People with disabilities in North Macedonia face a significantly higher risk of poverty compared to the general population. In 2020, nearly 30% of working‑age people with disabilities lived in households with very low work intensity, more than double the rate for those without disabilities. Among all children, 32.7% lived below the national poverty line, reflecting inequalities that likely worsen for children with disabilities. Households that include disabilities often incur extra costs for medical care, assistive devices and travel, further increasing financial strain. These systemic barriers keep many with disabilities trapped in poverty. Here is more information about the correlation between disability and poverty in North Macedonia.

Breaking the Cycle of Institutionalization

For decades, individuals with intellectual disabilities lived in large-scale institutions in North Macedonia, isolated from their communities. In 2020, People in Need (PIN) launched “Getting a Life”, an EU‑funded project to shift residents into small, community‑based homes. PIN transformed institutions into nine independent living houses across Demir Kapija, Negotino and Skopje and relocated 45 residents from the Demir Kapija Special Institution to set up a better system to end disability and poverty in North Macedonia. Each house supports under five individuals and includes accessible living spaces designed to encourage autonomy.

Training for Quality Care

PIN trained more than 120 professionals, including social workers, physiotherapists and educators,  in person‑centered care. Eighty of them now prepare individualized care plans focusing on skills such as employment, daily living and social integration People in Need. PIN also launched a daily activity center in Skopje offering cooking, art and computer workshops, helping individuals develop confidence, skills and friendships.

Raising Awareness Across Communities

Community acceptance plays a crucial role in inclusion. PIN organized 18 awareness‑raising events, such as open houses and film screenings, that involved local officials, self‑advocates and neighbors. They helped form self‑advocacy groups and hosted the first national conference in 2023. All of this effort, drew multiple participants to feature policy recommendations. to government officials. PIN has managed to create an inclusive space to normalize disabilities in North Macedonia and to normalize their presence in communities that are often marginalized by poverty.

Measuring the Impact

In just three years, “Getting a Life” improved lives for 45 residents, built capacity for 120 professional caregivers and established community facilities. A final project evaluation found that 66% of trained caregivers found the training relevant, and 86.7% agreed that the principles of inclusion informed their approach. Residents now leave home slightly more regularly, 77.8%  reported occasional outings, whereas institutional conditions previously limited these opportunities. These findings provide further evidence that projects like “Getting a Life” can help identify ways to address disability and poverty in North Macedonia.

The Road Ahead

Despite these milestones, more than 60 individuals still live in the Demir Kapija institution awaiting relocation. Expanding community-based living will require steady funding, strong political leadership and innovative partnerships between government agencies, NGOs and international donors. People in Need aims to use the lessons from “Getting a Life” to guide further deinstitutionalization efforts across the Western Balkans, adapting the approach to meet different local needs. Scaling this model would not only open the door to independence for those still in institutions but also create more inclusive neighborhoods, generate care-sector jobs and reduce the long-term costs of institutional care. Investing in disability inclusion safeguards human rights, lowers poverty rates and strengthens the social fabric for everyone.

– Nilay Ersoy

Nilay is based in Cambridge, MA, USA and focuses on Global Health for The Borgen Project.

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