North Macedonia’s New Care Economy: Changing Lives, Creating Jobs

“I can’t imagine life without her, she brings me such joy,” says Roza Mihajloska, affectionately speaking about her caregiver, Cvetanka Risteska. For Roza, Cvetanka is much more than a caregiver--she is a trusted companion who encourages an independent, dignified, and fulfilling lifestyle.

Even just a few years ago, this kind of in-home service was extremely rare and too expensive for most families in North Macedonia to afford. Instead, the burden of care would fall on family members, most often women. For many, this posed a significant barrier to fully participating in the workforce, keeping these women from reaching their full economic and social potential. And without professional assistance and monitoring, this approach left significant gaps in coverage and care that could threaten the safety of the elderly or persons with disabilities and leave them socially isolated.

Investing in North Macedonia’s Care Economy Improves Lives

In response to this challenge, the Government of North Macedonia, with support from the World Bank, launched the North Macedonia Social Services Improvement Project (SSIP) in 2018. Aimed at overhauling the local social service infrastructure, SSIP has worked to not only expand access to essential services but also raise quality standards.

One key component of SSIP was the development and expansion of noninstitutional social services, such as home-based care and assistance for the elderly. Many seniors did not have access to essential care, help around the house, or just someone to talk to.

“It means so much to me that Cveta comes to my house—it brings life into every day. She cares for me in countless ways: preparing meals, organizing my medications, and even picking up groceries when needed. We’ve been together for a year and four months, sharing a love that fills our lives with warmth and joy,” explains Roza.

The project also introduced a new approach for delivering social services by combining public resources with private expertise on offering in-home care. This strategy aims to better address individual needs while allowing the elderly or persons with disabilities to stay in familiar surroundings, with the option to adjust services as needed.

Thanks to SSIP, more than 1,600 beneficiaries from 43 municipalities in North Macedonia have been able to lead more comfortable, independent lives. Building upon this success will help tens of thousands more to get the care they need.

Creating New, More Productive Jobs through In-Home Care

SSIP’s efforts have also created opportunities within the care economy for individuals traditionally excluded from the labor market, particularly women and Roma. To date, SSIP-funded services have employed 773 professional caregivers and 26 coordinators.

One of those caregivers is Verica Petkoska, who now works as a professional nurse. "I am very grateful for the opportunity to work in a field I love and for which I trained,” Verica shares. “The satisfaction is mutual—not only do I find purpose in providing care, but our elderly beneficiaries truly appreciate the service. I am here to meet their needs and support those who depend on us."

SSIP has enabled caregivers—including grandmothers, mothers, and young women—to enhance their skills and earn a better income, improving their own lives while benefiting so many in need through the care economy.

Additionally, the initiative has opened new pathways for Roma, North Macedonia’s poorest community. With World Bank-support and funding from the European Union, an innovative social mentoring scheme supported 120 Roma women to join the workforce via the care economy as trained and certified care providers.

By pioneering a new model for elder care and investing in its care economy, North Macedonia is taking a significant step toward building a more inclusive and prosperous society for all.