over by statutory authorities that will then be ‘politicised’.

It will be a key task of workshop participants to continue the initiated collaboration across institutional and organisational boundaries. The Local Action Group with its most engaged members as well as the Municipality of Krivogaštani are in a good position to further advance social care issues in this region. However, further support is needed to not only build capacities but to facilitate tangible improvement.

The European Centre for Social Welfare Policy and Research supports the Sustainable Development Goals

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UN SDG Good Health and Well-Being
UN SDG Reduced Inequalities


Centre for Public Administration Research and Austrian Development Cooperation (BACID Programme)


03/2016 – 09/2016