AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN

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BYRNE, Kevin An analysis of the situation of women and children in the Republic of North Macedonia [Електронски извор] : final report / Kevin Byrne. - Skopje : UNICEF, 2020

Начин на пристап (URL): https://www.unicef.mk. - Текст во PDF формат, содржи 108 стр., илустр. - Наслов преземен од екранот. - Опис на изворот на ден 28.02.2020

ISBN 978-608-4787-66-2 This report was commissioned by the United Nations Children’s Fund (UNICEF) and prepared by the individual consultant Kevin Byrne. The statements in this report are the views of the author and do not necessarily reflect the policies or the views of UNICEF. INSTITUTIONS RESIDENTS IMMUNIZATION MARRIAGE ASSISTANCE EMPLOYED

The States Parties to the present Convention PARENTS shall respect and ensure the rights set forth in this Convention to each child within their jurisdiction without discrimination of any ROMA kind, irrespective of the child’s or his or her parent’s or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, HEALTH disability, birth or other status

Article 2.1 UN Convention on the Rights ETHNIC of the Child DISABILITY CULTURE EQUALITY POPULATION DEVELOPMENT CHILD-CARE CHILDHOOD HUMAN-RIGHTS

CONTENTS

Acknowledgements...... 1

Acronyms and Abbreviations...... 2

CHAPTER 1 Introduction

1.1 Context, purpose and aim...... 5 1.2 Conceptual framework and approach...... 5 1.3 Methodology...... 6 1.4 Limitations and constraints...... 7 1.5 Ethical framework...... 9

CHAPTER 2 Country context

2.1 Geography, climate and environment...... 11 2.2 Population and demographic trends...... 13 2.3 Governance...... 14 2.4 Economic development...... 15

CHAPTER 3 Development and human rights

3.1 National development and human rights framework...... 19 3.2 Women’s rights and gender equality...... 20 3.3 The framework of child rights...... 23

CHAPTER 4 Children at high risk of poverty and exclusion

4.1 Roma children and families...... 27 4.2 Children living with disability...... 31 4.3 Children in migration...... 33

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA CHAPTER 5 Duty bearers’ capacity, commitment and understanding of child rights

5.1 Government...... 37 5.2 Civil Society...... 40 5.3 Media...... 42 5.4 Community...... 43 5.5 Family...... 45

CHAPTER 6 The state of children’s rights – a thematic analysis

6.1 The right to early care and development...... 49 6.2 The Right to Education...... 51 6.3 The Right to Health...... 57 6.4 The right to protection...... 65 6.5 The right to survival and development...... 72

CHAPTER 7 Conclusions and recommendations

7.1 Drivers of inequity...... 79 7.2 Recommendations...... 84

Bibliography...... 91

WEBSITES...... 98

Annex 1: List of key informants...... 99

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 08

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA ACKNOWLEDGEMENTS

As part of the process of developing a new particularly Elspeth Erickson who designed, country programme of cooperation, UNICEF managed and facilitated the whole process; commissioned this Situation Analysis in the Republic of North Macedonia in order to Aleksandar Lazovski and Marija Mokrova who provide an objective and verifiable analysis provided technical support and guidance; as well of the situation of children and child rights as Zarko Antonoski and Suzana Sinadinovska who that can be used by UNICEF, its partners and provided logistical and administrative support. other duty-bearers in-country to identify and Special thanks are owed to my local partner address barriers to, and opportunities for, full Boge Bozinovski of INDAGO who designed achievement of their rights by all children. It is and implemented a series of consultations with intended to inform programme planning and children and young people, one of the most vital guide policy advocacy and partnership efforts; elements of this report. Finally, thanks are due to contribute to development of the new United all the key informants who gave their time freely, Nations Sustainable Development Cooperation not just to provide research data, but also to Framework (UNSDCF); as well as update share their experiences, opinions, and insights. In the existing knowledge base, especially in return I have tried to respect their confidentiality relation to equity and gender. By improving the and have refrained from attributing direct understanding of decision-makers, partners and statements to them in this report. stakeholders of the current status of children’s rights in the country, this Situation analysis can This text seeks to comply with the European provide a basis for policy formulation to address Union and the Council of ’s adopted the causes of inequities in North Macedonia. usage of the term ‘Roma’. The term, as used in official EU, Council of Europe and Organisation The independent analysis contained in this report for Security and Cooperation in Europe (OSCE) is based on qualitative and quantitative data documents, includes Roma, Egyptian, Traveller, obtained through a desk-review of the latest Sinti and other groups often inaccurately research, statistics and reports available; face described as ‘Gypsies’. For readability purposes, to face interviews with key stakeholders; and the adjective ‘Roma’ in this document refers focus group discussions (FGDs) with children and to the Roma people as a whole or to groups or adolescents. Although the report includes input individuals, e.g. Roma children, Roma families, from UNICEF management, staff and partners, while ‘Romani’ refers to languages and culture. the views expressed within it do not necessarily Readers should note that the use of the term reflect those of UNICEF management and staff, “Roma” is not intended to deny the diversity its donors or partners in North Macedonia. that exists across Roma, Egyptian, Traveller and other groups. This report would not have been possible without the support and cooperation of the UNICEF Kevin Byrne country office management team and staff, October 2019

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UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA ACRONYMS AND ABBREVIATIONS

ABR Adolescent Birth Rate ECtHR European Court of Human Rights AJM Association of Journalists of EGMA Early Grade Mathematics Macedonia Assessment ANED Academic Network of European EGRA Early Grade Reading Assessment Disability Experts EMIS Education Management BTI Bertelsmann Transformation Index Information System CA Child Allowance EMS-1998 European Macro-seismic Scale CBMIS Cash benefit management ENS European Network on information system Statelessness CCA Common Country Assessment EPP Emergency Preparedness Planning CCT Conditional Cash Transfers EQLS European Quality of Life Survey CEDAW Convention on the Elimination ERP Economic Reform Programme of all forms of ERRC European Roma Rights Centre Discrimination ESE Association for Emancipation, against Women Solidarity, CFS Child Friendly School(s) and Equality of Women in CLA Climate Landscape Analysis Macedonia CMC Crisis Management Centre EU European Union CMT Country Management Team EU28 The member countries of the EU CoE Council of Europe Eurofound European Foundation for Convention UN Convention on the Rights of Improvement the Child of Living and Working Conditions CPA Child Protection Allowance CPD Country Programme Document FES Friedrich Eburt Stiftung CPR EC Country Progress Report FGD Focus Group Discussions(s) CPS Country Partnership Strategy FRA European Union Agency for CPT Committee for the Prevention of Fundamental Torture Rights CRC Committee on the Rights of the Child GDP Gross Domestic Product CSO Civil Society Organisation GNI Gross National Income CSW Centre for Social Work GP General Practitioner CWD Child(ren) with Disability HBS Household Budget Survey DPDP Directorate for Personal Data HDI Human Development Index Protection HERA Health education and research DRR Disaster Risk Reduction association HIF Health Insurance Fund EC European Commission HIV Human Immuno-deficiency Virus ECD Early Childhood Development HRBA Human Rights Based Approach ECE Early Childhood Education ECDC European Centre for Disease ICF International Classification of Prevention and Control Functioning, ECHR European Convention on Human Disability and Health 2 Rights IDU Injecting drug user

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA IHR Institute for Human Rights OTW Open the Windows IMCH Institute of and Child Health PN Patronage Nurse IMR Infant Mortality Rate PWD Person(s) with Disability IPA Instrument for pre-Accession Assistance RHM Roma Health Mediator IPH Institute of Public Health ISA Institute of Social Affairs SAA Stabilisation and Association ISI Institute on Statelessness and Agreement Inclusion SDG Sustainable Development Goal(s) SEI Social Exclusion Index KAP Knowledge, attitudes and practice SEN Special Educational Needs Km Kilometre SFA Social Financial Assistance Kosovo Kosovo under UNSC 1244 SILC Survey of Income and Living Conditions LGBTI , , bisexual, transexual SIOFA Secretariat for the Implementation and intersex of the OFA SitAn Situation Analysis M&E Monitoring and Evaluation SOP Standard Operating Procedure MCH Mother and Child Health SPO Special Prosecutor’s Office MES Ministry of Education and Science SSO State Statistical Office MICS Multiple Indicators Cluster Survey STI Sexually transmitted infection MKD MLSP Ministry of Labour and Social TFR Total Fertility Rate Policy TIP Trafficking in Persons MMR Maternal Mortality Rate MoH Ministry of Health UN United Nations MOI Ministry of the Interior UNCRC UN Convention on the Rights of MRG Minority Rights Groups the Child MSM Men who have sex with men UNSDCF UN Sustainable Development MTR Mid-term Review Cooperation Framework NAPC National Plan of Action on the UNDP UN Development Programme Rights of the Child UNICEF United Nations Children’s Fund NATO North Atlantic Treaty Organisation NEC National Examination Centre VAC Violence against children NEET (Young people) Not in education or VET Vocational education and training training VETC Vocational Education and Training NGO Non-governmental Organisation Center

ODIHR Office for Democratic Institutions WHO World Health Organisation and Human Rights OECD Organisation for Economic Cooperation and Development OFA Ohrid Framework Agreement OSCE Organisation for Security and Cooperation in Europe 3

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA CONTEXT, PURPOSE AND AIM CONCEPTUAL FRAMEWORK AND APPROACH METHODOLOGY ECONOMY CHAPTER 1 CONTEXT INTRODUCTION PROFILE GEOGRAPHIC LOCATION AND DEMOGRAPHIC GOVERNANCE AND POLITICAL HUMANITARIAN RISK4 PROFILE GENDERUNICEF AN ANALYSIS OF THEPROFILE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 1.1 Context, purpose in the country, this Situation analysis can and aim further provide a basis for policy formulation to address the causes of inequities in North UNICEF commissioned this study to provide Macedonia. The main aim of the Situation an independent analysis of the situation analysis therefore is to highlight strategic of children and child rights in the Republic priorities for duty-bearers in-country to of North Macedonia that can be used by reduce disparities and address vulnerabilities, UNICEF, its partners and other duty-bearers and hence contribute to shape the national in-country to identify and address barriers development agenda and accelerate to and opportunities for full achievement achievement of the Sustainable Development of their rights by all children. It is intended Goals (SDGs)1 . to inform programme planning and guide policy advocacy and partnership efforts; 1.2 Conceptual framework contribute to development of the new and approach Country Programme Document (CPD), the Common Country Assessment (CCA) and the The rights-based research approach adopted by UN Sustainable Development Cooperation UNICEF2 uses the UN Convention on the Rights Framework (UNSDCF); as well as update of the Child (UNCRC)3 as an essential reference the existing knowledge base, especially in and is guided by key human rights principles relation to equity and gender, children and (universality, equality and non-discrimination, adolescents. By improving the understanding accountability and participation). This Situation of decision-makers, partners and stakeholders analysis has adapted this human rights-based of the current status of children’s rights approach (HRBA) so that the underlying

1 Transforming our world: the 2030 Agenda for Sustainable Development Resolution 70/1 adopted by the 70th meeting of the United Nations General Assembly on 25 September 2015 available at https://sustainabledevelopment.un.org/ post2015/transformingourworld 2 As outlined in Garde M. Parameswaran S. Tso S-YK et al Core Guidance: New Generation Situation Analysis UNICEF (May 2019) NY 3 Convention on the Rights of the Child adopted by the General Assembly of the United Nations on 20 November 1989 hereafter ‘the Convention’ or UNCRC. For the full text see https://www.ohchr.org/en/professionalinterest/ pages/crc.aspx 5

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA principles of the UNCRC underpin the research, 1.3 Methodology as well as assessments of the extent to which children in North Macedonia are able to enjoy This study is based on a wide-ranging and their rights as established by the Convention on in-depth analysis of the situation of all the Elimination of All Forms of Discrimination children up to 18 years of age who live in Against Women (CEDAW)4, the UN Convention the country but focuses as far as possible on on the Rights of Persons with Disabilities those who are most vulnerable, marginalised (CRPD)5 and other key international and regional and disadvantaged. The core of this study treaties and conventions. is a causality analysis of the realisation of the rights of children in North Macedonia The HRBA implies a practical commitment and examination of barriers that prevent or to (i) put the child at the centre of the impede a child’s enjoyment of her or his research process and (ii) to filter analysis of rights. This approach was used to assess the available data through the lens of article the capacity of all the key actors to fulfil their 2.1 of the Convention, which guarantees responsibilities for ensuring that children’s “the rights set forth in this Convention to rights are respected, protected and fulfilled. each child within their jurisdiction without The methodologies employed include: discrimination of any kind, irrespective of the child’s or his or her parent’s or legal ∙∙ A desk review of existing studies, guardian’s race, colour, sex, language, reports, surveys, statistical data and other religion, political or other opinion, national, information on legislation, policies and ethnic or social origin, property, disability, programmes produced by the Government birth or other status 6”. Therefore, this report of the Republic of North Macedonia; as examines the situation of all children in North well as documents and studies from the Macedonia, although it focuses as far as Committee on the Rights of the Child possible on those who are most vulnerable, (CRC), OECD, OSCE, various EU bodies, marginalised and disadvantaged in terms of UN agencies, academic institutions, access to their rights and entitlements. As local and international NGOs, and other part of its integrated, cross-sectoral approach sources. The study drew as far as to data collection and analysis, and a holistic possible on the most up-to-date data view of the child, this study has tried to available and research post 2014, and analyse existing disparities related to gender, every effort was made to rely primarily geographical location, wealth, ethnicity on official government data and analysis, and ability. Thus, the Situational Analysis supplemented by documented evidence explicitly encompasses analyses of particularly from other independent sources; vulnerable or at-risk populations e.g. children ∙∙ Semi-structured interviews with key with disability; children in institutional care; informants drawn from Government, civil children in detention. As far as possible, data society, academia and donors. These and analysis are disaggregated on the basis of included discussions with child-focused gender; ethnicity (Macedonian/Albanian/Roma) organisations, as well as NGOs concerned and region. Special attention is also paid with women, Roma, disability and early throughout this report to public knowledge, childhood development (ECD). Input from attitudes and practices relating to children, key informants was triangulated with data behaviour, family values, and community from documentary sources and other traditions and culture that affect the realisation informants. No one statement in this of children’s rights. report can be attributed to a single key

4 See https://www.un.org/womenwatch/daw/cedaw/ for full text and wider discussion of implications for children 5 See https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html for full text and wider discussion of implications for children 6 UNCRC op cit Article 2.1 See Hodgkin R. Newell P Implementation Handbook for the Convention on the Rights of the 6 Child UNICEF (2002) New York pp19-38 for a fuller discussion of the implications of Article 2.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA informant and any statements attributed the last decade in national development, to key informants refer to a number of the main focus to date has understandably informants. A list of key informants is been on improving the overall situation in attached as Annex 1. the country, rather than promoting equity, ∙∙ Focus Group Discussions with a sample and this is reflected in the data. A significant of children and adolescents aged between proportion of national data is not sufficiently 15 and 18 from a spectrum of locations, disaggregated, particularly according to ethnic and socioeconomic groups; ethnicity. The State Statistical Office is ∙∙ Consultations with key UNICEF staff. continually upgrading its capacity to provide data to required standards and should be The Situation analysis was conducted by supported to develop an agreed framework an international consultant and a national of disaggregated child-related indicators. The consultant working together. The international data base in relation to the most vulnerable consultant focused on data collection children – Roma, children with disabilities and analysis, including document/data (CWD) and poor children – is particularly review, supplementary interviews with limited. Where possible, these gaps have key stakeholders in the country and overall been identified in the body of the report. strategic analysis and recommendations. While the national consultant supported the The second constraint was the imbalance wider analysis, his primary responsibility was between stakeholder sectors. Every attempt organisation of a stand-alone participatory was made to achieve a fair balance between process for gathering inputs from children and UNICEF, government, civil society and adolescents on their situation and prospects, donor perspectives, and the views of all four as well as a quick analysis of potential new stakeholder groups are represented in this partnerships, with an emphasis on the private report. However, time did not allow for an sector. objectively balanced cohort of key respondents and availability played a significant part in A visit by the international consultant in June deciding the final respondents’ list. Parents’ was used to plan and prepare a series of FGDs and communities’ perspectives in particular with children, to be organised by the national are not well represented but it has to be consultant. A questionnaire was developed and noted that adult key informants were very amended as a result of feedback from UNICEF open and spoke with us as men, women, staff. Nine FGDs were held throughout July parents and concerned citizens as well as and August encompassing a sample of children representing their ‘official’ role. Civil society disaggregated by gender, ethnicity, residence in North Macedonia remains quite restricted and socioeconomic status. 65 children and and there are few child-related NGOs to adolescents participated in FGDs. provide alternatives to the official narrative on children’s rights. There are very few child- 1.4 Limitations and led organisations in North Macedonia, but, constraints fortunately, the child participation element of this exercise was designed to ensure that a There were inevitably time and resource fair and balanced cross-section of children’s constraints on preparation of this situation opinions were heard. analysis. There is an abundance of quality studies related to North Macedonia, but it Time constraints prevented causality analysis is scattered and much of the available data on a rights-by-rights basis, so this study is inconsistent and non-comparable. The presents as comprehensive a picture of the author prioritised post-2014 research and range of causes as possible from the available data, but also had to draw on some earlier data and then analyses and categorises them studies, where no later data was available. across the spectrum of rights, within the body While the country has invested heavily over of analysis. 7

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 8

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 1.5 Ethical framework published in aggregated form only, and that the identity of child participants would The Situation analysisprocess was designed not be disclosed under any circumstances; to comply at all times with UNICEF ethical ∙∙ Collected data is securely stored on standards as laid down in Memo CF/PD/ INDAGO servers. After the analysis is DRP/2015-0017, especially as it included done, the data will be transferred to a strong child participation element. The UNICEF for future storing. research was conducted in compliance with ∙∙ No payment or compensation for the UNICEF Procedure for Ethical Standards in participants was used in the research. Research, Evaluation, Data Collection and Analysis. In addition, ethical standards for Bearing in mind that the research involves research involving children, reflected in the children, the data collection tools and following principles, were also adhered to – procedures were reviewed and approved by UNICEF, in line with UNICEF Procedure for ∙∙ No conflict of interest was identified as a Ethical Standards in Research, Evaluation, part of the research; Data Collection and Analysis. An inception ∙∙ Informed consent – all participants were report, together with schedules, protocols, informed about the research, its objective and questionnaires for the planned focus and their part in the process. It was clearly group discussions (FGDs) with children, stated that their participation would cause was submitted to an autonomous no harm, but also no immediate benefit for committee, authorized by the US Office them. They were asked to express verbal for Human Research Protections within consent to participate in the research and the US Department of Health and Human were explained that they could withdraw Services to review and approve research from the process at any time. involving human subjects before the start ∙∙ Confidentiality and anonymity – all of research. Researchers also undertook participants in the research were informed approved training on ethics prior to that their privacy would be protected, that undertaking research with children and data collected in the research would be adolescents.

7 See Memo CF/PD/DRP/2015-001 (01 April 2015) UNICEF PROCEDURE FOR ETHICAL STANDARDS IN RESEARCH, EVALUATION, DATA COLLECTION AND ANALYSIS p8 para viiiA 9

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA GEOGRAPHY ENVIRONMENT SUSTAINABLE DEVELOPMENT CHALLENGES SUSTAINABLE ENERGY PROGRESS MIGRATION CHAPTER 2 CLIMATE COUNTRY CONTEXT TRENDS IMPLEMENTATION POLLUTION DEMOGRAPHIC GOVERNANCE IMPLEMENTATION DECENTRALIZATION IMPLEMENTATION10 ECONOMICUNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 2.1 Geography, climate receiving approximately double the annual and environment average rainfall of the lowest, and seasonal differences of up to 70o°C between summer North Macedonia, officially the Republic and winter temperatures. Average annual of North Macedonia, is a small country in rainfall has steadily decreased in recent years, Southeast Europe, bounded by Serbia and while average temperatures increased. These Kosovo8 to the north, Bulgaria to the east, trends are expected to continue and if, as to the west and Greece to the south. seems likely, they amplify, a general increase The country covers an area of 25,713 square in aridity threatens almost the entire landscape kilometres (km) with total boundaries of 899 of North Macedonia. km. It comprises about 79 per cent hilly, mountainous terrain and only 19 per cent Between 2013 and 2017, the Seismological plains. About two per cent is covered by water. Observatory at the Faculty of Natural Science The country’s average altitude is 830 metres9. and Mathematics in Skopje recorded 27 earthquakes of between five and eight Overall, the climate is mild continental with degrees of intensity11 across the country. some Mediterranean influence, but a recent North Macedonia is also prone to flooding, climate landscape analysis for children mudslides, landslides, droughts and storm. (CLAC)10 found that rainfall and temperatures Heatwaves, which facilitate both water vary widely, with high elevation locations shortages and forest fires, have been on the

8 This designation is without prejudice to positions on status and is in line with UNSCR 1244/1999 and the ICJ Opinion on the Kosovo declaration of independence 9 Figures taken from Statistical Yearbook of the Republic of Macedonia, 2018 State Statistical Office (SSO) (2018) Skopje Chapter 02. Environment and Geography p14 10 Molyneux N. Climate Landscape Analysis for Children in Macedonia UNICEF (2018) Skopje 11 Quoted in Statistical Yearbook of the Republic of Macedonia, 2018 SSO op cit p37. The degree of earthquake intensity was measured on the European Macro-seismic Scale (EMS-1998) of 12 degrees prepared and proposed for use in Europe by the European Seismological Commission. The 12 degrees are measured according to the following effects: a) Effects on people; b) Effects on objects and nature (except demolition of buildings and land); c) Demolition of structures and comprise I. Not felt; II. Scarcely felt; III. Weak; IV. Widely observed earthquake; V. Strong earthquake; VI. Earthquake that provokes slight damage; VII. Earthquake that provokes damage; VIII. Earthquake that provokes heavy damage; IX. Destructive earthquake; X. Very destructive earthquake; XI. Devastating earthquake; XII. Completely devastating earthquake. 11

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 rise in recent years, and as temperatures standard stoves, as is common amongst continue to rise, extreme events are poorer households, multiplies the risks and predicted to become more intense. Rising makes energy poverty an equity issue in North temperatures due to climate change present a Macedonia. The impact of the pollution crisis specific threat to children’s health, especially on children’s health in Skopje and other urban where higher peak temperatures and longer centres is a pressing child rights issue. The hotter heatwaves combine with the urban lack of sufficient administrative and financial heat island effect to raise temperatures to resources is still the main obstacle to putting dangerous levels that threaten human health. air quality improvement measures in place. Hotter temperatures also combine with air pollution to significantly increase the risk of Other environmental concerns include respiratory and cardiovascular diseases during untreated mining, municipal and industrial summer months. waste entering water systems, potentially affecting drinking water. Reduced water Also, although average rainfall is likely to availability is a significant threat to children, decrease, destructive rainfall events will likely and the children most affected will be in become more extreme. A Crisis Management families where water availability is already Centre (CMC) has been assigned by the under stress i.e. in rural, agriculture Government as the National Platform for dependent communities. Direct impacts Disaster Risk Reduction, and flood hazard and include likely increases in household risk mapping has been developed for almost deprivations; increasing economic migration; all areas. However, the country still lacks higher rates of energy poverty; and potentially streamlined, coordinated and efficient disaster increasing barriers to the already low rates of mitigation and response action at every exclusive breast feeding. level12 of government. An inter-institutional working group has been set up to propose North Macedonia also has a number of recommendations for improvement. challenges in relation to sustainable energy. Its main energy source – low quality coal – is Pollution constitutes a significant threat to both non-renewable and polluting. Although sustainable development in North Macedonia. hydropower currently makes up about 1/3 of Air pollution, due mainly to wood burning, the country’s electricity generation capacity, traffic and industry, is already at dangerously climate change-driven reductions in rainfall high levels in populated and industrial areas threaten its long-term feasibility, and wind across the country. Ambient air pollution alone and solar electricity generation are still in was responsible for some 1,600 deaths in their infancy. Limited access to clean energy 2016 and about half of the total number of sources like electricity or gas, combined with deaths occurred in Skopje13. Wood burning old, poorly insulated buildings and temperature is used by 62 per cent of households for extremes, result in considerable energy heating across the country, particularly in those poverty across the country and contribute areas where district heating is unavailable14. strongly to air pollution. This is exacerbated by unregulated burning of waste, especially in the winter months. Limited progress has been achieved in Solid fuel burning, the most common form of aligning policies and legislations with EU heating in North Macedonia, always results standards in the water, nature protection in emissions that can be harmful to children; and waste sectors. Implementation and burning of poor quality solid fuels in sub- enforcement are lagging behind and the EC

12 North Macedonia 2019 Report European Commission (May 2019) Brussels hereafter CPR 2019 13 Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank Group (2018) Washington 12 14 Molyneux N. UNICEF (2018) op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA is strongly recommending15 that the country per cent) live births were to aged should implement air quality improvement 25-29 and the mean age of mothers for all live measures by ensuring efficient coordination births was 28.9 years21. between central and local authorities, and the allocation of sufficient financial Since the majority of births (88 per cent) occur resources; implement the adopted regional within marriages, the falling birth rate may waste management plans and establish be due to a fall in the marriage rate from 7.2 an integrated regional waste management in 2011 to 6.6 in 2017, or to later marriages. system; and implement the Paris Agreement There is a pattern of postponement of by developing a comprehensive strategy on marriage to an older age, the average age at climate-related action, consistent with the first marriage in 2017 was 26.6 years for the EU 2030 framework. It is important that all bride and 29.3 for the groom22. Whatever the these measures are sufficiently informed by reasons, population growth is slowing, with children’s perspectives. a fall in the rate of natural increase from 1.6 in 2011 to only 0.7 in 2017 and a drop in the 2.2 Population and index of vitality (births per 100 deaths) from demographic trends 120.5 in 2013 to 107.1 in 2017.

Official estimates16 based on the last census The last national census in 2002 showed a in 2002 indicate that the total population of growing urban/rural divide and a severely North Macedonia in June 2017 was 2,074,502, skewed distribution of population, with 58 divided almost evenly between males (50.1 per cent of the population living in cities, the per cent) and females (49.9 per cent). There highest concentration (20.5 per cent) being in were an estimated 466,152 children aged Skopje. The Eurofound23 European Quality of 0–19 years. Overall the population is ageing, Life Survey (EQLS) data indicated 72 per cent with the percentage of children dropping of the population in urban settings in 2016 from 24 in 201117 to 22.5 in 2017, while the and the 2017 SSO estimates24 show 45 of proportion of the general population aged 65 81 municipalities having negative population or over increased from 12 per cent in 201118 growth, undoubtedly caused by falling birth to 13.5 per cent in 2017. Although women of rates and migration. Migration is a traditional reproductive age make up 21 per cent of the feature of society in North Macedonia, and the total population, the birth rate has continued net migration rate25 now stands at -0.5/000 to decline, falling from 11 live births per 1000 meaning that more people are emigrating from inhabitants19 in 2011 to 10.5/000 in 2017. The the country than migrating to it. average fertility rate in 2017 was calculated to be 1.43, down from 1.48 in 2013. This fertility Although the net migration rate is low, rate is below the EU average (1.6) and far estimates26 based on census data from below replacement level (2.1)20. Most (34.7 destination countries (mostly Western

15 North Macedonia 2019 Report European Commission op cit. 16 Unless otherwise stated, the figures quoted in this section are from Statistical Yearbook of the Republic of Macedonia, 2018 SSO op cit Chapter 03 Population 17 Macedonia in Figures 2012, State Statistical Office, Skopje, 2012 18 State Statistical Office, Skopje, 2013 www.stat.gov.mk 19 IMCH Annual Report, Skopje, 2011 20 Milevska Kostova N, Chichevalieva S, Ponce NA, van Ginneken E, Winkelmann J. The former Yugoslav Republic of Macedonia: Health system review European Observatory on Health Systems and Policies/WHO (2017) Copenhagen available at http://www.healthobservatory.eu 21 SSO Women and Men in North Macedonia SSO (2018) Skopje 22 Ibid 23 Leoncikas T. et al/Eurofound Life and society in the EU candidate countries, European Quality of Life 2016 series Publications Office of the European Union (2019) Luxembourg hereafter Eurofound 2019 24 Statistical Yearbook of the Republic of Macedonia, 2018 SSO op cit Chapter 03 Population 25 See Macedonia Migration Rate, Index Mundi at https://www.indexmundi.com/macedonia/net_migration_rate.html 26 Country Partnership Framework for the Republic of North Macedonia 2019 – 2023 World Bank Group (2019) Washington 13

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA European countries and North America) to a dispute with Greece over the name suggest that more than 500,000 citizens ‘Macedonia’. Regime transition has been from North Macedonia reside abroad, one relatively peaceful and since its inception, of the largest diasporas in the world as a the state’s commitment to democratisation, percentage of the total population. Half of the economic reform and peaceful and stable young people in a recent national survey27 relations with neighbouring countries has expressed an intention to emigrate in the been reflected in its pursuit of accession to next 1-2 years. This intention was strongest the European Union (EU). A Stabilisation and among unemployed youth; those who identify Association Agreement (SAA) was signed in as Albanian or another ethnic minority; LGBTI April 2001 and came into force in April 2004. youth; and youth who express strong feelings The European Council granted the status of of social exclusion. According to the same candidate country in December 2005 and survey, gender is not a factor in terms of plans adopted the Accession Partnership for the to emigrate. country, including key priorities for reform, in February 2008. In October 2009, the European No new population estimates have been Commission recommended to the Council to issued in relation to ethnicity, so the figures open negotiations and to move to the second remain based on the 2002 census - 64 per phase of SAA Implementation. The name cent ethnic Macedonian; 25 per cent ethnic issue, which had impeded progress towards Albanian; Turks (3.85 per cent); Roma (2.66 per full EU accession since 1991, was resolved cent); Serbs (1.78 per cent); Bosniaks (0.84 through official adoption of the name Republic per cent); and Vlachs (0.48 per cent). of North Macedonia in February 2019. constitute a majority in Northwestern (Polog) region and form a significant minority in Governance in North Macedonia is divided Skopje, Northeastern, and Southwestern between parliament, the executive (the regions. Although officially Roma constitute government, with president and premier) and only 2.66 per cent of the population, the the judiciary. The country is a relatively stable Council of Europe estimates28 the Roma parliamentary democracy and Parliament population of North Macedonia to be between reflects the ethnic composition of the country 134,000 (6.5 per cent) and 260,000 (12.5 as well as the outcome of proportional party per cent). According to the National Roma voting. Political parties are generally perceived Inclusion Strategy (NRIS)29, Roma live in 64 of to be ethnically based and, over the last two the 81 municipalities across the country. About decades, the model of government has been 43 per cent live in Skopje, half of them in the to form coalitions of parties representing both Roma-majority municipality of Shuto Orizari. major ethnic groups. The last parliamentary elections were held in 2016 and the 2.3 Governance current cabinet is a coalition of the Social Democratic Union of Macedonia (SDSM), North Macedonia is one of the successor the Democratic Union for Integration, the New states of the former , from which Social Democratic Party, Liberal Democratic it declared independence in September 1991 Party, Alliance for Albanians, Party for the Full under the name Republic of Macedonia. Emancipation of the Roma of Macedonia, The country became a member of the and the Party for the Movement of Turks in United Nations in April 1993 under the Macedonia. Presidential elections were held in provisional description of ‘the former 2019 and President Pendarovski took office in Yugoslav Republic of Macedonia’, due May 2019.

27 ZIvetz L./ Navanti Group Cross Sectoral Youth Assessment North Macedonia USAID (2019) Skopje 28 See Estimates and official numbers of Roma in Europe updated July 2012.xls.(01) Council of Europe available at https://rm.coe.int/CoERMPublicCommonSearchServices/DisplayDCTM 29 MLSP in collaboration with the National Coordinator of the Decade and Strategy for the Roma Strategy for the Roma 14 in the Republic of Macedonia 2014-2020 MLSP (2014) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Administratively the country is divided ranked services in the EQLS 2011 and 2016 into 81 municipalities, 10 of which are were social housing and long-term care amalgamated into Skopje. Most municipalities services, followed by health services, the average30 about 22,000 citizens, which state pension system, the education system, compares favourably internationally but 34 childcare services and public transportation. have a population of less than 10,000 (the However, the state pension system, still approximate minimum size necessary to had a relatively high rating in 2016 when exploit economies of scale in the delivery of compared with other candidate countries and public services) and 16 of these have less than member states. 5,000 residents. While acknowledging progress in the fight Decentralisation is a core element of the against corruption, the European Commission country’s development model and the ongoing Country Progress Report 201932 acknowledges programme for strengthening local self- that corruption is still prevalent in many areas government ties devolution of authority and and remains an issue of concern. North resources to agreed indicators of capacity Macedonia scored 37 points out of 100 on and preparedness at the local level. Despite the Corruption Perceptions Index reported considerable progress, the programme by Transparency International33 in 2018. is still some way from achieving a more EQLS 201634 also found that perceived levels responsive and effective local social service of corruption in all services are also higher delivery system that takes account of the than the EU28 average. Key informants needs of vulnerable populations. Efficiency acknowledged that politicisation is still a major problems are most visible in low-population issue affecting service delivery at local level. municipalities but overall North Macedonia’s Although the government has put legislation intergovernmental finance system does not in place to depoliticise appointment of school adequately recognize the vast differences principals and other key management and between municipalities, and this detracts from professional posts, these laws are not fully its efficiency. The intergovernmental transfer applied across the administration. However, system needs to be reshaped to take account a new State Commission for Prevention of of municipalities’ capacities and requirements Corruption was appointed in February 2019 and to strengthen and support long-term local and vested with new powers to address service planning and development. issues of corruption across functions.

Eurofound’s EQLS 201631 study in North Macedonia found that citizens rated the 2.4 Economic development quality of their public services lower than in any other candidate country or EU member North Macedonia has advanced to upper state, and that the quality ratings had dropped middle-income status, and progress in terms of significantly for all services since 2011. economic reform and development has been The rural population is considerably more considerable since achieving independence. disadvantaged than the urban population in The Human Development Index35 (HDI) in 2018 respect of access to services. The lowest noted a gross national income (GNI) per capita

30 Figures from World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future. World Bank. (2018) Washington, D.C. pp 49-50 31 Eurofound (2019) op cit 32 North Macedonia 2019 Report European Commission op cit. (https://ec.europa.eu/neighbourhood-enlargement/sites/ near/files/20190529-north-macedonia-report.pdf) 33 Macedonia Corruption Index available at https://tradingeconomics.com/macedonia/corruption-index 34 Eurofound (2019) op cit 35 Human Development Index. Country Reports The former Yugoslav Republic of Macedonia UNDP (2018) available at http://hdr.undp.org/en/countries/profiles/MKD 15

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA of 12,505 and the EC CPR36 noted a GDP per Almost one quarter of respondents reported capita equivalent to 37 per cent of the EU28 in that they had economised on food in the 2018. Steady economic growth was set back previous two weeks. somewhat by the global economic downturn in the late 2000s, but overall North Macedonia After 200943, the living standards of those in was spared the worst effects of the economic the bottom quintiles grew faster (6.4 per cent crisis, with average GDP growth of 2.0 per annually) than the national average (2.9 per cent from 2009 to 201737. The economy was cent) and no ECA country reported a larger stagnant in 2017, with real GDP growth of difference between the bottom 40 per cent only 0.2 per cent but this was back up to 2.7 and average growth. But progress started per cent in 201838 and the EC assessed39 from a very low base and this growth simply the economic outlook for 2018-2020 as brought the country’s poverty rate more positive. The government’s Economic Reform in line with its level of development. North Programme (ERP) is based on a moderate Macedonia is more unequal than its peers acceleration of growth from 3.2 per cent in and more advanced European economies. In 2018 to 4.0 per cent in 2020, mainly driven by 2016, the 20 per cent of the population with exports, private consumption and investment. the highest income earned 6.6 times more than the 20 per cent of the population with the However, it must be remembered that lowest income44. The Gini coefficient45 for 2017 growth is climbing from a very low baseline. remained the same as in 2015 at 32.5. Only The country remains one of the poorest Lithuania and Bulgaria have worse Gini indices, in Europe and both absolute and relative and recent Ministry of Finance estimates46 poverty rates have remained high throughout based on tax records show that the proportion this period of rapid development. In 2016, of the total income of the richest 1 per cent is North Macedonia’s relative poverty rate higher than in the 12 most advanced European was 22 per cent, and more than half of the economies with comparable data. respondents in the ELQS survey40 said they found it hard to make ends meet, which is The overall unemployment rate has fallen above the EU28 average but 18 percentage slightly from 26 per cent in 2015 to 24 per points less than in 2007. SSO calculates41 cent in 2016, 22.5 per cent in 2017 and 21 per that 41.1 per cent of the population was at cent in 2018. However, youth unemployment risk of poverty or social exclusion in 2016 and remains high. The unemployment rate for 30 per cent were severely materially deprived, 15-19-year olds was 46 per cent in 2015; 59 a rate higher than in any neighbouring country per cent in 2016; and 58 per cent in 2017. or the EU28 average. The EQLS42 in the same For 20 – 24-year olds it was 48 per cent year noted that respondents from North (2015), 46 per cent (2016) and 45 per cent Macedonia were unable to afford 2.5 basic (2017) 47. Employment does not necessarily items compared to just 1.1 in the EU28. guarantee freedom from poverty. The

36 North Macedonia 2019 Report European Commission op cit. 37 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future. World Bank. (2018) Washington, D.C. 38 North Macedonia 2019 Report European Commission op cit. p 45 39 Economic Reform Programme of the former Yugoslav Republic of Macedonia (2018-2020) Commission Assessment EC (2018) Brussels 40 Figures from Eurofound (2019) op cit. 41 Sustainable Development 2018 SSO (2018) Skopje p70-77 42 Eurofound (2019) op cit. 43 Based on figures from https://www.finance.gov.mk/mk/neednakvost quoted in World Bank (2019) op cit. 44 See News Release 21/12/2018 Laeken poverty indicators in 2017 - final data SSO (2018) Skopje 45 This indicator of inequality is defined as a ratio of the total income received by 20 per cent of the population with the highest income (top quintile) to that received by 20 per cent of the population with the lowest income (lowest quintile). Income represents equivalent disposable income. 46 See https://www.finance.gov.mk/mk/neednakvost quoted in World Bank (2019) op cit. 16 47 Statistical Yearbook of the Republic of Macedonia, 2018 SSO op cit. Chapter 07 Labour Market

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA high rate of informal employment in North cent49. Recent research50 also shows a high Macedonia, estimated at 18.1 per cent in rate of underemployment (57.1 per cent) so 201748, has decreased only slowly over the that a high proportion of young people work past years. The at-risk-of-poverty rate for less hours than they want, are overqualified, employed persons was 9.0 per cent in 2017, underpaid, hold temporary positions or are while for pensioners it was only 7.7 per without a written contract.

48 North Macedonia 2019 Report European Commission op cit. 49 News Release 21/12/2018 Laeken poverty indicators in 2017 - final data SSO (2018) op cit. 50 Petreski B et al Analysis of Youth Underemployment in North Macedonia, Montenegro and Serbia Policy Study 22 Finance Think (2019) Skopje 17

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA NATIONAL DEVELOPMENT AND HUMAN RIGHTS FRAMEWORK SUSTAINABLE DEVELOPMENT WOMEN’S RIGHTS PROTECTION CHAPTER 3 RIGHTS DEVELOPMENT AND GOALS HUMAN RIGHTS IMPROVING GENDER EQUALITY EMPOWERMENT CHILD RIGHTS DEVELOPED STRONGER AWARENES18 MONITORINGUNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 SUPPORT 3.1 National development A Partnership for Sustainable Development and human rights 2016-2020 (PSD) that defines five priority framework areas of cooperation toward realization of the Sustainable Development Goals (SDGs) North Macedonia was ranked 80 out of 189 was officially signed between the UN and countries on the Human Development Index the Government of North Macedonia on 31 (HDI)51 in 2017. The country’s HDI value for October 2016. Its priority areas, which are 2017 is 0.757, which puts it in the high human aligned with specific corresponding SDGs, development category. The rank is shared with include employment, social inclusion, good Azerbaijan and Lebanon. Between 2000 and governance, environmental sustainability and 2017, North Macedonia’s HDI value increased gender equality. The PSD also supports North from 0.669 to 0.757, an increase of 13.1 per cent Macedonia’s overarching national priority for because (i) life expectancy at birth increased by European Union (EU) accession and affiliates 4.7 years, (ii) mean years of schooling increased with the National Strategy for Sustainable by 3.1 years, (iii) expected years of schooling Development (NSSD) and Action Plan, as well increased by 3.0 years and (iv) GNI per capita as with sectoral strategies. The document increased by about 31.3 per cent between details the goals, targets and indicators agreed 1990 and 2017. Macedonia’s 2017 HDI equals by the national partners for the first five-year the average of 0.757 for countries in the high period of implementation of the 2030 Agenda. human development group but falls below the average of 0.771 for countries in Europe The State’s commitment to human rights and Central Asia. Also, when the HDI value is is reflected in the fact that the country is a discounted for inequality, North Macedonia’s signatory to most relevant international human HDI falls to 0.661, a loss of 12.6 per cent. The rights treaties. The database of the Office of average loss due to inequality for Europe and the Higher Commissioner of Human Rights52 Central Asia is 11.7 per cent. notes 13 treaties, conventions or protocols

51 Human Development Index. Country Reports The former Yugoslav Republic of Macedonia UNDP (2018) available at http://hdr.undp.org/en/countries/profiles/MKD 52 United Nations Human Rights. Treaty Body Database available at https://tbinternet.ohchr.org/_layouts/15/ TreatyBodyExternal/Treaty.aspx?CountryID=173&Lang=EN 19

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA ratified by the government of the territory of of association, religious freedom, right to liberty North Macedonia since 1994 including the and security, and right to a fair trial. Although UN Convention on the Rights of the Child and the number of applications is decreasing, there the Convention on Elimination of all forms are 339 cases pending before the court and the of Discrimination against Women. In 2011 it number of pending ECtHR judgements to be ratified the UN Convention on the Rights of executed stood at 51 at the end of March 2019. Persons with Disabilities and the corresponding Optional Protocol. The enforcement of human rights has been strengthened and new competences have been At its 41st session, on 4 July 2019, the Human granted to the Ombudsman’s office in relation Rights Council (HRC) considered and adopted to oversight of the police and monitoring the the outcome of the third Universal Periodic implementation of the Convention of the Rights Review (UPR) of North Macedonia53 submitted in of Persons with Disabilities. Additional staff 2018. It noted that North Macedonia accepted have been recruited and the budget has been 167 of 169 recommendations54 made at the increased. Although the government made good UPR Working Group session, and highlighted progress on the implementation of measures the efforts made by North Macedonia to stemming from the Ombudsman’s 2016 report, implement accepted recommendations since the Ombudsman’s Office will need further the UPR Working Group session. These strengthening to fully exercise its prerogatives. included - opening shelters for women victims The Office received 3,458 complaints in 201856, of violence; educational reform; efforts for the with the largest share concerning the judiciary social inclusion of Roma minorities through birth followed by labour relations, penitentiary registration and access to education; introduction conditions and consumer rights. The largest of social protection mechanisms and the Law on number of confirmed violations related to Protection of Children to combat child poverty; financial and tax issues, followed by labour development of a primary health care national relations, child rights and the judiciary. plan; and measures to strengthen inclusive education for children with disabilities. 3.2 Women’s rights and gender equality The 2019 CPR55 notes the legal framework for the protection of fundamental rights is largely in The right to equality between men and women line with European standards, but the country is enshrined in the Constitution and gender needs to make additional efforts to consistently equality as a social norm is supported by a disseminate and address recommendations of strong legislative framework (although it needs European and international human rights bodies, upgrading following the ratification of the notably regarding the treatment of detained Istanbul Convention in 2017). The government persons, women and persons with disabilities. has adopted a national action plan for gender It also recommends further development of equality (2018-2020) that proposes to introduce community services to identify children at risk a 50 per cent quota for women’s participation and to support child victims of violence, Roma in electoral processes and decision-making by children and children with disabilities, including 2020. However, it was generally acknowledged by improving inter-agency cooperation. The by all key informants that women are generally European Court for Human Rights (ECtHR) has accorded a lower status than men in most areas found violations of the European Convention on of life in North Macedonia, including within the Human Rights in 12 cases related to freedom family. Especially in rural areas discriminatory

53 Government of Macedonia National report submitted in accordance with paragraph 5 of the annex to Human Rights Council resolution 16/21* The former Yugoslav Republic of Macedonia OHCHR (2018) Geneva 54 The full list of recommendations is available at https://documents-dds-ny.un.org/doc/UNDOC/GEN/G19/102/86/PDF/ G1910286.pdf?OpenElement 55 North Macedonia 2019 Report European Commission op cit 20 56 See Annual Report, 2018 Ombudsman of the Republic of Macedonia (2019) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 21

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA customs, traditions and stereotypes are still bias is evident in pupil choices with female widespread and undermine women’s basic students more interested in general upper rights. secondary “gymnasium” education, while the male students prefer vocational education. Over North Macedonia has a Gender Inequality the years, there has been an increase in the Index (GII)57 value of 0.149, ranking it 35th number of women enrolling in, and completing, out of 160 countries in the 2017 index. The university courses, but the same gender bias is GII can be interpreted as the loss in human apparent as in schools. The number of women development due to inequality between graduates is generally higher in social sciences, female and male achievements in three humanities and medical sciences, while for gender-related dimensions - reproductive technical and technological sciences the health, empowerment, and economic activity. number of women is lower in comparison with In relation to reproductive health, and some the number of male students59. measures of empowerment, North Macedonia compares favourably to other countries in The unemployment rate for women (21.8 per Europe and Central Asia (ECA), but only 40.5 cent) is slightly lower than for men (22.7 per per cent of adult women have reached at cent) but this is probably due to women’s least a secondary level of education compared lower participation in the formal labour market to 78 per cent in the rest of the ECA region. – women’s employment rate (34.6 per cent) is Participation in the labour market (42.5 per cent) significantly lower than men’s (53.6 per cent). is also lower for women in North Macedonia The gap between women’s economic activity than for women in the rest of the ECA region rate (44.3 per cent) and men’s (69.3 per cent) (45.5 per cent). is even greater60. Gender bias and women’s greater representation in the informal labour The gender structure of female and male market tends to keep women’s wages low students in primary and lower secondary and – the 2019 CPR61 noted that 39.2 per cent of in upper secondary education has remained women employed in the private sector earn the same since 2015. The number of female lower salaries than men. Only 26 per cent of students who are continuing their education firms have a manager and just 16 per from primary to upper secondary level has cent are owned by women62, although these decreased (from 99 per cent in 2017 to 90 per percentages are slightly higher than the ECA cent in 2018),58 while the number of males has average. Fewer women (7 per cent) decide to been increasing, although the net enrolment start a business than men (14 per cent), but of rates (NER) for both sexes in primary, lower those who do, close to 70 per cent succeed63. secondary and upper secondary education Very few women own property in North showed a slight decrease in this period. In Macedonia. Only 17 per cent of properties upper secondary education, some gender have a woman as owner or co-owner, because

57 The 2010 HDR introduced the GII, which reflects gender-based inequalities in three dimensions – reproductive health which is measured by maternal mortality and adolescent birth rates; empowerment which is measured by the share of parliamentary seats held by women and attainment in secondary and higher education by each gender; and economic activity which is measured by the labour market participation rate for women and men. For more details on GII please see Technical Note 4 at http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/MKD.pdf This means that the grouping takes into consideration inequality in favour of men or women equally. 58 Women and Men in North Macedonia OSS (2019) Skopje 59 Ibid 60 Ibid 61 North Macedonia 2019 Report European Commission op cit 62 Figures from N. Mojsoska-Blazevski, M. Petreski, and O. Ayhan, National Research on Low Female Labour-Market Participation in Macedonia: Quantitative-Based Estimates from a New Survey UN Women (2017) Skopje available at http://eca.unwomen.org/en/digital-library/publications/2017/06/national-research-on-lowfemale-labour-market- participation quoted in COUNTRY PARTNERSHIP FRAMEWORK FOR THE REPUBLIC OF NORTH MACEDONIA 2019 – 2023 World Bank (2018) op cit 63 Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank 22 (2018) op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA property is usually registered in the name of the of the population, especially women. In the husband or a male relative64. This low rate of EQLS study68 in 2016, 84 per cent of women female ownership limits women’s productive reported that they are too tired to do some of the use of property and makes their access to household jobs that need to be done after they finance difficult. come back from work, yet the gap between the contribution of women and men to household In the public sector, where women represent tasks in North Macedonia is among the highest more than 50 per cent of the work force, there in Europe - 71/10 hours per week compared with is no difference in salaries between women and an EU average of 79/34. As in many countries, men, but women tend to work in lower paid women experience a greater burden when it sectors and posts. Primary, lower secondary comes to balancing the demands of work with and upper secondary education are dominated those outside the workplace. A Government by female teachers. Women hold 38.3 per review of the policy on flexible working time cent of seats in Parliament, but in executive arrangements may benefit women, but there bodies, where quotas do not exist, women’s also needs to be a significant change in gender representation is low. Women hold only 10 relations to achieve any significant improvement per cent of ministerial posts and 4 per cent in women’s work—life balance. of mayoral posts and the total representation of women in the appointed functions and in Another related concern raised by the decision-making, management and governing Committee on the Elimination of Discrimination bodies is only 11 per cent. Out of these, seven against Women (CEDAW) in its 2018 response per cent were appointed as deputy Ministers, is the lack of visibility of gender equality 25 per cent as state secretaries and 9 per cent as an issue in North Macedonia, and the in other appointed positions65. general lack of awareness of CEDAW, and the limited effectiveness of the Law on Equal Beyond the labour market, women’s participation Opportunities for Women and Men, in particular in collective actions is limited, gender at the municipal level. It strongly recommends stereotypes are pervasive, and gender based strengthening the decision-making capacity violence (GBV) is common. For instance, in 2017, and authority of the Department of Equal 35% of 1,696 women participating in an online Opportunities, and even upgrading it to the survey indicated that they had experienced some ministerial level. form of sexual violence66. Gender stereotypes of men as breadwinners and women as the main 3.3 The framework care-provider are prevalent. The Committee on of child rights the Elimination of Discrimination against Women has noted in their response67 to the National Besides the UN Convention on the Rights of Report in 2018 that the persistence of these the Child (UNCRC)69, the Republic of North outdated gender stereotypes in the family, the Macedonia has also ratified the: education system and in society constitute the greatest threat to women’s equality in North a. Optional Protocol on the sale of children, Macedonia. In North Macedonia, as in the other child prostitution and child pornography; EU candidate countries, work–life imbalance is b. Optional Protocol on the involvement of experienced by a comparatively large proportion children in armed conflict;

64 Ibid 65 North Macedonia 2019 Report European Commission op cit. 66 See Dimushevska E. Trajanovska L. Scoping Study on different form of sexual violence in the Republic of Macedonia National Network to End and Domestic Violence – Voice against Violence (2017) Skopje available at http://www.glasprotivnasilstvo.org.mk/wp-content/uploads/2013/11/Scoping-study-on-sexual-violence.pdf 67 Committee on the Elimination of Discrimination against Women (2019) op cit. 68 Eurofound (2019) op cit. 69 See United Nations Human Rights. Treaty Body Database available at https://tbinternet.ohchr.org/_layouts/15/ TreatyBodyExternal/Treaty.aspx?CountryID=173&Lang=EN 23

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA c. Council of Europe Convention on Action active in planning policies and setting priorities, against Trafficking in Human Beings and the and that there were limited possibilities for European Convention on Nationality; local government, civil society and children d. Hague Convention on Protection of Children to participate in the Commission’s work. The and Cooperation in respect of Inter-country Ministry of Labour and Social Policy (MLSP) Adoption; provides a secretariat for the Commission. e. UN Convention against Transnational A National Plan of Action on the Rights of Organized Crime and its protocols on the Child (NAPC) 2006 – 2015 was adopted trafficking in persons and smuggling of in November 2012. The CRC, however, was migrants; concerned about the pace of implementation f. International Labour Organization and that no specific funds had been earmarked Convention No. 29 on Forced or for implementation, monitoring and evaluation. Compulsory Labour and Convention A new action plan for children is still pending No. 182 concerning the Prohibition and since the last one expired in 201573, which Immediate Action for the Elimination of the indicates that the level of NCRC activity has not Worst Forms of Child Labour; increased significantly. g. Convention on preventing and combating violence against women and domestic The EC acknowledges74 that the legal violence framework for the rights of the child largely complies with international standards and a North Macedonia has not yet ratified considerable number of the articles of the the Convention on the Rights of All UNCRC have been appropriately reflected in Migrant Workers and their Families; the domestic legislation75 but according to the 2010 1954 Convention relating to the Status of Concluding Observations, the major barrier Stateless Persons; or the 1961 Convention on to full realisation of children’s rights is weak the Reduction of Statelessness, which could enforcement of legislation, poor implementation have a negative impact on realising the rights of of policy, low capacity for implementation and children without documentation, of whom 70 poor coordination across sectors. Most key per cent are likely to be Roma70. informants indicated that this was still the case The second report of the Government of and the CPR 2019 noted that implementation Macedonia was considered by the Committee of legislation needs to be reinforced and that all on the Rights of the Child (CRC) in May 2010 and stakeholders should make the best interests of Concluding Observations71 issued in June 2010. the child a guiding principle. The government submitted the combined III, IV, V and VI reports72 to the CRC in March 2019 but Following the monitoring of the Lanzarote these have not yet been considered. Committee of the Council of Europe, a number of recommendations were issued to the A National Commission on the Rights of the country related to protection of children from Child (NCRC) was established in 2005 and in sexual abuse covering prevention, awareness- September 2007 its members were elevated raising and screening of professionals in contact to the rank of State Counsellors. The CRC, in with children. The amendments to the Criminal its 2010 Concluding Observations, expressed Code adopted in December 2018 expand the concern that the Commission is not sufficiently definition of violence against a child, explicitly

70 Based on research by MYLA in Regional Research on Statelessness: Macedonia, Serbia, Kosovo, Montenegro, Bosnia and Herzegovina, Croatia, quoted in Roma Belong. Statelessness, Discrimination and Marginalisation of Roma in the Western and Ukraine ERRC/ENS/ISI (2017) Budapest 71 Concluding Observations: former Yugoslav Republic of Macedonia CRC (June 2010) Geneva 72 The report is available at https://tbinternet.ohchr.org/_layouts/15/treatybodyexternal/Download. aspx?symbolno=CRC%2fC%2fMKD%2f3- 6&Lang=en 73 North Macedonia 2019 Report European Commission op cit. 74 North Macedonia 2019 Report European Commission op cit. 75 See Davitkovski B. et al Comparative Review of Legislation in the Republic of Macedonia and the Convention on the 24 Rights of the Child Ministry of Justice Republic of Macedonia (2010) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA covering psychological violence, online violence for an additional year because of elections to and peer violence. The national Coordination be held in early 2020. But these need to be Body for Protection of Children from Abuse and child focused and adapted to ensure stronger Neglect has been monitoring violence against capacity for child rights monitoring. For children against an agreed set of indicators. instance, migration statistics need to be further An amendment to the Law on the Ombudsman expanded, particularly in relation to children in 2009 formally established a child rights and a framework needs to be developed to protection unit headed by a deputy ombudsman ensure sufficient and satisfactory monitoring within the Ombudsman’s Office, and this is of currently invisible populations of vulnerable still very active. The Ombudsman’s Office children – children in detention; children in confirmed 66 violations of child rights in State care. Statistics on children in contact 201876. The CRC expressed concern that this with the law, education and public health need unit lacked the authority, capacity, human and improvement. Another concern is insufficient financial resources and independence to carry sharing of information and poor coordination out its mandate effectively, and that children between the relevant bodies. For example, and their parents lack information on the the National Coordination Body for Protection possibility to submit complaints. Successive of Children from Abuse and Neglect and the Annual Reports have expressed the same Council for Prevention of Juvenile Delinquency concerns. Despite a network of regional monitor some of the same indicators but the offices, the Ombudsman’s Office receives few data obtained differs significantly due to the complaints from children themselves. different interpretation of the methodology adopted by the different bodies. There is also a Council for Prevention of Juvenile Delinquency, that monitors the The number of NGOs operating in the child- situation of children in contact with the law, related sector is quite small. Although an NGO and promotion and protection of children’s coalition produced an alternative report to the rights would also fall within the remit of other CRC in 2010 it does not appear to be active human rights monitoring bodies in-country. The at this time, and children’s issues have been Directorate for Personal Data Protection (DPDP) absorbed into youth concerns. For instance, for instance undoubtedly has responsibilities for SEGA, a coalition of 27 youth organizations that monitoring use of children’s data, and children works with young people aged 10-29, promotes ought to be able to make complaints to the student participation in primary and secondary Commission for Protection from Discrimination. schools. They have worked in 13 different cities It may be however that some of these bodies and towns, with about 30 schools. There is are not perceived, by themselves or others, as also a National Youth Council77 comprising 46 monitors of child rights. organizations. However, for effective monitoring and support of children’s rights, there may need The work of all these oversight bodies is to be a broader coalition of child-specific NGOs hampered by the lack of a clear monitoring and covering a wider spectrum of child-related evaluation framework that would enable the issues affecting all children aged 0 -18. relevant disaggregated data to be collected A strong civil society sector is a vital prerequisite by the State Statistical Office. Generally, of a democratic society and full realization of social protection statistics have improved. children’s rights requires active engagement The survey for statistics of income and living by the full range of duty bearers, including a conditions was successfully conducted and vibrant, diverse and proactive NGO movement. preparations for a new population and housing Promoting and supporting that movement should census using a combined methodology are well be as much a priority for donors and international advanced, though the census will be delayed agencies as supporting government.

76 Annual Report, 2018 Ombudsman of the Republic of Macedonia (2019) Skopje 77 More information on the National Youth Council is available at http://www.nms.org.mk/en/ 25

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA ROMA CHILDREN AND FAMILIES ETHNIC COMMUNITY FAMILIES QUALITY EDUCATION TRAINING INTEGRATE CHAPTER 4 SUCCESS CHILDREN AT HIGH POSITIVE RISK OF POVERTY HOUSING AND EXCLUSION IMPROVEMENT ENROLMENT EDUCATION INTERACTION HEALTH SERVICES EMPLOYMENT26 SOCIALUNICEF AN ANALYSISWELFARE OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 CHILDREN IN MIGRATION 4.1 Roma children one Roma representative each, with 9 out and families of 16 members of the municipal council in Shuto Orizari being Roma. Additionally, several Roma are the poorest, most socially excluded municipalities employ Roma civil servants, and most vulnerable ethnic group in North usually for the purpose of addressing the Macedonia, just as they are in the rest of situation of Roma or minorities in general79. Europe. Officially there are about 55,000 Roma in North Macedonia but the Council of Europe However, Roma remain excluded from estimates78 the number between 134,000 and mainstream society and experience 260,000. National census data indicates that discrimination in almost every aspect of more than 90 per cent of Roma are Muslim, their lives. They are the country’s most and approximately 80 per cent speak Romani disadvantaged and most vulnerable minority as their first language. and the current situation of most Roma families is one of chronic multi-dimensional Roma are explicitly recognised as an ethnic poverty. At 49 per cent, the unemployment community in the Preamble of the Constitution rate of Roma is significantly above that of and, compared with Roma in neighbouring their non-Roma neighbours and the number of countries, Roma are well represented in Roma benefiting from concrete employment government. At the central level, since 2008, measures is very limited80. Roma families one Roma MP has acted as a minister without face some of the worst housing conditions portfolio serving as National Coordinator for in the country81 - 28 per cent live in poor the Strategy for Roma in the Republic of neighbourhoods, in badly constructed housing. Macedonia, and a deputy minister. At the Overcrowding is widespread - many Roma local level, eight municipal councils include families live in houses with less than 5

78 See Estimates and official numbers of Roma in Europe updated July 2012.xls.(01) Council of Europe available at https://rm.coe.int/CoERMPublicCommonSearchServices/DisplayDCTM 79 See National Strategy for Roma in the Republic of Macedonia 2014-2020 for updated information. Available at www.rcc.int/romaintegration2020/inc/download.php? 80 See North Macedonia 2019 Report European Commission op cit 81 Government of Macedonia, National Strategy on Alleviation of Poverty and Social Exclusion in the Republic of Macedonia 2010-2020, (2010) Skopje 27

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 square metres per person, frequently without even their teachers, including being insulted adequate drinking water, electricity, heating or marked down for discriminatory reasons88. or sanitation82. The incidence of food-secure It can be particularly difficult for Roma children Roma households is only 66 per cent in North whose mother tongue is not Macedonian Macedonia in contrast with 92 per cent among to integrate at school. Although the Law neighbouring non-Roma households83. A guarantees that Roma language and culture further indication of family poverty is that, can be taught as an optional subject, in according to the Ombudsman’s Office84 practice this option is not available for 328 of 337 child beggars reported on the most Roma pupils and there is a lack of streets in 2018 were Roma of all age groups, qualifed Roma teaching staff in primary and including babies. secondary schools.

Children from the Roma community in North Although there are signs of improvement Macedonia still face severe barriers to their in enrolment and completion among Roma access to quality education and training85. Pre- students in primary and secondary schools89, school enrolment of Roma children is low. A the quality of education provided remains a survey of selected Roma settlements found particular issue - 40 per cent of Roma students that only 14 per cent of Roma children aged aged 7-15 were attending segregated schools 3-6 receive pre-school education, compared in 2017 (up from 25 per cent in 2015), and a to 29 per cent of their non-Roma peers86, significant number attend segregated classes which was attributed to Roma migration or are physically separated from their non- patterns; lack of personal documentation; Roma peers in the classroom. The quality of segregation; and the lack of public transport education in segregated schools is typically to and from Roma settlements87. Poverty poorer, with limited resources and less qualifed and discrimination are further barriers to teaching staff90. Evidence91 show that in the education. Many Roma parents do not have Skopje region, for example, Roma children enough money to buy clothes, shoes or attending schools that are not segregated and school material, and their children may not have ethnically mixed classes have much more have running water to clean themselves. success and achieve higher grades. Roma health mediators have reported several occasions when Roma children have suffered Recent research92 indicates that one of prejudice and hostility from their peers and the main factors enabling and supporting

82 Spitálszky A. Roma in the Republic of Macedonia: Challenges and Inequalities in Housing, Education and Health SONCE/MRG (2019) 83 Robayo-Abril M. Millan N. Breaking the Cycle of Roma Exclusion in the Western Balkans World Bank Group (2019) Washington available at http://documents.worldbank.org/curated/en/642861552321695392/pdf/Breaking-the-Cycle-of- Roma-Exclusion-in-the-Western-Balkans.pdf 84 Quoted in North Macedonia 2019 Report European Commission op cit 85 North Macedonia 2018 Report European Commission (April 2018) Brussels 86 UNDP/World Bank, Roma at a Glance – The Former Yugoslav Republic of Macedonia UNDP (2018) available at https://www.eurasia.undp.org/content/dam/rbec/docs/Factsheet_FYROM_Roma.pdf 87 CEA/Romalitico, Shadow Report – Implementation of the Roma Strategy in the Republic of Macedonia in the Years 2016 and 2017 (2018) Budapest available at https://www.rcc.int/romaintegration2020/download/docs/Shadow per cent20Report per cent20- per cent20Implementation per cent20of per cent20the per cent20Roma per cent20Strategy per cent20in per cent20the per cent20Republic per cent20of per cent20Macedonia per cent20in per cent20the per cent20years per cent202016 per cent20and per cent202017.pdf/2fb396ff6b92538bc6cf80fb5dfc0096.pdf. 88 Spitálszky A. (2019) op cit 89 UNDP/World Bank, op. cit 90 Spitálszky A. (2019) op cit. For a full analysis of how segregation impacts negatively on quality teaching in schools see Duminica G. and Ivasiuc A. One School for All? Access to Quality Education for Roma Children Agentia Impreuna/ UNICEF (2010) Bucharest available at file:///C:/Users/Pc/Documents/ROMA/One_school_for_all_pt_WEB.pdf 91 See Spitálszky A. (2019) op cit. Also Dzeladin D. Doda K Segregation of Roma Children in Elementary Schools in Republic of Macedonia IHR/ERRC (2016) available at https://www.ihr.org.mk/uploads/segregation-of-roma-children-in- elementary-school_EN.pdf and Dzeladin D. The Effects of School Segregation in North Macedonia on Roma Children’s Future Careers unpublished thesis submitted to Central European University (2019) Budapest 92 Dzeladin D. The Effects of School Segregation in North Macedonia on Roma Children’s Future Careers unpublished 28 thesis submitted to Central European University (2019) Budapest

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA segregated schooling is the tendency of non- are covered, compared to 97 per cent of the Roma parents to circumvent the catchment non-Roma population98. However, although system in order to secure places in their health care coverage for Roma is comparable preferred schools – and school principals’ to that of non-Roma, the services Roma collusion in ‘poaching’ non-Roma children from receive tend to be of a lower quality than the neighbouring schools where Roma enrolment services ofered for the general population99, is rising. However, when Roma parents want and this may contribute to the signifcantly to enrol their children in another school, the lower average life expectancy among usual answer from the educational service is Roma (68 years) compared to the national that they should enrol in the schools where population (73.5 years)100. Discrimination by they belong93. This situation leads to the medical personnel against Roma patients creation of ‘Roma only’ elementary schools often dissuades Roma from seeking medical and contributes to a decline in the quality of attention – a situation that contributes to schooling as it grows more segregated94. their poor health outcomes101. One survey102, for example, found that almost the same The negative impact for Roma children is percentage of Roma suffer from chronic non- deep as educational segregation reinforces contagious diseases as non-Roma, but a lower and makes explicit these children’s exclusion proportion of them received regular therapy from wider society in a very concrete way. As and those who did were provided with lower Dzeladin95 points out, children entering school quality health care services. Similarly, a smaller have often attended kindergarten together share of Roma children are vaccinated than and play together on the same streets – children from other ethnic groups103. school segregation establishes a hurtful and destructive division and deprives Roma and Lack of documentation104 is often presented non-Roma children alike of positive interaction as a major obstacle to Roma’s access to their and friendship between neighbours. entitlements but in reality, the registration system is frequently weighted against Although it goes largely unreported, in practice Roma. The documentary evidence required discrimination against Roma in health care is to register a child’s name and birth in North still widespread96 and this tends to discourage Macedonia is not set out in law, which means Roma from seeking access to, or engaging that practice varies and the evidence required with, health services at all. Coverage by health is at the discretion of the registry officer. For insurance among Roma is among the best in late registration, the law allows officials to the region97 - 94 per cent of Roma aged 16+ request additional information such as medical

93 See http://life.ugd.edu.mk/index.php/nauka-life/item/824-istrazuvanje-praven-segregacija-na-decata-romi quoted in Spitálszky A. Roma in the Republic of Macedonia: Challenges and Inequalities in Housing, Education and Health SONCE/MRG (2019) 94 See Duminica G. and Ivasiuc A. One School for All? Access to Quality Education for Roma Children Agentia Impreuna/ UNICEF (2010) Bucharest available at file:///C:/Users/Pc/Documents/ROMA/One_school_for_all_pt_WEB.pdf for a full analysis of how segregation impacts negatively on quality teaching in schools 95 Dzeladin D. (2019) op cit 96 See Spitálszky A. (2019) op cit. However, please note that a UNICEF 2016 survey of Roma households showed that a total of 9% of surveyed household representatives did not have any form of health insurance, a slightly higher number of uninsured people being men (12% vs. 7% of all female respondents). At the household level, 5% of the respondents stated that no member of their household had health insurance and a further 10% said that at least one family member had no health insurance. The main reasons for not having access to health services were lack of identity documents, lack of health insurance, inability to pay for official and unofficial costs relating to healthcare, poor health literacy and discrimination. 97 North Macedonia 2018 Report European Commission op. cit. 98 UNDP/World Bank, op. cit 99 Spitálszky A. (2019) op cit 100 Spitálszky A. (2019) op cit 101 Spitálszky A. (2019) op cit 102 Spitálszky A. (2019) op cit 103 Ibid 104 For a full discussion, see ERRC Roma Belong (2017) Budapest op cit. 29

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA evidence or other civil documentation. In them even for services which otherwise some cases, where several years have passed would be free. Many Roma women do not since birth, the parents may need to obtain receive any type of health education and are DNA analysis, presenting an additional costly therefore not aware of their rights. barrier. Long-term residents may acquire citizenship through naturalisation, most often The Ministry of Labour and Social Policy in either on the basis of marriage to a national, 2012 noted109 that the majority of marriages or after a period of legal and continuous concluded in North Macedonia between residence. However, both of these options persons under the age of 18 were with girls require documentation, and legal residence from the Roma community. The Multiple requires a registered address, which excludes Indicator Cluster Survey (MICS) in 2011 those in informal housing arrangements. showed110 that the rate of marriage or For undocumented Roma, who face severe cohabitation of Roma girls aged 15 to 19 poverty, these conditions are almost was 22 per cent when the national rate was impossible to meet. 4 per cent (2 per cent among Macedonians and 6 per cent among Albanians). The rate In 2013, the European office for asylum- of young women aged 15-19 years who had seekers assessed105 that around 70 per cent given birth or were currently pregnant was 3 of asylum-seekers from North Macedonia per cent at the national level, and 18 per cent were Roma, and Roma are disproportionately among Roma. A recent case study111 found represented among asylum-seekers rejected that institutions in North Macedonia still do by EU Member States. Recent research106 not have accurate data on this phenomenon, indicates that Roma returnees have difficulties or even an agreed terminology, but noted accessing health, education and social welfare that early marriage was still more common and the children of Roma returnees face in Roma communities. Further research is particular dificulties in integrating and having clearly needed to establish the parameters of a their foreign school certificates recognized in sustainable and effective response. North Macedonia107. The National Strategy for Roma in the Republic Roma women are particularly vulnerable as of Macedonia 2014 - 2020 includes action they face both physical and financial barriers plans for education, employment, housing, in their access to primary gynaecological gender and health but implementation has health care. They often live in remote been slow. The strategy is not particularly child settlements without any public transport and focused and no targets were set in relation Roma Health Mediators have reported108 on to child protection or social welfare. The a number of occasions that Roma women government acknowledged112 in 2018 that had dificulties in arranging an appointment achievements are often unclear, as indicators with their registered gynaecologist and differ from what is reported, and impact noted cases when the gynaecologist charged assessment was not provided in the monitoring

105 See Lazovsky et al THE CHALLENGES FACED BY ROMA - RETURNEES IN MACEDONIA European Policy Institute, Skopje available at http://www.epi.org.mk/docs/The%20challenges%20faced%20by%20Roma%20returnees%20in%20 Macedonia%20-%20report.pdf 106 Lazovsky et al THE CHALLENGES FACED BY ROMA - RETURNEES IN MACEDONIA op cit. 107 Ibid. 108 See European Social Policy Network Roma Health Mediators in Macedonia: a successful model under threat? ESPN Flash Report 37/2017, June 2017 quoted in Spitálszky A. (2019) op cit 109 See http://a1on.mk/wordpress/archives/48872 quoted in Salioska N. “the GRAY AREA” between tradition and children’s rights Roma Organization for Multicultural Affirmation/S.O.S. (2018) Prilep 110 See http://www.unicef.org/tfyrmacedonia/macedonian/MICS_Infografics_MKD22AprilfINAl(3).pdf quoted in Salioska N. (2018) op cit. 111 Salioska N. “THE GRAY AREA” between tradition and children’s rights Roma Organization for Multicultural Affirmation S.O.S.(2018) Prilep available at https://www.unicef.org/northmacedonia/media/3706/file/MK_ RomaChildMarriages_2016_Report_ENG.pdf 30 112 Government of North Macedonia National Platform on Roma Integration: Policy Recommendations (2018) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA report, except in some education areas. It visual impairment; 2,750 persons with hearing recommends that the State Statistical Office impairment; 13,500 persons with physical should be involved more to provide impact disabilities; 3,922 persons with intellectual assessment and baseline data, and this could disabilities; and 2,775 persons with combined provide an opportunity to set child-related disabilities. targets. The lack of expenditure monitoring, combined with the poor absorption of funds, The government’s deinstitutionalisation remains a problem. strategy116, which explicitly aims to take into account the needs of people who are not in contact with social services calculates a total of 4.2 Children living with 7,346 children with disability already registered disability with social services, 43 in institutions and another 700 under the general social service In its Concluding Observations113 on the net, giving an estimated total of 8,388 children government’s report in 2018, the Committee with disability in North Macedonia in 2018. on the Rights of Persons with Disability However, this may well be an under-estimate. expressed concern at the lack of consistent The majority of children with disabilities live and comparable statistics on persons with with their families, and the rate of identification disabilities in North Macedonia, the lack is likely affected by the size of benefits of human rights indicators in the available available; the stigma attached to disability in the data, and the extent to which disability- local community; and the quality of, and time related indicators are effectively applied necessary for, diagnosis. In September 2017 in the implementation of the Sustainable the government announced the adoption of Development Goals (SDG). The Academic the International Classification of Functioning, Network of European Disability Experts Disability and Health (ICF) assessment format117 (ANED)114 also notes the limitations on policy in the country. This represents a significant and programme development inherent in step forward in terms of social inclusion North Macedonia’s lack of official statistical practice in North Macedonia, but the shift from data on persons with disabilities. The only the traditional “medical” assessment used official data available from the SSO relates until now to a more flexible social model of to those using some sort of social services disability that offers support options to families or claiming benefits. Based on this data, is likely to lead to better use of the assessment ANED115 calculated that in 2017 there were service and a possible increase in the number 26,296 persons with disabilities in contact of children found to be living with disability. with social services – 3,349 persons with WHO118 for instance estimates that at least

113 Committee on the Rights of People with Disability Concluding observations on the initial report of the former Yugoslav Republic of Macedonia (2018) OHCHR Geneva 114 Shavreski Z. Kochoska E Living independently and being included in the community ANED (2018) Brussels. The Academic Network of European Disability experts (ANED) was established by the European Commission in 2008 to provide scientific support and advice for its disability policy Unit. In particular, the activities of the Network support the development of the European Disability Strategy 2010-2020 and implementation of the United Nations Convention on the Rights of Persons with Disabilities in the EU. 115 Ibid 116 National Deinstitutionalisation Strategy of the Republic of Macedonia for 2018–2027 ‘Timjanik’ & Action plan Ministry of Labour and Social Policy (2018) Skopje available at: http://mtsp.gov.mk/content/pdf/strategii/Strategii%202018/ Strategija_deinstitucionalizacija_Timjanik_2018-2027.pdf 117 The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a classification of health and health-related domains. As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors. ICF is the WHO framework for measuring health and disability at both individual and population levels. ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21) as the international standard to describe and measure health and disability. ICF is operationalized through the WHO Disability Assessment Schedule (WHODAS 2.0). WHODAS 2.0 was developed through a collaborative international approach with the aim of developing a single generic instrument for assessing health status and disability across different cultures and settings. For more information see https://www.who.int/classifications/icf/en/ 118 WHO World Report on Disability WHO/World Bank (2011) available at https://www.who.int/disabilities/world_ report/2011/en/ 31

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 5.1 per cent of children in any country will be day care centres for people with mental or affected with some form or level of disability. physical disabilities; supported living; foster This could mean a national population of around care; and small group homes. SSO data121 20,000 children with disability. indicates that 93 children with different types of disabilities were placed in foster families The national programme of reform envisages in 2017122, while in 2016123 this number was a major shift from institutional to community- 171. In 2017, 261 children with disability were based support to people with disability referred to day centres. (PWD). This process started in 2002 with implementation of a special programme for However, the greatest threat to children with movement of about 30 children out of the disability in North Macedonia may still be Special Institute Demir Kapija119. It was brought the lack of a national policy and strategy on fully into effect through the 2009 Social disability awareness, which was identified Protection Act that enabled the adoption of by the Committee on the Rights of Persons measures and activities for the promotion of with Disabilities,124 and the lack of efforts to alternative forms of social services for people prevent and combat disability stereotypes and with disabilities, children without family or discrimination on the basis of impairment. parental care, and elderly people. The first A knowledge, attitudes and practices (KAP) phase of the deinstitutionalization process study125 in 2017 noted a shift towards support focused mostly on deinstitutionalization of for a social rights based model of inclusion persons with intellectual disabilities, primarily in comparison with a 2014 baseline, as well children. The results over the past few years as a significant change in the general public’s include resettlement of over one hundred understanding of the need for society and the residents and the creation of a number of new environment to change to support inclusion. day centres, group homes and a network of There was also a notably positive shift in public foster carers. attitude related to the possibility for a child with disabilities to lead an independent and Through adoption of a national productive life as an adult, if given support deinstitutionalization strategy120 in 2018, from professionals, institutions and society, the current government has reconfirmed but this was counter-balanced by pessimistic its commitment to developing community- attitudes towards the impact of efforts by based services for children with and without the state and families to support inclusion of disabilities. The 2018 strategy acknowledges children with disabilities. This suggests that that the process has been uneven, but more work is needed to address social norms the social care system now comprises related to disability and other system reforms institutional and non-institutional forms, to support inclusion are needed to support including Centres for Social Work (CSW); their inclusion. This impression is reinforced

119 “Demir Kapija Special” was the largest residential institution in the country, established in 1958 for persons with severe intellectual and physical disabilities. It accommodated 223 residents aged from 5 to over 70 years old, including 24 children. 120 National Strategy for Deinstitutionalisation 2018-2027 Ministry of Labour and Social Policy op cit 121 Statistical review 2.4.14.15 Social Welfare for Children, Juveniles and Adults for 2013 t- 03, available at http://www.stat.gov.mk/xls_publikacii/2014/2.4.14.15.xls quoted in ANED op cit 122 Statistical review 2.4.18.10/901 Social Welfare for Children, Juveniles and Adults for 2017 t- 03 available at http://www.stat.gov.mk/xls_publikacii/2018/2.4.18.10.xls quoted in ANED op cit 123 Statistical review 2.4.17.11/884 Social Welfare for Children, Juveniles and Adults for 2016 t- 03 Available at http://www. stat.gov.mk/xls_publikacii/2017/2.4.17.11.xls. Statistical review 2.4.16.12/859 Social Welfare for Children, Juveniles and Adults for 2015 t- 03 Available at http://www.stat.gov.mk/xls_publikacii/2016/2.4.16.12.xls. Statistical review 2.4.15.17/831 Social Welfare for Children, Juveniles and Adults for 2014 t- 03 Available at http://www.stat.gov.mk/xls_publikacii/2015/2.4.15.17.xls. 124 See Concluding observations on the initial report of the former Yugoslav Republic of Macedonia (2018) op cit 125 GFK Skopje Follow-up Survey on Knowledge, Attitudes, Practices towards Inclusion of Children with Disabilities UNICEF (2018) Skopje available at https://www.unicef.org/northmacedonia/reports/follow-survey-knowledge-attitudes- 32 practices-towards-inclusion-children-disabilities

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA by two local surveys126 in 2018 that found that managed to bring the situation under control persons with disabilities and the parents of in cooperation with the EU and neighbouring children with disabilities consider that they are countries. Although numbers have declined, not equal with other citizens (99.5 per cent); the flow of migrants and asylum-seekers do not enjoy equal protection of the law in continues, and there is likely to be demand comparison with other citizens (83 per cent) on North Macedonia’s children’s services and that they are discriminated against (87 per by migrant and asylum-seeking families for cent). Social protection (96 per cent) and health the foreseeable future. The migration flow (94 per cent) are the two areas in which the continues to be mainly transitory, with most respondents think that persons with disabilities migrants leaving North Macedonia after a are most often discriminated against. couple of days.

A clear national policy and strategy is still The number129 of officially reported illegal lacking and considerable structural and crossings has substantially increased (16,895 systemic barriers remain to achieving full attempts in 2018 compared to 2,831 in inclusion. But it is important to note that in 2017), mainly from Greece, but the actual July 2019 the National Assembly adopted a number of migrants transiting the country new law on primary education which provides is considered to be much higher. About the legal basis for full inclusion of CWD in 32,500 migrants are considered130 to have mainstream schools. Among other provisions, illegally crossed the country’s borders in both the new law envisions a concept of inclusion directions since the beginning of 2018. There in schools that could serve as a national policy are no statistics available as to the number of and strategy for inclusion in education. children but the Macedonian Young Lawyers Association (MYLA) noted131 that of the 361 persons detained at the Reception Centre 4.3 Children in migration for Foreigners in 2018, 55 were children of whom 37 were unaccompanied. MYLA’s The implication of North Macedonia’s strategic first quarterly report132 for 2019 noted 47 location on the transit route for migrants to women and 72 children using the local Europe was clearly demonstrated in 2015 reception centres, 21 of them unaccompanied. when many of the estimated 1,015,078127 However, based on a 2015 estimate of 25 per asylum-seekers arriving in Europe by sea cent of migrants being children, there could be reached North Macedonia. More than one in as many as 8,000 vulnerable children passing five of these migrants were children. As with through North Macedonia in a year in need of most of its neighbours, North Macedonia’s health, welfare and protection services. asylum, migration and protection services were initially overwhelmed128 by the thousands CPR 2019 reports133 that progress has been of families arriving on its territories but made in improving the legal framework with

126 The lost agenda - demystification of the issue of disability in the field of equality and non-discrimination Polio Plus (2018) Skopje and Terra Incognita - Demystification of the rights of persons with disabilities in the Republic of Macedonia in the field of the right to social protection Polio Plus (2018) Skopje. Both are available at: www.polioplus.org.mk. 127 UNHCR Refugees/Migrants Emergency Response – Mediterranean accessed March 2016 at http://data.unhcr.org/ mediterranean/regional.php quoted in Byrne K et al The Legal Entitlements of Refugee and Migrant Children in 33 European Countries UNICEF (2016) Geneva 128 See Eapen R. et al Initial Assessment Report: Protection Risks for Women and Girls in the European Refugee and Migrant Crisis UNHCR/UNFPA/WRC (December 2015) available at https://www.unhcr.org/569f8f419.pdf 129 Figures from North Macedonia 2018 Report European Commission op. cit. 130 2018 CSO’s REPORT ON IRREGULAR MIGRATION FOR SOUTH-EASTERN EUROPE Macedonian Young Lawyers Association (MYLA) (2019) Skopje hereafter MYLA (2019). Available at http://myla.org.mk/en/publications/reports/ 131 Ibid. 132 Quarterly Report on the Status of Migrant and Refugee Human Rights January-March 2019 MYLA (2019) Skopje available at http://myla.org.mk/en/publications/reports/ 133 North Macedonia 2018 Report European Commission op. cit. 33

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA the adoption of amendments to the Law on Institutions and procedures to handle International and Temporary Protection and asylum claims are in place, but the 2017- the Law on Foreigners but that there is a 2027 Integration Strategy for Refugees and fragmentation of tasks between the Ministry Foreigners has not yet been adopted and more of the Interior (which deals with security and efforts are needed to address negative public management of the borders), the Ministry attitudes towards migrants and refugees. The of Labour and Social Policy (which manages time taken to process asylum applications has access to services and socioeconomic been reduced and arbitrary practices related integration of migrants and refugees), and to accessing the asylum procedure have the Department for Serious and Organised been eliminated, but the quality of decision Crime’s specialised unit fighting trafficking making on asylum procedures still needs to in human beings and people smuggling. The be improved, including at the appeal level. priority understandably is control of external A list of safe countries of origin has been borders and prevention of people smuggling adopted and Standard Operating Procedures but efforts continue to ensure basic living (SOPs) on unaccompanied children and on conditions and services for all migrants vulnerable categories of foreigners are in place, staying in the country. Some progress has but difficulties persist in providing adequate been made on improving conditions in translation services for asylum-seekers and free the reception centres but the authorities legal aid is not always accessible in practice138. continue to be reluctant to provide more The practice of illegal returns continued139 - than a temporary stay and MYLA notes134 international organisations recorded 8,823 police returns of migrants to Greece from persons returned irregularly to Greece in 2018. reception centres. This is not in line with Council of Europe directives and guidance135 Following a readmission agreement with which promote a more child focused and Kosovo, 299 applications for asylum were rights-based response. It is also of some submitted. Six individuals were awarded concern that 361 migrants were detained at subsidiary protection, but none were granted the Reception Centre for Foreigners in 2018, refugee status and most decisions involved including 55 children, (37 unaccompanied)136, revoking asylum claim. Kosovo Roma were in order to ensure their witness statements particularly affected, many of whom now in court cases against smugglers. This is remain in the country with no legal status. totally contrary to the stipulation of the Between September 2017 and December joint statements137 from the CRC and the 2018, subsidiary protection was lifted in 64 Committee on the Protection of the Rights of cases affecting 184 individuals, all Kosovo All Migrant Workers and Members of Their Roma, including six cases on grounds of threat Families in 2017. to national security140.

134 MYLA (2019) Skopje op cit 135 See Lanzarote Committee Protecting children affected by the refugee crisis from sexual exploitation and sexual abuse Council of Europe (2017) Luxembourg; and Congress of Local and Regional Authorities From reception to integration: the role of local and Regional authorities facing migration Council of Europe (2017) Strasbourg adopted at the 34th plenary session of the Council in Strasbourg on 27 March 2018. Available at https://rm.coe.int/unaccompanied-refugee- children-current-affairs-committee-rapporteur-na/1680791c99 136 MYLA (2019) Skopje op cit 137 CRC/Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families Joint general comment No. 3 (2017) of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families and No. 22 (2017) of the Committee on the Rights of the Child on the general principles regarding the human rights of children in the context of international migration OHCHR (16 November 2017) Geneva available at http:// www.refworld.org/docid/5a12942a2b.htmlhttp://www.refworld.org/docid/5a12942a2b.html and CRC/Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families Joint general comment No. 4 (2017) of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families and No. 23 (2017) of the Committee on the Rights of the Child on State obligations regarding the human rights of children in the context of international migration in countries of origin, transit, destination and return OHCHR (16 November 2017) Geneva available at http://www.refworld.org/docid/5a12942a2b.html 138 MYLA (2019) Skopje op cit. 139 North Macedonia 2018 Report European Commission op. cit. 34 140 Ibid.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA The return of failed asylum-seekers from needs to revive the coordinating body on the EU includes a high share of Roma. returnees led by the Ministry of Labour Local research141 indicates that almost one and Social Policy. Increased cooperation tenth of the Roma population requested communication and coordination is needed asylum in an EU member states between between central level governments, among July 2016 and June 2017 alone. But EU central and local authorities and with member states have rejected most of the international organisations and NGOs. The asylum requests submitted by Macedonian Ministry recently abolished the integration citizens - only 0.9 per cent of the asylum centre tasked with initiating, supporting requests submitted by Macedonian citizens and coordinating activities for promoting to EU countries have been approved142. integration, and its responsibilities have been More effort is needed to successfully integrated into the workload of the Inter- reintegrate returnees, and the country Municipal Centre for Social Work in Skopje.

141 Lazovski V. et al The Challenges Faced by Roma Returnees in Macedonia European Policy Institute, Skopje 142 Ibid 35

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA GOVERNMENT ADMINISTRATION IMPROVING BUDGET CODES OF ETHICS TRANSPARENCY PUBLIC SERVICE INSTITUTIONAL MODEL CHAPTER 5 PUBLIC DUTY BEARERS’ MEDIA CAPACITY, COMMITMENT REFORM AND UNDERSTANDING PLANNING OF CHILD RIGHTS STRUCTURES DEVELOPMENT CHALLENGES CIVIL SOCIETY ACTIVE36 AND EMPOWEREDUNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 COMMUNITY 5.1 Government There are now codes of ethics in place in various state institutions and steps have been Government is a major guarantor of children’s taken to improve transparency, including rights and is the largest provider of services to by publishing the number of public service children in North Macedonia. Strengthening all employees and increasing the use of public three branches of government – Parliament, consultations. Citizens’ right to access the judiciary and the executive – has been a public information has improved somewhat consistent element of the reform programme through the publication of standard sets of since its inception. The 2018-2022 public documents, and establishment of an open administration reform strategy and the 2018- data mechanism. Progress has also been 2021 public financial management reform made in improving budget transparency programme are the umbrella strategies for through the publication of a citizens’ budget public administration reform. The government and increased budgetary data available for has started to monitor and report on their general consumption. Public consultations implementation, but an integrated monitoring have improved through the national electronic and reporting framework has yet to be consultation system, but while, formally, established. Despite considerable improvement information (including fiscal information) in all three branches of government over the on services and entitlements is publicly past decade, North Macedonia registered the accessible, it is not always presented lowest average trust in national institutions consistently or coherently, and research144 among all the EU candidate countries in EQLS indicates that individual citizens may find it 2016143. Trust in the government was 3.5 on difficult to access or comprehend. a scale of 1–10 and had diminished since the 2011 EQLS survey. Trust in local authorities The government has also expended (3.7) in particular was the lowest in comparison considerable effort to tackle corruption to all other countries and it too had decreased within the public service. The former since 2011. Special Prosecutor’s Office (SPO) filed 18

143 Eurofound 2019 op cit 144 Ivanovska A. Mojsovski A Kacarska M National PAR Monitor Macedonia 2017/2018 European Policy Institute (2018) Skopje 37

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 indictments for serious criminal offences Key informants in every sector identified in 2018, most of them concerning abuse poor staff morale – among teachers, social of office, embezzlement, and large-scale workers, patronage nurses - as a significant fraud. A total of 112 individuals are on trial factor impeding effectiveness, efficiency and in 17 cases145. However, respect for the accountability within the public service and as principles of transparency, merit and equitable a major barrier to full realisation of children’s representation is still not embedded in the rights. It may be that management culture public service and the perception of corruption enables and even contributes to poor morale. within government agencies persists. This is Managerial appointments need to be more particularly the case in relation to hiring and transparent and management accountability personnel practices, which impact negatively still needs to be fully embedded in the and visibly at point of service delivery. Youth organisational culture of the public sector. At in the CSYA study146, for instance, openly present management is centralised with little acknowledged that access to a government delegation of decision-making and budgetary job is not always based on qualifications. authority to middle management. This can Although the State Commission for Prevention lead to long delays as decision-making gets of Corruption has started to address cases of referred inappropriately up the management politicised appointments, there still tends to chain and/or managers defer action in be higher representation of some minorities in anticipation of possible changes in ministers. those institutions whose upper ranks include Managerial accountability is further limited by that minority. Smaller ethnic minorities remain a primary focus on compliance, rather than on underrepresented in the public sector147. performance.

The public service is seen by many young A 2017 survey150 of staff morale among people148 as bloated, with staff whose teachers and social workers noted five qualifications are mismatched with their factors contributing to poor staff morale - an jobs. Although, in principle, the Law on excessive burden of administration; absence Administrative Servants and the Law on of visible social outcomes; low salaries and Public Sector Employees stipulate merit- poor career prospects; inadequate working based recruitment, promotion and dismissals, conditions; and lack of discretion and a rules- these laws are not fully applied across the based culture. Respondents estimated that administration and procedures for temporary between 60 and 90 per cent of their time was or service employments with lower criteria are spent on administrative duties, the purpose used in many cases to bypass the criteria set in of which was unclear. The introduction of the law. Eighty-seven per cent of respondents digital-based systems has at least initially in the CYSA survey149 believed that it would be made the situation worse by effectively difficult to get a job if their family did not have doubling the amount of administrative work the right connections. The grounds for dismissal required, as paper-based records are also need to be made more transparent. No decision still necessary in most cases. Unrealistic has been taken yet on how to tackle the issue expectations set by the current legal of public employees not showing up for work. framework and the focus on adherence to Young people understandably resent the fact processes, as opposed to outcomes, by that public servants collect a salary but don’t regulatory bodies undermined professionals’ come to work, when they themselves cannot initiative and sapped staff appetite for find employment. discretionary behaviours and judgement.

145 North Macedonia 2019 Report European Commission op cit 146 ZIvetz L./ Navanti (2019) op cit 147 North Macedonia 2019 Report European Commission op cit 148 ZIvetz L./ Navanti (2019) op cit 149 Ibid 38 150 Ruda S. Silva A./BIT Applying Behavioural Insights to Teachers’ and Social Workers’ Motivation UNICEF (2019) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Another potential contribution to poor staff A functional review has been launched to morale may be that no significant progress assess around 128 governmental institutions has been made on mutual recognition of and to identify possible overlaps in order to professional qualifications. The Law on improve the administration’s effectiveness, Recognition of Professional Qualifications efficiency and accountability. This might be a designed to align with EU standards has good opportunity to introduce child-centred, not been adopted, and the necessary family-friendly and rights-based concepts adjustments to national law to comply and models of service delivery into North with minimum EU training requirements Macedonia’s public service structures, outlined in the EU Directive have not been systems and institutions. implemented. Professional development is not yet systematic, and there is no centralised Decentralisation of responsibility for service database of the training offered by various delivery to the municipalities is a key element institutions. Many key informants felt that of the government’s development model the quality of professional education in child and a core principle of the 2001 Ohrid related areas had dropped since the university Framework Agreement153. A programme154 for market was opened, and that as a result the implementing decentralisation and local self- calibre of job applicants in teaching, social government was adopted in 2011 but is still care and health was lower than previously. some way from achieving an effective local North Macedonia does spend less on tertiary social service delivery system, responsive to education than peer countries – an estimated vulnerable groups’ needs. All 81 municipalities 0.4 percent of GDP in 2015, significantly have entered the second phase of fiscal lower than the OECD average of 1.1 per decentralisation enabling a more substantial cent151. As a result, public universities lack transfer of responsibilities and financial the infrastructure and resources they need management to the local level, but a World to improve their quality, and this inevitably Bank review155 of the public finance system impacts negatively on the quality of found that too little revenue autonomy, vaguely professional degree or qualification obtained defined and disparate delegated functions, by graduates. unclear expenditure assignments, and uneven institutional capacity all make it difficult for The legal framework and institutional municipalities to deliver public services. structures to support policy making are in place but policy planning still needs to be North Macedonia’s municipalities face several reinforced, and especially to be aligned challenges in providing public services. with medium-term budgetary planning. At Different sectoral models of decentralization present, evidence-based policy and legislative seem to apply in terms of children’s services development are only partially ensured152. and these need to be explored further in Administrative data collection and consistent relation to their effectiveness and efficiency. use of data for decision-making need to be Interviews with key informants confirm strengthened. Inter-ministerial consultations weaknesses across all sectors at the interface need to be properly integrated into the policy- between centrally-defined legislative, policy making process. The quality of regulatory and strategy frameworks and local service- impact assessments needs to be further delivery mechanisms and management improved, and comprehensive budgetary systems. This is where most rights violations impact assessments need to be introduced. are manifested and barriers to access become

151 For a fuller discussion see World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit 152 See North Macedonia 2019 Report European Commission op cit 153 https://www.osce.org/skopje/100622?download=true 154 Programme for Implementation of the Decentralisation Process and Local Self-Government Development in the Republic of Macedonia 2011-2014, Ministry of Local Self-Government (2011) Skopje 155 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit 39

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA most apparent. In some service areas, as they have fewer resources to set up the operational and allocation decisions remain same municipal services. For instance, at at central level, although responsibility for present the municipality with the most funding resourcing has been devolved down. Key has six times the revenue of the one with informants identified weak staff capacity, bad the least funding. Small municipalities are staff attitudes and high staff turnover as major disadvantaged due to economies of scale, factors in the poor quality of services and as with a smaller tax base they need to restricted access; and these were attributed to finance equivalent services to those in larger the negative influence of an accepted culture municipalities. The transfer system should of political patronage and undue politicization to resolve or at least mitigate such sizable of local government structures. horizontal imbalances, but currently it does little to resolve the disparities, thus confirming But while criticism at central level tends to and reinforcing gaps in children’s access to emphasise political patronage and a perceived their basic rights. Balanced actions across hand out mentality evidenced by a reluctance several dimensions are necessary to address to either raise revenue or rationalise service these gaps, including building capacity for provision, independent reviews156 indicate raising, accessing, absorbing and using funds, a more complex set of challenges. Many and cooperation between municipalities to municipalities are unable to finance some share and consolidate services. of their basic functions, and critical child- related services, like education for example, Because of these disparities, increasing local are underfunded. Revenues from local taxes revenue autonomy in North Macedonia will and fees represent about one third of total not on its own improve spending efficiency. local government revenue, and the fiscal Simple and transparent methods are required imbalance is met with transfers from central to calculate the spending needs associated government. Block grants account for about with functional responsibilities like education 80 per cent of these transfers and for about or more broadly with specific population 49 per cent of municipalities’ total revenue groups like children. In effect a children’s but their value as a percentage of GDP has budget is required for each municipality declined, and the current level of funding they building on a holistic assessment of children’s provide is inadequate. Although there has needs in each local government area. been some increase in the collection of local taxes and fees, this has not kept pace with the devolution of responsibility for expenditure to 5.2 Civil Society local level. An active and empowered civil society is a There are also problems with the grant crucial component of any democratic society distribution formulas, including the and a significant duty-bearer in relation to child transparency of the calculations and the rights. Civil society is still at an early stage process for selecting which municipalities of development in North Macedonia and the get what transfers. The current transfer relationship between civil society and other system fails to address and does not duty bearers is still evolving. There has been a seem capable of addressing the very real rapid expansion of higher education institutions social and economic disparities between in recent years, mainly through the creation of municipalities caused by location, population a range of private universities, but overall there size, expenditure needs, differing economic is little civic tradition in the country. Initiatives bases and capacity to generate revenues. or networks of social or professional contacts Rural and small municipalities with small are quite limited and few people belong local tax bases are especially disadvantaged, to the kind of civic, professional or union

40 156 Ibid

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA organizations that help to create and sustain Component, via participation in the biannual social cohesion in society. Instrument for Pre-accession Assistance Monitoring Meetings. This is a key opportunity The society is quite politicised, and people for civil society organisations (CSOs) to raise generally engage with politicians, rather the profile of children’s rights, influence than take collective action, to resolve social government, donors and the international problems and community issues. Civic community, and expand their own networks engagement is not therefore a tradition and advocacy approaches. in North Macedonia – only 19 per cent of respondents in the EQLS157 study reported Local civil society is still under-developed and involvement in civil or political activity in appears quite skewed in terms of capacity, 2016, compared with an EU average of 26 with a number of prominent research and per cent. Only 9 per cent reported doing advocacy CSOs usually funded by international unpaid voluntary work at least once a month, donors. Local NGOs on the other hand are in comparison to an EU28 average of 17 per quite weak and scattered and their division cent. The more recent CSYA data158 confirms by ethnic affiliation tends to weaken them that this pattern continues among young further. While the ‘Colourful Revolution’ in people. Only a minority of young respondents 2017 showed that cooperation across ethnic participated in volunteer or civic activities that lines was possible for civic organisations, it contribute to society. Marginalized youth are has proved to be an exception to the rule. even less engaged than the national average. A perceived lack of common ground among Respondents tended to attribute low levels NGOs can be a substantial barrier in the of civic engagement to a history of being development of the civil sector and its role excluded from discourse and decision making in fostering dialogue and advocating for the in the public sphere. It is however hopeful to rights of the disenfranchised. Moreover, note that a different youth study159 found that the obvious political affiliations of some civil the rate of volunteering reported by youth organizations damage the whole sector’s increased from 13 per cent to 20 per cent public image and credibility. between 2013-2016. There are several child-related NGOs in North The climate in which civil society organisations Macedonia particularly with children with operate has improved under the current disability. There are few NGO networks focused government and there have been positive solely on children in the country and most local efforts at greater consultation and involvement NGOs are project based and donor dependent. with civil society. Strategic documents have CRC records indicate that there was previously been adopted, providing guidance on the an NGO Coalition for Children’s Rights that cooperation between government and civil submitted an Alternative Report (an NGO report society and progress was made towards on the CRC developed in response to the official the regular functioning of the Council for Government report) in 2007, but unfortunately Cooperation between Government and Civil there is no evidence that it is still in existence. Society. Further efforts are needed to address Although Children’s Embassy and SEGA have sustainability of civil society organisations such evidenced their capacity and capability to as a broader tax harmonisation and predictable promote children’s rights and advocate with public budgeting. Since 2012, civil society can and for children, the extremely limited range be involved in monitoring the implementation of civil society actors engaged with children’s of EU aid, particularly the assistance given issues represents a real barrier to realization of under the Transition and Institution-Building children’s rights at national and local level.

157 Eurofound (2019) op cit 158 ZIvetz L./ Navanti Group (2019) op cit 159 Topuzovska Latkovikj M. et al Youth Study North Macedonia 2018/2019 Friedrich Ebert Stiftung (2019) Berlin hereafter FES 2019 41

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA It also implies a lack of public interest be reported, although the frequency of such in children’s rights that needs to be attacks declined during the year. According to challenged and addressed urgently. the Association of Journalists of Macedonia A strong civil society sector is a vital (AJM), six reporters were attacked between prerequisite of a democratic society and January and September 2018, down from 18 full realization of children’s rights requires during the same period in 2017. However, the active engagement by the full range of duty Ministry of the Interior is now cooperating with bearers, including a vibrant, diverse and AJM to establish accountability for incidents proactive NGO movement. Promoting and of physical and verbal abuse or threats against supporting that movement should be as journalists. On the other hand, there have been much a priority for donors and international two incidents of statements against the media agencies as supporting the government. being made by high government officials in the last year. While there are children’s organisations active in some municipalities, there appears There are six daily newspapers, including to be no child-led organisations or initiatives two in the . Although at national level to advocate on their behalf North Macedonia’s media landscape is or to promote positive images of children’s polarized along political and ethnic lines, resilience, capacity and contribution to and private media outlets are often tied to wider society. There are networks of youth political or business interests that influence organisations focused on those aged their content, open political debate and between 15 and 29 with mechanisms for critical media reporting continued. The dialogue with government, but their focus number of investigative articles rose from tends to be on older age-groups. Children’s 0.8 per cent in 2017 to 2 per cent in 2018, absence from public discourse, and the lack although generally the quality of reporting of concrete opportunities to actually engage and respect for professional standards need with adult decision-makers, perpetuates further improvement. In 2018, the Public a popular negative stereotype of children Prosecutor’s Office opened an investigation as passive beneficiaries rather than active against a journalist on the grounds of hate citizens and net contributors to society. speech and the Council of Media Ethics Service planning and development also received 68 complaints for disrespect of inevitably suffers from the lack of children’s ethical standards, notably online (76.5 per feedback on service provision and input cent). Since March 2018, 12 new lawsuits into planning. The growth of children’s on defamation were registered against councils within schools envisaged in the journalists. Preliminary steps have been new law for primary education will hopefully taken to reduce fines for defamation to lay the foundation for increased student a symbolic amount, which is expected to engagement and activism. improve the sense of balance between freedom of expression and protection of 5.3 Media reputation. Since there was no progress on improving the labour and social rights While the EC has noted160 that the climate for of journalists whose working conditions media freedom and freedom of expression are very poor, journalists remain financially improved in North Macedonia in 2018, quite insecure and consequently, still Freedom House reported161 that Macedonian practice self-censorship. journalists are subject to political pressure and Overall, trust in the news media is low (3.6 harassment, and physical attacks continue to on a scale of 1 to 10)162. This low level of trust

160 North Macedonia 2019 Report European Commission op cit 161 See Freedom in the World 2019 available at https://freedomhouse.org/report/freedom-world/2019/north-macedonia 42 162 Eurofound (2019) op cit

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA could be due to deep polarisation of the media ethnic groups. Proportions were similar in along political lines, particularly during times of this regard between Albanian speakers and political crisis, and it likely reflects the public’s Macedonian speakers. desire for more objective information. Online media is unregulated and disinformation, Although North Macedonia is a small country, hate speech, disrespect of professional the growing divide between urban and rural standards and violations of intellectual property communities is leading to high rates of internal rights are frequent. Legal measures and/ migration. EQLS data165 indicated 72 per cent or self-regulatory principles and ownership of the population in urban settings in 2016, the transparency are needed to increase respect highest concentration (20.5 per cent) being for ethics and professionalism in online in Skopje. SSO estimates166 show at least media. Key informants were not aware of any 45 municipalities having negative population ‘alternative’ channels for children’s voices in growth, undoubtedly caused by falling birth online media. rates and migration, which means that entire communities face continuing depopulation Research is needed to identify patterns over the next decade. The rural population is of reporting related to children but key already more disadvantaged than the urban informants felt that media interest in population in many respects. Poverty is higher children’s issues is quite low, and neither in rural areas167. The reduction in poverty since print nor electronic media take a lead in child 2009 was not sufficient to close geographic rights discourse. Although the major media gaps in living conditions. An initial difference of outlets are generally supportive of child 13 percentage points went down only to 12.5: rights campaigns, overall, children are not the urban poverty headcount is 17 per cent but presented in the media in a way that respects the rural is nearly 30 percent. The poverty gap their rights. Training in child rights-based — distance to the poverty line — decreased by reporting is not compulsory for journalists 50 per cent in urban areas over the same time and treatment of children in the media can be period but only 40 per cent in rural districts. quite sensationalist and without any respect or regard for the child’s rights or welfare. One-fifth of people living in rural areas report experiencing problems accessing banking 5.4 Community services, while 36 per cent have difficulty accessing a cinema, theatre or cultural centre. Community is a key institution in North A further 16 per cent find it difficult to access Macedonia and a strong element of individual, recreational or green areas168. Social isolation family and social life. Yet on average, people and lack of services are real problems for in communities across North Macedonia families in rural communities that reinforce rate their life satisfaction at only 5.1, the each other and contribute significantly to a second lowest rating among all the Member cycle of rural decline. About 10 per cent of States and candidate countries surveyed respondents in the CSYA national survey169 during the EQLS study163. As indicated had moved from rural to urban areas in the earlier, communities tend to be aligned with, last five years. These internal migrants were and defined by, ethnicity and one-third of most commonly young families (27 per respondents (33 per cent) in the EQLS study164 cent included the respondent and a spouse/ reported tension between different racial or children); the respondent and his or her family

163 Eurofound (2019) op cit 164 Eurofound (2019) op cit 165 Eurofound (2019) op cit 166 Statistical Yearbook of the Republic of Macedonia, 2018 SSO op cit Chapter 03 Population 167 Figures that follow are from and Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank Group (2018) op cit. 168 Figures from Eurofound (2019) op cit. 169 ZIvetz L./ Navanti Group (2019) op cit. 43

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA of origin (21 per cent); or students (11 per population growth in the next decade. cent). While economics and education were Recent surveys171 of youth and young important reasons for moving, the prospect people in North Macedonia indicate that of a better life in the city appears to be just this trend is likely to continue and perhaps as important. grow in the next decade. Only one third of respondents in the FES study172 (33 per Service provision is more costly in rural areas. cent) indicated that they did not wish to Key informants confirmed that education, emigrate and half of the young people in health and social care professionals are still the CSYA national survey173 expressed their reluctant to accept assignment in remote intention to leave the country in the next locations and facilities are scattered, adding 1-2 years. to travel and other costs for providers and beneficiaries alike. The geographic distribution While economic empowerment is the primary of the population across the country is also motivation for emigration, families affirmed such that many municipalities are effectively that widely held frustrations with prevailing dominated by a single ethnic group, and the political and lifestyle challenges contributed interests of other ethnic groups within the area to decisions for their children to leave the are not always given due attention. As a result, country. CSYA results174 also suggest that many families in rural areas already living with desire to migrate is statistically stronger poverty, multiple deprivation and geographic among those young people who feel most isolation also face social exclusion and reduced strongly excluded from mainstream society - access to services. the unemployed; ethnic minorities including those who identify as Albanian; and those who However, emigration – internal and external identify as LGBTI. This suggests that there - is ‘hollowing out’ both urban and rural may be strong undercurrents of prejudice, communities and contributing to a cycle intolerance and social exclusion within of poverty by depleting local communities communities in North Macedonia directed of their greatest resource - young people. at those who are perceived to be different. Although the net migration rate is low, The hostility and violence described by LBGTI it is mainly young people of working-age youth in the FES study175 further illustrate the who are leaving. Because emigrants are effects of prejudice and social exclusion. So self-selected, they tend to be motivated does the experience of Roma children and workers in their most productive years families, all across North Macedonia. The and because they constitute an estimated Academic Network of European Disability 32 per cent of the country’s high-skilled Experts (ANED) acknowledges176 the workers, their departure is a severe blow to prevalent ‘stigma of disability’ in villages productivity. Inevitably this depletes both and towns when describing the massive the work force and the tax base170, but it resistance organised to oppose building of also has the potential to further reduce a group home for people with disability in

170 See Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank (2018) op cit for a fuller discussion 171 A majority of respondents in both ZIvetz L./Navanti Group (2019) op cit and Topuzovska Latkovikj (2019) M. et al op cit indicated that migration was a preferred option for them. 172 Topuzovska Latkovikj M. et al (2019) M. op cit 173 ZIvetz L./ Navanti Group (2019) op cit 174 Ibid 175 Topuzovska Latkovikj M et al (2019) op cit 44 176 Shavreski Z. Kochoska E. (2019) ANED op cit

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA their area177. It is somewhat disheartening considered satisfaction with family life as the to note that prejudices against minorities most important factor influencing their overall and those differing from the norm were life satisfaction. noted in the attitudes of young participants in the FES study178. Although this pattern is changing, extended family remain close, connected and very 5.5 Family involved in children’s lives. Young people still tend to live at home even into their late The culture in North Macedonia is very twenties, partly, but not totally, for economic family oriented. The family is the key unit of reasons. Based on a survey182 of more than Macedonian society across all ethnic and social a thousand young people aged between 14 groups and is still perceived to be the primary and 29, FES suggested this profile of a family protector of children’s interests. Traditional in North Macedonia – ‘an average family is family networks are strong, and three made up of 4 members among Macedonians generation households are common, especially and 5 among Albanians: two parents and their in rural areas179. This can be a significant children. The family lives in their parents’ advantage for vulnerable families in a country home mainly because it is the most practical where pensions are higher than social welfare and simplest solution. Family members get benefits. Living with an older person can have along well with each other. Both parents are a positive impact on family income and an involved in young people’s decisions. Young extended family network can offer practical people see themselves as married with two support in terms of child-minding, transport to children, they are raised to respect their and from school, hospital, health centres etc. parents, and they would like to bring up their as well as emotional and psychological support children in the same manner.’ The strength of to parents. Adult children often stay in the the extended family model is such that social home of their parents until they are married. pressure on single parents is high in small Traditionally, sons live in their parents’ homes communities, and this can be a factor in child with their wives throughout their adulthood. abandonment. Single parents and their children But even where siblings are living away from can feel stigmatised and socially excluded, and the original family home, extended family living on only one income can severely reduce members tend to be very involved in raising the child’s quality of life. children. In a recent survey180, approximately 73 per cent of parents with children between Traditionally, family dynamics were patriarchal 0 to 6 relied on parents, siblings or other with the oldest male holding the most family members for child-care. Although decision-making power. Today family decisions modernisation and increasing urbanization is are more consensus-based although age inevitably changing the structure and dynamics is still highly regarded, and older family of family life, a strong commitment to, and members have significant authority. However, engagement with, the extended family is still gender roles remain quite traditional with clearly a valued social norm. Respondents women taking on the bulk of responsibility in the Eurofound research181 for instance for housework and child-care. The inter-

177 There was a call for massive resistance from the people of Timjanik when they learned of plans to build a group home in their village. The call for massive resistance was made through the media. After intense discussions between community members, government and other stakeholders, the home was built and is operating successfully with full community support. See https://plusinfo.mk/%D0%B1%D1%83%D0%BD%D1%82-%D0%B2%D0%BE-%D0%BD%D0%B5 %D0%B3%D0%BE%D1%82%D0%B8%D0%BD%D1%81%D0%BA%D0%BE%D1%82%D0%B8%D0%BC%D1%98%D0%B0 %D0%BD%D0%B8%D0%BA-%D0%BD%D0%B5-%D1%81%D0%B0%D0%BA%D0%B0%D0%B0%D1%82/. 178 Topuzovska Latkovikj M et al (2019) op cit 179 See Cultural Atlas Macedonia available at https://culturalatlas.sbs.com.au/macedonian-culture/family-a0847809-fab6- 494c-8c7e-633970c21dab 180 WYG International Promoting alternative childcare services Fieldwork Report of Survey among Parents UNICEF (2017) Skopje 181 Eurofound (2019) op cit 182 Topuzovska Latkovikj M et al (2019) op cit 45

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA generational structure of the family can also believed that violence is an effective ways reinforce negative child-rearing practices and to correct the child’s behaviour. Parents in make it difficult for parents to adopt more North Macedonia have little information on rights-based or developmental perspectives. positive parenting – only five per cent of UNICEF supported research183 shows that surveyed parents were aware of education the use of corporal punishment is linked to programmes or material related to child parents’ own childhood experience. One third discipline and/or parenting methods. A large of the parents surveyed experienced corporal majority (67 per cent) of parents/caregivers punishment by their parents when they were share a traditional attitude that a child should children and 72 per cent of them confirmed not talk back to an adult, and 64 per cent using minor physical punishment to discipline believed that children were more disciplined their children – significantly more than parents in the past. An extremely low proportion of who did not experience corporal punishment parents mentioned ‘curious’ (3 per cent), as a child (46%). The extended family model ‘considerate’ (2 per cent), ‘ambitious’, ‘self- of home ownership can also be a serious confident’, ‘independent’, ‘persistent’ (1 per obstacle to removing abusers from the family cent) or ‘creative’ (0,5 per cent) as qualities home or helping women to leave abusive of a “good” child.185 relationships. Family structures are being affected by Violence seems to be an accepted feature modernisation, especially urbanisation, a long- of family life. A survey184 commissioned term decline in birth rates and demographic by UNICEF shows that 79 per cent of ageing. The number of divorces has risen parents used at least one violent method steadily since 1991 and reached 1,985 in 2016. (i.e. psychological aggression; minor or While most children are still born into, and severe physical punishment), while only 21 raised by, two-parent families, the pattern of per cent used only positive parenting and family relationships is changing. The birth rate non-violent methods. It also shows that 73 is dropping and the average age at marriage per cent of those who witnessed violence has risen. More couples are living separate against a child did not report it. It should be from parents and other relatives (although noted that while most parents/caregivers maintaining strong family contacts remains the were able to identify at least one negative norm). There has been a decline in the number impact that physical violence (72 per cent), of marriages, and the numbers of extra-marital and psychological punishment (67 per cent) births and single parents are rising. People have on children’s physical and emotional are more open about problems within the wellbeing, a considerable number (44 per family, and women are less prepared to stay in cent and 37 per cent respectively) still abusive relationships.

183 WYG International Promoting alternative childcare services Fieldwork Report of Survey among Parents op cit. 184 GFK Skopje Survey on parents’ and caregivers’ Knowledge, Attitudes, Practices & social norms associated with Violent Forms of Child Discipline UNICEF (2017) Skopje associViolent Forms of Child Discipline 185 Ljakoska M. Madjevikj M. Toshevska B. Divorced Marriages in the Republic of Macedonia. Regional Analyses of the 46 Frequency International Scientific Conference GEOBALCANICA (2018)

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 47

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA EARLY CHILDHOOD CAREAND DEVELOPMENT ECCD FRAMEWORK ACCESS, QUALITY AND PARTICIPATION RIGHT TO HEALTH EQUITY CHAPTER 6 RIGHTTHE STATE OF CHILDREN’S ACCESS RIGHTS – A THEMATIC EDUCATION ANALYSIS PARTICIPATION AND COMPLETION QUALITY EQUITY HEALTHSERVICES MOTHER,48 CHILD AND ADOLESCENTUNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THEHEALTH REPUBLIC OF NORTH MACEDONIA 2019 THE RIGHT TO PROTECTION 6.1 The right to early care In North Macedonia, pre-primary education and development is under the responsibility of the Ministry of Labour and Social Policy (MLSP), Convention on the Rights of the Child186 although the development of curriculum for Article 6.2: States Parties shall ensure to the this level is carried out by the Bureau for maximum extent possible the survival and Development of Education (BDE), which development of the child. falls under the aegis of the Ministry of Education and Science (MES). Investment a. The ECCD framework in early years learning is crucial to tackle disadvantage and poverty but North Care and childrearing practices play a Macedonia spends less on early childhood vital part in the child’s early development education and care, and on primary and lay the foundation for the child’s education, than any of the EU28 countries attitudes to, and aptitude for, their later and allocates more resources per student educational experiences. A period of to upper secondary and higher education187. rapid brain development occurs in the This is not cost-effective, given that there first three years of life, and the quality of are fewer students enrolled at higher levels, home care is the major determinant of the and that secondary and tertiary education child’s development during this period. In enrolment is significantly lower among this context, adult activities with children, ethnic minorities. the presence of books in the home for the child, and the conditions of care are Prioritising spending on early education is important indicators of quality of care. particularly important in North Macedonia, Children should be physically healthy, given the low and uneven coverage of its mentally alert, emotionally secure, socially current pre-primary system. Directing existing competent and ready to learn before they resources more towards the early years of are enrolled in school. education would also be cost-efficient, since

186 https://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf 187 North Macedonia 2019 Report European Commission op cit 49

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 high quality pre-primary and primary education North Macedonia for public kindergartens has a lasting impact on student outcomes and (69 per cent) as opposed to other forms is less costly than remedial actions later on. of early childhood care. Demand for public kindergartens is higher among parents having b. Access, quality and participation 3-6-year old children, while non-formal care provided by other family members is more The level of enrolment in early childhood frequent among parents of children below the education in North Macedonia remains a age of two. Single parents, parents of special- concern. Overall, enrolment in pre-primary needs children and unemployed parents are school among children aged 3 to 6 has least likely to be using child -care services. increased from 21.8 per cent in 2007 to 35.5 per cent in 2017188, but participation rates While most parents recognised the benefits remain low compared to neighbouring countries of early education to the child’s development, - Albania (81 per cent), Montenegro (56 per employment seems to have been the main cent) and Serbia (40 per cent) – and far below factor for choosing care options – of the 16.1 the average across OECD countries (95 per per cent of the interviewees who had had cent)189. With only about 30 per cent of children some trouble finding appropriate child care attending licensed preschool institutions in the services, around 10 per cent stated that lack of 2018/2019 school year190, enrolment still falls child care services reduced their employment far short of the EU Education and Training 2020 opportunities. The quality issues that parents target of 95 per cent. were most concerned about were child/ provider ratio, (68.3 per cent), experience Low levels of pre-primary attendance mean of the childcare providers (60,5 per cent), that children enter school without basic literacy relationship with provider (62.4 per cent) and and numeracy skills, as well as social and location and transportation costs (51,2 per emotional skills. The current Comprehensive cent). More than 60 per cent of those who are Strategy for Education envisages introducing not using childcare services indicated that they a compulsory year of pre-primary education were personally taking care of their children. for children aged 5-6 years in order to ensure that children enter school well-prepared. c. Equity The government has also taken measures to increase resources and preschool places Although pre-primary education is by investing in preschool infrastructure and predominantly public, with 98 per cent high-quality preschool education teacher of children attending public pre-primary training. These reforms should help address institutions, less than 1 per cent of children existing wide variations in children’s basic from the poorest quintile attend pre- competencies when they enter primary school, primary school compared to 55.9 per cent which partly reflects low participation in pre- of children from the richest quintile192. All primary institutions. parents, regardless of household income, must cover about 21 per cent of the cost of A survey191 of more than 1,800 parents preschool programs (€25/month), an additional of children from birth to six years old in barrier for low-income families,193 while 2016 found that there is most demand in socioeconomically advantaged households

188 See TransMonEE database available at http://www.stat.gov.mk/TransMonee_en.aspx 189 Republic of Macedonia - Teacher Education Programme on Early Numeracy and Literacy in the former Yugoslav Republic of Macedonia. OECD (2018) available at http://www.oecd.org/education/ceri/UNICEF.MCD.SystemNote.pdf quoted in OECD (2019) op cit 190 North Macedonia 2019 Report European Commission op cit. 191 Report on Quality Analyses of data gathered from the survey Conducting a nation-wide survey for identifying the demand for child care services” (both formal and informal) amongst parents with children WYG Ltd. (2017) Skopje 192 OECD (2019) op cit 50 193 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA that can afford preschool fees, conversely, of understanding, peace, tolerance, equality are more likely to benefit from public of sexes, and friendship among all peoples, resources. Another reason that children from ethnic, national and religious groups and disadvantaged backgrounds are less likely to persons of indigenous origin; attend pre-primary education is that places in (e) The development of respect for the natural kindergartens still tend to more accessible to environment. the children of working parents, sometimes from double-income families. There are also a. General Framework of Basic regional and urban/rural disparities in terms Education197 of access and availability. In 2016, the share of 0–5-year-old children in kindergartens The duration of compulsory education in North was about 32 per cent for the East and Macedonia is the highest in the region - from Pelagonija regions but only 8 per cent for the the start of primary school to the end of upper Northeast194. secondary education (13 years). The vast majority of students attend public schools. Participation in pre-primary education is also There are a number of pilot programmes with low across minority groups. Over half of private education institutions which provide Macedonian children attended pre-primary primary and lower secondary education in education, compared to less than one in five North Macedonia but the majority of students Albanian children. Only 2.6 per cent of four- (97 per cent) attend public schools in upper year-olds from Roma communities attend pre- secondary. There is greater diversity of primary education195. Children in urban areas providers in tertiary education, where 15 per are also six times more likely to be enrolled in cent of students attend private institutions, pre-primary education than those in rural areas. reflecting an expansion of private universities in recent years. 6.2 The Right to Education The Ministry of Education and Science (MES) Convention on the Rights of the Child196 Article is accountable for the overall educational 29.1: States Parties agree that the education system from primary to tertiary education, of the child shall be directed to - including establishment, accreditation and (a) The development of the child’s personality, operation of the educational institutions, talents and mental and physical abilities to approval and adoption of curricula and their fullest potential; publication of textbooks. There are also a (b) The development of respect for human number of autonomous specialised bodies rights and fundamental freedoms, and for affiliated to the ministry that provide the principles enshrined in the Charter of the technical expertise and develop policies in United Nations; specific areas including the State Education (c) The development of respect for the child’s Inspectorate; the Bureau for Development of parents, his or her own cultural identity, language Education; the National Examination Centre; and values, for the national values of the the Vocational Education and Training Centre; country in which the child is living, the country and the National Board for the Macedonian from which he or she may originate, and for Qualification Framework. civilizations different from his or her own; (d) The preparation of the child for The Comprehensive Strategy for Education responsible life in a free society, in the spirit for 2018-2025 adopted in 2018 sets out

194 Ibid 195 World Bank, Former Yugoslav Republic of Macedonia - SABER Country Report op cit. 196 https://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf 197 For a fuller description see Review of Assessment and Evaluation in Education North Macedonia OECD (June 2019) available at http://www.oecd.org/education/oecd-reviews-of-evaluation-and-assessment-in-education-north- macedonia-079fe34c-en.htm 51

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA key actions to improve children’s learning Spending on education has declined in experience. Its priorities include - increasing recent years. Between 2011 and 2016, North the share of children in pre-school and Macedonia’s public spending on education as introducing a compulsory year of pre- a percentage of GDP fell from 4.6 per cent to primary education; developing student- 3.7 per cent198. The share of total government centred instruction by reforming curricula expenditure allocated to education also and programmes to increase relevance declined from 13.3 per cent to 11.6 per cent and alignment with children’s stages of in the same period. Public expenditure on pre- development; measuring learning in terms university education in North Macedonia of outcomes rather than just knowledge is much lower than the OECD average acquisition; and introducing a national (5.2 per cent of GDP)199 and less than in most assessment framework. However, the peer countries. More importantly, OECD strategic documents do not set out any analysis200 shows that neighbouring countries specific goals for the sector. There are no have been able to achieve higher participation targets set to raise learning outcomes, and rates and better learning outcomes with similar the whole strategy lacks an implementation or lower levels of expenditure on education. plan or a defined process to monitor World Bank analysis201 indicate that the country progress. Underdeveloped and underused has low efficiency in terms of ensuring access data systems inhibit development of to lower secondary education—countries evidence-based policy. The Education spending similar amounts had on average 20 Management Information System (EMIS) per cent higher enrolment. North Macedonia remains understaffed and under-used both is also the least efficient in providing quality within the ministry and across the education education—countries with similar spending system. Central databases for school average nearly 34 per cent (112 points) higher inspection and student examination results in PISA tests. are not integrated with EMIS and data are collected multiple times from schools by The inefficient use of the available resources different parts of the ministry. Data are and the lack of oversight mechanisms are also not comparable across the sector e.g. some of the reasons behind the limited the State Statistical Office and EMIS use positive impact of North Macedonia’s different definitions for key indicators like education spending. Per student spending for school dropout. primary education, as a proportion of GDP per capita, is about 4 percentage points lower than The specialised agencies are also often under- EU28 averages. However, many municipalities staffed and lack specific skill sets and inadequate spend far less than the national per student resources frequently prevent them from fulfilling average. This in part arises from the funding their functions effectively. Although they are formula in which fiscal grants to the municipal meant to be autonomous bodies, they do level for education are done by a formula not have a strong independent voice, either through the central budget with no equalization separately or collectively, and their leadership of these grants to balance for municipal size positions can be subject to political interference or population. This means that less-populated and are often left open for long periods. There municipalities receive more funding to cover is no established forum to ensure that they education expenses. work together to share information, or to systematically and regularly contribute to policy Low levels of education spending, and the development within the ministry. absence of any explicit national mechanism to

198 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit 199 Education at a Glance 2017: OECD Indicators. OECD (2017) Pari available at http://dx.doi.org/10.1787/eag-2017-en 200 Ibid 52 201 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA target additional resources to disadvantaged numbers. Furthermore, teacher salaries schools or students, have resulted in many have increased without any corresponding schools lacking basic resources. Reports202 improvement in productivity or quality. indicate that203 one-third of schools require major repairs, and satellite and multiple-shift b. Access, participation and completion schools are particularly prone to infrastructure problems. While the large share of multiple Enrolment and participation in all levels of shift schools partly reflects the need to provide education has increased in recent decades, multilingual education, in many cases it also but children with disabilities and those from reflects inadequate capital spending. Overall, Roma communities continue to face barriers North Macedonia allocates a very small share to regular and quality education and training. of its total expenditure to capital expenses Despite high general completion rates in (5.2 per cent)204, compared to 9 per cent on primary, lower and upper secondary education, average across OECD countries205. While there an estimated208 10 per cent of children from is little evidence that material resources have Roma communities do not regularly attend a strong impact on student outcomes, OECD primary school and their dropout rates remain research206 suggests that ensuring minimum high. A new countrywide project is developing standards is necessary for high-quality a series of measures to support the inclusion education provision. of all children in schools during the current 2018-2019 academic year. The new Law on The large number of small schools and high Primary Education also stipulates that children teacher to student ratios indicate considerable with disabilities will be enrolled in regular scope to use resources more efficiently. primary schools and that migrant children will While there has been a 10 per cent decline be able to access schooling. in school students since 2007, the number of teachers has expanded by 10 per cent Increases in primary enrolment over the past but quality of teaching and learning remain decade mean that North Macedonia, like most unimproved. (ref OECD). More than 85 per of its Western Balkan neighbours, has now cent of primary and lower secondary schools met the benchmark of “full” primary school enrolled less than 50 students in 2016/17207. enrolment, but enrolment and participation While average student-teacher ratios (13.8) rates in other levels of schooling have varied. are similar to OECD averages (13.1), there Enrolment in secondary school, which had are wide variations across municipalities. In risen from 75 per cent in 1993 to 85 per some schools, there are just three students cent in 2005 had regressed to 79 per cent per teacher, while in urban areas this can by 2016209, with an increase from 23 per increase to eighteen students per teacher. cent to 41 per cent in higher education210. Low student teacher ratios partly reflect the Similarly, nearly one third of young adults in need to cater to a multilingual student body, North Macedonia have now attained tertiary but the teacher workforce could undoubtedly education compared to only 13.5 per cent of be more effectively managed to match student older adults (35-64 years)211.

202 World Bank Improving the Efficiency of Education Spending to Enhance Skills Development quoted in OECD (2019) op cit. 203 PISA 2015 Results (Volume III): Students’ Well-Being OECD (2017) Paris available at http://dx.doi.org/10.1787/9789264273856-en 204 Ibid 205 PISA 2015 Results (Volume III): Students’ Well-Being OECD (2017) op cit 206 OECD PISA 2015 Results (Volume I): Excellence and Equity in Education OECD (2016) op cit 207 Statistical Yearbook of the Republic of Macedonia, 2018 SSO op cit Chapter 06 Education and Science op cit 208 North Macedonia 2019 Report European Commission op cit 209 See Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank (2018) op cit 210 UNESCO-UIS. (n.d.). The former Yugoslav Republic of Macedonia | UNESCO UIS quoted in OECD (2019) op cit. 2 11 Ibid 53

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Despite improvements, gross enrolment in upper took place at a time of intense civil unrest but secondary remains more than 10 percentage a USAID assessments of student learning points lower than in other countries in the outcomes in the primary grades in 2016214, region, and significantly below the EU average. with a sample of around 8 000 students at the However, low levels of completion in upper end of grades 2 and 3 found similar issues. secondary (47.2 per cent) and high rates of out- The USAID results indicate that students in of-school children (16.2 per cent) suggest that North Macedonia master elementary reading actual attendance in upper secondary may be and mathematics skills, but they struggle significantly lower than gross enrolment data (76 with essential skills such as oral reading per cent). Enrolment is lowest among students fluency, reading comprehension skills or from a lower socio-economic background and subtraction. In grade 2, less than 40 per cent in rural areas212. Non-attendance at this level is of students completed subtasks on reading usually attributed to poor learning conditions and comprehension, compared to an international families’ and students’ low expectations, which benchmark of 80 per cent. are in turn influenced by parents’ low educational attainment. Parents with lower levels of Schools provide limited instruction time. education may have lower expectations for their Grade 1 students in North Macedonia have children’s educational attainment and may be only 552 hours of teaching time and by the less engaged in their children’s school activities time they are 14 years old, students in North and progress, which has been shown to impact Macedonia will have had nearly 900 hours students’ attitudes towards school. less instruction on average than students in other OECD countries. This limits the c. Quality breadth and depth of study and the scope to pursue additional subjects or remedial North Macedonia has one of the highest classes. One of the obstacles to increasing proportions of students (52.2 per cent) failing instructional time in North Macedonia is the to demonstrate basic proficiency in all three high prevalence of double-shift schools. There domains of science, mathematics and reading is also evidence215 that the use of learning time among all PISA-participating countries. Notably is not well adapted to children’s development in reading, more than three out of five 15-year stage. An OECD report216 also notes that olds lack basic reading skills (70.7 per cent) teachers lack the means – either through as measured by PISA. This compares to 20 learning standards focused on outcomes or per cent across OECD countries, 50 per cent assessment resources linked to curriculum in Albania and 42 per cent in Montenegro. In expectations – to detect and diagnose addition, while the share of low-performers students’ learning needs. This leaves teachers has fallen over time in neighbouring setting objectives for their students in terms of countries, the share of low performers in content knowledge to be acquired, rather than North Macedonia increased by nearly seven of individual learner improvement over time in percentage points between 2000 and 2015213 . relation to broader competencies.

Key informants have pointed out that the Schools in North Macedonia have limited 2015 PISA are not representative as testing resources to support student learning. PISA

212 World Bank Improving the Efficiency of Education Spending to Enhance Skills Development quoted in OECD (2019) op cit. See also Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank (2018) op cit. 213 OECD PISA 2015 Results (Volume I): Excellence and Equity in Education OECD (2016) Paris available at http://dx.doi.org/10.1787/9789264266490-en 214 This included Early Grade Reading Assessment (EGRA) and Early Grade Mathematics Assessment (EGMA). See USAID. (n.d.). Main findings and recommendations from the nationwide assessment of reading and numeracy skills in early grade students quoted in OECD (2019) op cit. 215 See OECD (2019) op cit. 54 216 OECD PISA 2015 Results (Volume I): Excellence and Equity in Education op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2015217 data indicates that teachers are usually of strong mechanisms for initial certification available to provide students with remedial at the end of teacher education means that classes but often lack the space to do so, new teachers enter the profession without especially in multi-shift schools. Only 38 per cent any assurance that they have met minimum of students are enrolled in schools that provide teaching competencies. a room where students can do their homework, compared with an OECD average218 of 73 Given the limitation of initial teacher per cent. Teachers generally lack professional education, professional development is pedagogical guidance in how to respond to especially important for teachers in North learning needs. Schools in North Macedonia Macedonia, but in fact teachers participate in have well-established support teams that include professional development less than in many special education, pedagogical and psychological other countries. Teachers are expected to advisors, but they lack any practical preparation participate in at least 60 hours of professional in the classroom and their support is often based development over three years, but limited on an outdated concept of special educational funding means that this does not happen needs that emphasises students’ ‘problems’ or in practice. A new law for teachers and ‘disabilities’. school support staff220 adopted in July 2019 introduces a system of merit-based career However, global evidence indicates that the advancement and systematic support to peer main driver of good education outcomes is learning. Teachers can move between four the quality and competence of teaching, and distinct grades - Teacher-novice; Teacher; this is an area where strong interventions Teacher-mentor; and Teacher-advisor. The may be required in North Macedonia to build requirements needed to advance between teacher morale. Despite increases in base grades stimulate demand for peer learning and salary, a UNICEF supported analysis219 found a systemic community of practice in schools. that teachers in North Macedonia feel that Furthermore, this system takes into account their profession is undervalued, and they lack that these roles are filled according to the the infrastructure and conditions to teach needs of the municipality, thus ensuring that effectively. Key informants indicated that initial all municipalities develop such systems. teacher education does not adequately equip new teachers with teaching competencies. d. Equity Entry to initial teacher education at university level is not sufficiently selective, with the vast Schools in Macedonia are among the least majority of candidates who apply receiving a socio-economically segregated across PISA place. The lack of robust accreditation, which participating countries, which means that is not programme specific, also means that children of advantaged and disadvantaged there are few mechanisms to ensure that backgrounds are more likely to attend the teacher programmes sufficiently prepare same school than in other countries. As a teachers, especially to the practical demands result, student’s socio-economic background of teaching. While teacher candidates have influences learning outcomes less than in a teaching practicum in a school, this is not many OECD countries221. To a large extent this always well-integrated in the rest of their reflects the fact that all students in the country, initial education and teacher candidates are regardless of socioeconomic background, frequently not coached by experienced teacher achieve low levels of learning outcomes when mentors during this practicum. The absence compared to their peers in neighbouring

217 OECD PISA 2015 Results (Volume I): op cit 218 Ibid 219 Ruda S. Silva A./BIT op cit. 220 http://www.mon.gov.mk/images/Zakon_za_nastavnicite_i_str.sorab._161-2019.pdf

221 PISA 2015 Results (Volume III): Students’ Well-Being OECD (2017) Paris available at http://dx.doi.org/10.1787/9789264273856-en 55

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA countries, and in reality, large inequities remain urban settings in science (compared to an average and children from minority communities and OECD difference of 17 points)224. Limited access children with disability are still less likely to to schools at all levels in rural areas may be one access quality education and to successfully factor behind this performance gap - enrolment progress through the system. Students from in upper secondary in rural areas (61 per cent) disadvantaged backgrounds are less likely to is significantly lower than in urban areas (75 per be enrolled in upper secondary education and cent)225 but learning conditions are also poorer in are three times more likely to be enrolled in a rural settings (e.g. damaged floors, old electrical prevocational or vocational programme than networks), reflecting the greater concentration of their advantaged peers. Students in vocational double-shift and satellite schools. programmes tend to achieve lower results in the State Matura (school exit exam), but unlike The government has implemented a number in many OECD countries, vocational education of initiatives to encourage more equitable and training (VET) students stand an equal school outcomes across ethnic groups, chance of progressing to higher education. especially among the ethnic Albanian The percentage of students enrolling in VET community, but disparities persist. While schools has decreased from 70 per cent of Albanians represent nearly 25 per cent of the students to almost 50 per cent since 2001 and total population, they account for only 15.6 per there is evidence of an increase in students cent of secondary students and only 5.5 per of both genders enrolling in gymnasium (high cent of tertiary enrolment226. PISA 2015 data227 school focused on an academic curriculum), indicates that ethnic Albanians were more rather than in vocational education. Thus, the than one year behind ethnic Macedonians government is now launching a campaign to in science, even after accounting for their increase the attractiveness of VET schools222. socio-economic background. Low levels of performance might reflect poor learning In terms of gender, boys are under-achieving in conditions, including the level of teacher North Macedonia, as in other Western Balkan qualifications - in predominantly Albanian countries. Girls outperform boys in science schools and municipalities228. Other smaller by 20 points and their advantage in reading is ethnic minorities also face similar challenges in even larger (46 score points). Boys are also accessing education. Roma are 2.2 per cent of more likely – by 10 percentage points - to be the total population but represent only 0.5 per low-performers in science than girls223. cent of secondary school students and 0.1 per cent of university students229. North Macedonia has a large rural-urban performance gap compared with other PISA- The education sector has recently amended230 participating countries, and results from the 2017 its laws to ensure equal access to education matura show a similar pattern. Students in rural for children with disabilities and to provide areas perform 47 points behind their peers in additional resources to facilitate their entry

222 See http://www.csoo.edu.mk/images/vet%20strategy_mac%20-%20final.pdf 223 OECD PISA 2015 Results (Volume I): op cit 224 Ibid 225 Former Yugoslav Republic of Macedonia - Early Childhood Development - SABER Country Report World Bank (2015) available at http://wbgfiles.worldbank.org/documents/hdn/ed/saber/supporting_doc/CountryReports/ECD/SABER_ECD_ Macedonia_CR_Final_2015.pdf 226 World Bank. (n.d.). Improving the Efficiency of Education Spending to Enhance Skills Development quoted in OECD (2019) op cit. 227 Macedonia in international assessment (PISA) - How to improve and take action? World Bank (2017) quoted in OECD (2019) op cit. 228 World Bank. (n.d.). Improving the Efficiency of Education Spending to Enhance Skills Development op cit 229 OECD (2019) op cit. 230 For a full discussion see Office of the Ombudsman Inclusion of children and youth with disabilities in mainstream secondary education in Macedonia UNICEF (2017) Skopje and Hollenweger J. Martinuzzi A. Assessment of capacity of services provided by health, education and social sectors for inclusion of children with disabilities UNICEF (2015) 56 Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA into schools, but there is still some way to go quantities of polyunsaturated fat, vitamin D to achieve inclusion in schools. The financial and iron and too much saturated fat, sugar and arrangements put in place means that funding salt with an insufficient intake of wholegrain is often only sufficient to cover teachers’ cereals, dietetic fibres, fish and seafood. salaries, so schools’ obligations to children with Forty to fifty per cent of the population above disabilities are not always respected. Overall, 15 years of age are regular smokers and the there is a lack of capacity in the education prevalence of hepatitis B is 6.5 times higher system to support inclusive education, with than the EU average. Air pollution is already the exception of a small number of inclusive at dangerously high levels in populated areas schools. More disappointingly, while the 2017 across the country and the EC is strongly KAP survey231 highlighted a six-fold increase in recommending234 that the country should the number of people who support the idea that implement air quality improvement measures. children with disabilities should attend regular Other environmental health concerns include schools and participate in regular classes with untreated waste entering water systems, peers (from 4 per cent in 2014 up to 24 per potentially affecting drinking water. cent), yet 66 per cent of respondents continued to believe that inclusion of children with Four national public health programmes focus disabilities into mainstream education would on addressing mother, child and adolescent inevitably mean depriving other children of health – the immunization programme; the teachers’ due attention. programme for active health protection of mother and child health; the programme for preventive 6.3 The Right to Health systematic check-ups of pupils and students; and the programme for subsidizing co-insurance Convention on the Rights of the Child232 Article for services provided to mothers and infants up 24.1: States Parties recognize the right of the to one year of age. These programmes have child to the enjoyment of the highest attainable contributed to favourable outcomes for access standard of health and to facilities for the to, and use of, maternal and child health services treatment of illness and rehabilitation of health. (MCH), although there are noticeable regional and States Parties shall strive to ensure that no urban/rural disparities in access to, and quality child is deprived of his or her right of access to of, MCH services. It is also of some concern that such health care services. adolescent health services rely heavily on the voluntary sector. a. General health context Data is scarce in relation to mental health Although life expectancy at birth had increased issues, and there is inadequate monitoring. to 75.1 years by 2010, death rates for diseases Although there is a decline in the share of of the circulatory system and smoking-related hospitalized mental health patients in the causes remain nearly twice as high in North overall hospital morbidity (from 4.6 per cent Macedonia as the EU average, driven mostly in 2000 to 2.6 per cent in 2012), there is still by unhealthy life-style habits and behaviour. a very slow decrease of the total number of The first Macedonian food consumption mental health patients staying in hospitals235. survey233 for adults in 2015 showed that adults Communicable diseases are the focus of three in North Macedonia consume insufficient programmes for prevention and control of HIV/

231 GFK Skopje Follow-up Survey on Knowledge, Attitudes, Practices towards Inclusion of Children with Disabilities op cit. 232 https://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf 233 Spiroski I. Nutrition and nutritional status of population groups in the Republic of Macedonia in Report about health of the population of the Republic of Macedonia for 2015 Skopje: Institute of Public Health of the Republic of Macedonia; 2016. 234 North Macedonia 2019 Report European Commission op cit. 235 Milevska Kostova N, Chichevalieva S, Ponce NA, van Ginneken E, Winkelmann J. The former Yugoslav Republic of Macedonia: Health system review European Observatory on Health Systems and Policies/WHO (2017) Copenhagen available at http://www.healthobservatory.eu 57

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA AIDS, tuberculosis and brucellosis. Because of practice a highly centralized system. The the low prevalence of all three diseases, these National Health 2020 Strategy adopted in programmes are mainly focused on preventive December 2016, constitutes the fundamental activities and health education, with only a health policy document for the country. small part of the funding allocated to diagnosis The Ministry of Health is responsible for and treatment costs. The implementation of formulating, developing, implementing and these programmes has demonstrated very monitoring health policy in consultation with positive results in some areas. The prevalence other Ministries and relevant agencies. Some of HIV remains low, with a total number of policies have been enacted without sufficient 236 registered cases in the period 1987 to consultation with civil society organizations, 2014, which is the second lowest reported professional associations or the general level in the south-eastern European region. public, but consultation has now improved However, trends in prevalence must continue with obligatory publishing of draft laws on the to be monitored closely as behavioural studies website and the possibility for commenting on have indicated that high-risk behaviours and draft documents by any interested organization low level of knowledge on prevention are still or individual. present among key populations such as sex Although the Law on Local Self-government workers, injecting drug users, men who have (2002) provides for the transfer of responsibilities sex with men and prisoners236. for health care provision to a local level, this responsibility has not yet been assumed by the b. The general framework of health municipalities, and almost all decisions are made services237 by the Ministry of Health, without any input from the municipalities. This centralized model of Health care in North Macedonia is provided by decision-making is reflected in, and reinforced by, a mix of public and private providers funded the direct appointment of Directors of the local through a statutory health insurance system, public health care institutions by the Minister of with a purchaser–provider split, based on Health. compulsory wage-based contributions and some out-of-pocket payments. The two North Macedonia is the only country among its central institutions in the health care system peers where public health spending as a share are the Ministry of Health (MOH) and the of GDP has consistently decreased over the Health Insurance Fund (HIF). The Ministry of past 15 years238, reaching 4.1 per cent in 2014, Health is responsible for health policymaking, well below the average for regional peers and organization of the health care system and the EU. Between 2006 and 2014 spending the enforcement of health legislation, while on health as a share of general government HIF is responsible for purchasing services expenditures also went down from 15.5 to from public and private providers on behalf of 12.9 per cent. In 2015, North Macedonia still users, through performance-based contracts ranked among countries with the most modest negotiated for a predefined period of time. allocations for health in the region, with 6.1 The Law on Health Care (2015) and the per cent of GDP, or USD 295 per capita239. In Law on Health Insurance (2015) underpin terms of distribution of the health care budget the health system and set the parameters by sector, spending on public health accounted of its organization. The Law on Health Care for 63 per cent of total health spending in in particular defines the MOH’s wide range 2014, which is again lower than the EU of responsibilities and roles in what is in average240.

236 See Lucheska I. Mladenovikj B. Reproductive health care in the Republic of Macedonia: situational analysis with a focus on human resources HERA - Health education and research association (2019) Skopje 237 For full description and analysis see Milevska Kostova et al WHO (2017) Copenhagen op cit. 238 Figures from World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit. 239 Finance Think Policy Brief 31 What is the state budget, and what is the private cost of health for children? UNICEF (2018) Skopje 58 240 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA In 2017, the Government spent 65 million euros numbers, qualification, age, professional on children’s health241, which is an absolute distribution or duration of absence of health increase of 31.7 per cent over 2010. However, in professionals working abroad but it is real terms, spending on children’s health did not estimated that more physicians than other follow the pace of economic growth and actually professionals apply to work abroad. A study244 fell as a proportion of GDP from 0.68 per cent conducted in 2015 showed that 70 per cent in 2010 to 0.63% in 2017, at a time when some of all medical doctors surveyed considered child-related health indicators were worsening. migrating to EU countries for better The average immunization rate for children remuneration, working and living conditions. decreased from 94.2 per cent in 2010 to 90.7 per cent in 2017, with the most notable decline in c. Access and quality MMR coverage of 82.6 per cent, with “pockets” of 65.8% coverage - Veles and Kavadarci and In theory all citizens should have access to most unvaccinated children (41.2 per cent) in medical services through the emergency care Skopje. Infant and child mortality and mortality units that are evenly distributed throughout the under five years of age have increased and have a country, regardless of their cost-effectiveness rate of 12 and 13.7/1000 live births, respectively, in a particular region. There are general in 2017, compared with 9.2 and 10.4 in 2010. hospitals in all major towns and three clinical hospitals in the major cities (Bitola, Tetovo National statistics based on self-reported data and Shtip), but all tertiary health care services indicate that North Macedonia has relatively are located in Skopje. Although the number of few health professionals per capita242. Despite hospital beds per capita (443/100k) is below a steady increase in the number of doctors, regional and EU averages, hospitals operate dentists and pharmacists, the country’s ratio well below full capacity and the bed occupancy of 280 physicians per 100,000 inhabitants (2.8 rate of 59.7 per cent245 in 2013 is one of the per 1000) ranks far below the EU average. The lowest in Europe. Waiting times for specialist nurse-to-population ratio reached 4.2 per/1000 services have been cut significantly through population in 2013 but also remains well below use of a sophisticated electronic health data the European and regional averages, probably system, based on electronic patient records due to emigration of nurses and the absence and with a module for online appointments. of adequate licensing and accreditation This system, which has been rolled out to systems for the nursing profession. Although 3,500 health care facilities and 15,000 users, the absolute number of community patronage has cut average wait times for a number of nurses increased from 278 in 2011 to 357 specialist services from about 15 months to in 2013, the number of midwives/1000 less than one week246. population decreased considerably from 0.7 in 1990 to 0.6 in 2013. Family doctors are usually patients’ primary point of contact with the health care system. The number of paediatricians in the past The Ministry of Health introduced the family five years notes a serious decline, from 9.54 medicine specialty in primary care in 2012, paediatricians per 10,000 children in 2011, requiring all GPs and paediatricians to undergo to 8.04 paediatricians per 10,000 children further specialization in family medicine and in 2016243. There is no data available on to become family physicians by 2020. Each

241 Figures in this paragraph from Finance Think Policy Brief 31 op cit. 242 Milevska Kostova N. WHO (2017) Copenhagen op cit. See also Lucheska I. Mladenovikj B. Reproductive health care in the Republic of Macedonia: situational analysis with a focus on human resources HERA (2019) op cit. 243 Finance Think Policy Brief 31 (2018) op cit. 244 Lazarevik V et al. (2015). Migration of health care workers from the western Balkans – analyzing causes, consequences and policies. Country report: Macedonia. Health Grouper (RRPP Project) quoted in Milevska Kostova N et al WHO (2017) op cit. 245 Milevska Kostova N et al WHO (2017) et al op cit. 246 Milevska Kostova N et al WHO (2017) et al op cit 59

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA primary care physician is obliged by law to However, the amount of the means-tested be associated with a medical nurse to form a cash benefit can barely cover the actual medical team, who then organize their work in expenses for daily living. single or group practices. If, after examination, there is need for further outpatient specialized Care for persons with mental health conditions services, the GP refers the patient to higher is mainly provided in the Specialized levels of care or specialist diagnostic or Psychiatric Hospital and the University Clinic therapeutic services. Specialists can further of Psychiatry with inpatient and day care refer the patient to other services. Provision services, both located in Skopje, and in several of tertiary care is conditional on previous day centres for mental health care, prevention examinations at the secondary level. The and treatment of depression located within the role of the GP is also central in the therapy Health Centres. The strategic determination management for the patient. Each primary care in social protection is towards community- provider has a number of registered patients oriented service delivery in line with the WHO for which capitation is paid, of which 70 per European Mental Health Action Plan247. The cent is a fixed amount and 30 per cent is a Law on Mental Health was enacted in 2006, variable amount for achievement of targets that regulating the rights and responsibilities include preventive check-ups and counselling of both health care providers and persons and education workshops for children in with mental health conditions. The law also schools. Patients have the right to choose their provides for establishing a Committee for physician, except for children under 14 years Mental Health in each municipality to enable of age for whom parents bear this right and close monitoring of the implementation and obligation. Gynaecologists at primary health protection of the rights of the persons with care (PHC) level work as entrepreneurs at their mental conditions. Very few municipalities own practices and are paid capitation fees, have established such committees and their which can result in patients paying fee-for- work is not publicized or widely disseminated service, causing financial hardship. to the public although the country has a long- standing public health programme for mental Service provision for persons in need of health that mainly comprises public education, continuous medical care or assistance to adolescents in particular, as well as remains underdeveloped, and care for counselling persons with severe mental health these patients is to a large extent provided conditions including suicidal young people. by family members and relatives, usually women. The scope and duration of the care d. Mother, child and adolescent health provided restricts the carers’ opportunities for employment in the formal sector, so the There is a set package of health care available Ministry of Labour and Social Policy has for mothers and children and according to the developed social and financial assistance latest estimates248, 98.6 per cent of pregnant instruments for persons in need of long- women receive prenatal care and 99.9 per term care at home. Financial assistance for cent of births are attended by skilled health informal care by a third person is provided to personnel. However, although maternal people with long-term mental and physical mortality decreased from 13 per 100,000 live disability, blindness and persons in need births in 1995 to 8 in 2015, neonatal mortality of assisted daily living in order to provide rates went down only from 12.6 per 1,000 live support in the home environment and reduce births to 8.3, infant mortality from 22.1 to 10.7, the number of people in residential care. and under-5 mortality from 24.7 to 12.2. North

247 The European Mental Health Action Plan 2013–2020 WHO (2013) Copenhagen available at http://www.euro.who.int/__data/assets/pdf_file/0020/280604/WHO-Europe-Mental-Health-Acion-Plan-2013-2020.pdf 248 World Development Indicators database. Washington, DC: World Bank. (2017) Washington DC http://databank. worldbank.org/data/reports.aspx?source=world-development-indicators quoted in North Macedonia 60 Public Finance Review: Sowing the Seeds of a Sustainable Future op cit

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Macedonia’s perinatal mortality rate of 16/1000 of the healthcare level responsible for providing in 2016 was the highest among peer countries specific reproductive healthcare services. The and its infant and under-5 mortality rates are specialized educational curricula for midwives higher than SEE and EU averages. encompass sufficient competences, but the healthcare system fails to sufficiently High rates of Caesarean sections (C-sections) utilize these competences in practice. This in North Macedonia may indicate inappropriate discourages students from enrolling in admissions and care, with potential midwifery secondary level studies, while the consequences for patient safety. C-sections competences acquired by patronage nurses are contraindicated among low-risk women are insufficient. This gap is offset by in-service and should not exceed about 15 per cent of training, which is not done systematically. There births nationally. In North Macedonia, they is no efficient professional protection for the now reach an estimated249 28.9 per cent of nursing and midwifery profession. The data births nationally and the C-section rate varies available on midwives and nurses is very limited from 0 to 51 per cent of births among facilities. because there is no updated registry for this In some health facilities, the total number of type of healthcare workforce, nor is there any deliveries annually is less than 400, which information regarding the share of midwives raises further concerns about quality of care and nurses that actually provide such services and patient safety. to patients.

A recent review250 of reproductive health The current cohort of gynaecology and services found that the current number of obstetrics specialists is ageing, and the specialist physicians involved or potentially number of general family physicians involved in the provision of reproductive is declining. About 30 per cent of the healthcare services in North Macedonia gynaecologists in the country are older than is satisfactory and comparable to that of 60 and about 50 per cent are between 50 and developed countries. However, there is little 60 years of age i.e. close to retirement. The consistency across the country in terms of number of midwives is rapidly decreasing, team composition, available professionals or especially those with higher vocational practice norms and most health specialists education. The distribution of the health are concentrated in the urban areas. North workforce, especially gynaecologists and Macedonia has 17 gynaecologists per 100,000 obstetricians, is extremely uneven, with big people, which is more than the EU average discrepancies between regions. The average (about 15.5 per 100,000), but their uneven number of women in their reproductive distribution with majority concentrated in period per primary gynaecologist is 3,610, Skopje leaves half of the big cities without this but there is a 1:3 ratio between the best service. The total of midwives and nurses is and most poorly supplied region. There are almost half of the European average. In 2016 also significant differences in the number there were a total of 1,020 midwives (55.1 of in-patient gynaecologists in different per 100,000 people) and 8,700 nurses (469 hospitals. The highest number of insured per 100,000 people), some of whom (311) women per gynaecologist is 8,679. Basing comprise the polyvalent patronage service. remuneration of gynaecologists solely on The specialist obstetrician-gynaecologists the number of registered insured women generally acquire the same set of skills creates problems for regions that have fewer irrespective of the level of healthcare they work women. Nor is there any regulation that sets in and there is no clear legal or policy delineation the standard of equipment to be provided

249 Figures from European Health for All Database. Copenhagen: WHO available at https://gateway.euro.who.int/en/ data- sources/european-health-for-all-database / quoted in North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit 250 See Lucheska I. Mladenovikj B. Reproductive health care in the Republic of Macedonia: situational analysis with a focus on human resources HERA - Health education and research association (2019) Skopje 61

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA by the gynaecologist, which creates further women over 18 considered obese252, the inequalities in accessing the right to quality number of overweight and obese children is reproductive health services. of particular concern. North Macedonia has The programme for compulsory still not performed a comprehensive food immunization has achieved very low consumption survey to assess children’s incidence rates for most vaccine- intake of macro and micronutrients, but preventable diseases covered by the data from anthropometric measurements national immunization calendar (diphtheria, of children show that the prevalence of tetanus, pertussis, polio, measles, mumps, overweight and obese children is increasing rubella, Haemophilus influenzae B). The over the years - about 39.4 percent of boys last case of poliomyelitis in the country and 32.9 percent of girls are overweight, and was diagnosed in 1987, and in 2002, WHO 20.3 percent of boys and 16 percent of girls certified the country as polio-free. The are obese 253. A UNICEF supported survey254 national immunization calendar has been on micronutrient intake in 2017 showed that upgraded three times to include mandatory the food for children in pre-school and school hepatitis B vaccine for children born after population was not planned systematically. November 2004; mandatory vaccination General recommendations for energy against human papillomavirus of girls consumption are not followed and there in the age group 9–12 years; and Rota is a low consumption of nutritionally rich virus and pneumococcal vaccine (June food like fruit and vegetables and milk and 2019). Since September 2015, polyvalent dairy. As a result of the survey, the MOES, vaccines were introduced in the regular in cooperation with the Ministry of Health, immunization calendar, reducing the number has adopted food standards for nutrition and of immunization visits in the first 12 months meals in primary schools, which bind service of life from 13 to seven. providers, as well as the kitchen staff in schools, to follow the recommendations for However, in recent years, there has healthy diet for school children. been a significant and worrisome drop in vaccination rates in North Macedonia. The While girls and boys are entitled to choose measles vaccination rate for 1–2-year-olds their own doctor after fourteen years of fell from 96 per cent in 2005 to 82 per cent age, most children and young people are in 2016—in EU countries the trend was the tied to their family doctor. It is of some opposite. World Bank analysis251 implies concern that adolescent reproductive health that the reasons for this could include fewer services are provided only through NGOs, resources for health, prioritizing specialized and that there is no specific statutory health care over preventive and primary adolescent reproductive health or mental care services, and facility inefficiencies. Key health services unit. Although the official informants however pointed out that the prevalence rate of HIV is the second biggest drop was in Skopje and attribute it lowest reported level in the south-eastern to a pro-active anti-immunisation campaign European region (only 236 registered cases organised through social media. between 1987 – 2014), there are some indications that reporting levels may be Given that over half of North Macedonia’s low due to traditional reticence to discuss adults are estimated to be overweight, with sexual matters and fear of stigma, prejudice 22.6 per cent of men and 22.1 per cent of and violence, and that vulnerable children

251 World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit 252 Figures from European Health for All Database. Copenhagen: WHO available at https://gateway.euro.who.int/en/ data- sources/european-health-for-all-database/ quoted in North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit 253 Institute of Public Health of the Republic of Macedonia. Report about the implementation of round 4 of the WHO European Childhood Obesity Surveillance Initiative (COSI) in the Republic of Macedonia. Skopje: IPH; 2017 62 254 Studiorum Micronutrient Study of Pre-School and School Meals in Macedonia UNICEF (2018) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA may be more exposed to risk than is effectiveness of the hormone contraception currently acknowledged. or barrier contraceptives and only 23.4 per cent of the men and 16.6 per cent of the In 2017 there were 151 people registered as women reported regular use of condoms. living with HIV in North Macedonia – a tiny figure when compared with Latvia, which e. Equity has a similarly sized population but in 2016 had 6,607 cases registered255. However, In terms of geographic distribution, primary North Macedonia’s small numbers mask care is easily accessible to almost all citizens a complex picture. In 2016, there were in the country due to financial incentives 40 new HIV diagnoses in the country, thirty to stimulate doctors to open practices and of which were among men who have sex provide services to populations living in rural with men (MSM). HIV prevalence among and remote regions. However, there are men who have sex with men is at 1.9 per significant regional and urban/rural differences cent, a staggering 271 times higher than and the number of physicians and specialist among the population at large. Given the physicians varies, their accessibility and prejudice, stigma and violence experienced quality, differ across regions, municipalities by LGBTI youth256, it is highly likely that and towns. Transport costs can be a significant a significant proportion of MSM in North barrier because all primary gynaecologists are Macedonia may not get themselves or their located in urban areas, so women from rural partner tested. Other marginalised groups areas and remote city neighbourhoods have like sex workers and intravenous drug users difficult access. In primary care, the number (IDUs) may also be at high risk. In certain of physicians per 1000 insured persons ethnic communities like the Roma, lack of varied between 0.8 in the Eastern region to knowledge and cultural and sexual practices 1.0 in the North-eastern region in 2015258. may make young people particularly This is undoubtedly a factor in the significant vulnerable to HIV and STIs. geographical differences in infant mortality rates (IMRs), ranging from 4.0 in Vardar Region Between 2010 and 2015, the Southeast to 8.7 in Polog Region in 2018, when the Europe (SEE) region saw a 50 per cent rise national average IMR was 5.7259. in new HIV infections annually, and there is no real reason why North Macedonia Fewer health needs are now unmet due to should be an exception, given its current the high cost of care but unmet needs are social attitudes towards sexual behaviour still high among households at the bottom of and its knowledge of preventive habits, the income distribution. In 2012, 6.1 per cent practices and methods. A survey257 of of the population reported an unmet need 2,691 respondents between 15 and 49 for care because it was too expensive. This years of age in 2009/2010 about sexual and proportion dropped nationally to 2.1 per cent reproductive health and rights found that in 2015, close to the EU average, but still women and men do not have sufficient remains 4.7 per cent, more than twice as high, knowledge of contraceptive methods and for the bottom income quintile. In 2017, more means. Between 52 per cent and 69 per than one third of all health services were paid cent of women had no knowledge of the for out of pocket, creating social discrepancies

255 See IPPF Blog (September 2017) available at https://www.ippfen.org/blogs/macedonia-crossroads-rising-hiv-numbers- and-funding-cutbacks-threaten-health-and-wellbeing 256 See FES (2019) op cit 257 Pavlovski B. Assessment of the Status of Sexual and Reproductive Health and the Rights of the Population in the Republic of Macedonia. Association for Emancipation, Solidarity and Equality of Women (2010) Skopje 258 HIF Annual Report, 2016b in Milevska Kostova N, WHO (2019) op cit 259 SSO MAKSTAT available at http://makstat.stat.gov.mk/PXWeb/pxweb/mk/MakStat/MakStat__Naselenie__Vitalna/625_ VitStat_Reg_StUmrDoen_mk.px/table/tableViewLayout2/?rxid=46ee0f64-2992-4b45-a2d9-cb4e5f7ec5ef 63

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA in health care260. Out-of-pocket expenditures have also suggested that they frequently inevitably invite informal charges and/or had to pay for services that should have payments, particularly by poorer and less been free of charge – 28.8 per cent of Roma educated patients less certain of their legal women and 28.4 per cent of the non-Roma entitlements. World Bank has calculated261 that population in several cities in the country264. over 40 per cent of the population in North The Ombudsman and the Health Insurance Macedonia have made informal payments Fund of Macedonia addressed 957 official to receive health services, with over 20 per complaints about this practice. In 2016, the cent stating that they “usually” or “always” Ombudsman provided an opinion265 to HIF made these kinds of payments. Informal regarding the need to perform extraordinary payments are especially made for expensive and unannounced controls to prevent the diagnostic or medical procedures, services illegal levying of charges for health services that are limited in volume or have long waiting to Roma women. lists. Informal payments are very difficult to identify, and it is assumed that total out-of- As in other countries, the health status of the pocket spending may be much higher than the Roma population is worse than the general estimates above. population with significantly shorter life expectancy. The causes of their poor health Furthermore, the cost of children’s health and shorter life expectancy are multiple and care has risen262 disproportionately for need to be addressed through the joint efforts families to an average of nearly MKD of health and non-health sectors, including 7,000 per year compared with an average education, employment and housing. The out-of-pocket cost of MKD 5,860 for Strategy for Roma 2014–2020 in North adults. This means that 55 per cent of Macedonia sets targets for increases in health expenditure per child in North immunization, health insurance coverage and Macedonia is from public funds and 45 per access to health services for Roma families. cent from private payments. This puts a The Health Insurance Law in 2009 made all disproportionate burden on families with residents eligible for compulsory insurance children, and particularly on poorer families. coverage subject to proof of citizenship, which The illegal charging of fees for health can be a particular challenge for the Roma services provided by a primary gynaecologist community. Prejudice and discrimination (which according to the law are free of are also significant factors. Fifteen percent charge) has been tracked, registered and of the Roma women surveyed in the Shuto reported since 2012. Eighty-three per cent Orizari community reported that they were of pregnant women in the Roma-majority rejected at least once while attempting to municipality of Shuto Orizari stated that select a gynaecologist. The gynaecologist they did not receive the ultrasound service justified this by stating that “he had enough free of charge, but instead had to pay the patients” or “his quota was already full”266. primary gynaecologist for it263. Other women It is likely that a certain number of women

260 North Macedonia 2019 Report European Commission op cit 261 FYR Macedonia public expenditure review, fiscal policy for growth. World Bank (2015) Washington DC available at http://respublica.edu.mk/attach/izvestaj.pdf 262 Figures from Finance Think Policy Brief No. 31 (2018) op cit. 263 Health Education and Research Association. Fourth Community Scorecard for Healthcare During Pregnancy, Childbirth and the Postnatal Period among Romani Women in Shuto Orizari, HERA (2016) Skopje available at: http://hera.org.mk/wp-content/uploads/2016/07/cetvrta-karta-web.pdf 264 Association for Emancipation, Solidarity, and Equality of Women in Macedonia (ESE). We are all human: Health care for all people regardless of their ethnicity: Health status, health care and right to health among Roma people in R. Macedonia. Foundation Open Society Macedonia (2014) available at: http://www.esem.org.mk/en/ pdf / Publikacii/2014/ We per cent20are per cent20all per cent20human.pdf 265 Republic of Macedonia, Ombudsman. Annual Report about the Level of Provided Respect, Promotion and Protection of Human Rights and Freedoms (2016) Skopje 266 HERA – Health Education and Research Association. Fourth Community Scorecard for Healthcare During Pregnancy, 64 Childbirth and the Postnatal Period among Romani Women in Shuto Orizari (2016) op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA had not documented their civil status, not health mediators and the extension of the registered their marital status, or did not have engagement of the programme into other personal identification documents or health municipalities with a high percentage of insurance, but it seems unlikely that health Roma. It is difficult to understand why a professionals could not have found some programme with such a successful track way to accommodate their registration. Roma record in improving the health and well-being women and men have complained267 of harsh, of vulnerable women and children has not yet disrespectful and discriminatory language and been fully integrated into government systems actions used by health professionals against and structures. them, and this has discouraged them from seeking professional health care. 6.4 The right to protection

A Roma Health Mediator programme was Convention on the Rights of the Child269: established in North Macedonia in 2012. The Article 19.1 States Parties shall take all first 16 Roma health mediators (RHM) were appropriate legislative, administrative, social engaged to serve in eight municipalities, and educational measures to protect the child providing outreach services to nearly half of from all forms of physical or mental violence, the whole Roma population in the country. injury or abuse, neglect or negligent treatment, The programme was funded in cooperation maltreatment or exploitation, including sexual between the government and the Foundation abuse, while in the care of parent(s), legal Open Society – Macedonia. The second phase guardian(s) or any other person who has the of the programme started in November 2014 care of the child. with the engagement of nine additional Roma health mediators for another four municipalities a. Violence and vulnerability in where the Roma population lives. The program North Macedonia aimed at improving the health of the Roma and their access to healthcare by improving There is insufficient empirical data in North communication between the Roma community Macedonia on the incidence, prevalence and and the healthcare system. The mediators help typology of violence involving children, and facilitate the access to healthcare services, baseline data on child protection issues is establish trust in the relationship between the not easily available. This dearth of up to date physician and the patient, as well as establish data may be due in part to public attitudes good habits and practices regarding health, which do not generally acknowledge violence hygiene and nutrition in Roma communities. against children as a problem. Violence is still widely accepted as a valid and effective form The programme has been successful in of correction and punishment for children improving Roma access to health services268 in families, communities and schools. A and is now supported by the budget of the 2013 study270 found that 65 per cent of the Republic of North Macedonia. Although the respondents have been exposed to some kind funding is growing, the main challenges of abuse and neglect, with 35 per cent exposed facing the implementation of the programme to multiple kinds of adverse experiences as a include the employment status of the Roma result of abuse and neglect during childhood. 271

267 Spitálszky A. Roma in the Republic of Macedonia: Challenges and Inequalities in Housing, Education and Health (2019) op cit. 268 See Bozinovski B. Stojanov Z. Evaluation of UNICEF Roma health mediators programme 2013-2015 UNICEF (2018) Skopje 269 https://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf 270 Raleva M. Jordanova Peshevska J. Sethi D. SURVEY OF ADVERSE CHILDHOOD EXPERIENCES AMONG YOUNG PEOPLE IN THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA WHO (2013) Copenhagen available at http://www.euro.who.int/__data/assets/pdf_file/0008/185570/e96810.pdf 271 ibid 65

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA A more recent KAP study272 of attitudes towards physical violence occurs most frequently at later child discipline found that the majority (79 per stages of childhood. Female participants more cent) of parents used at least one violent method often acknowledged physical violence as an of discipline (e.g. psychological aggression; minor issue than did males, and it was more frequently or severe physical punishment), while only 21 per reported in the larger cities. Only a small cent used only positive parenting and non-violent proportion of the participants mentioned sexual methods. Seventy-three per cent of those who violence in their definitions of violence against witnessed violence against a child indicated that children and it was more likely to be recognised they did not report it, and another recent study273 as commonplace by professionals in the legal indicates a similar response among professionals and law enforcement sectors e.g. judges and all across North Macedonia, despite a legal prosecutors. obligation to report all suspicions or concerns about violence or abuse against children. Participants in the VAC 2018 study275, particularly those employed in the educational sector but The cultural acceptance of low-level violence also medical doctors and other professionals, as ‘normal’ obviously influences professionals’ generally believed that violence is rare in the child assessment of the prevalence and incidence protection system and in child care institutions in of violence against children. Teachers within Macedonia. The type of violence that was most the VAC 2018 study274 had no difficulty openly frequently referred to, and estimated as most acknowledging that verbal violence exists frequent, was physical violence amongst child amongst older-age peers in primary and peers. The study showed significant differences secondary schools, especially where there are of interpretation between professionals in mixed ethnic groups, but generally tended to different sectors and regions of what constitutes see that as ‘normal’ from the age of 12 years unacceptable violence against children, and this on. They did not consider that they had a duty to seemed to be a significant factor in their low report incidents of such violence or to intervene. estimates of the prevalence of violence in child Generally, teachers estimated that there was only related institutions. However, once respondents a low level of violence in schools and that it was accepted a definition of physical violence as a mainly peer violence. Cases of violence where ‘physical attack on the child by peers, teachers, teachers were the perpetrators against students relatives, or even the parents,276’ their estimates were generally uncommon, with teacher against changed. Respondents then tended to agree child violence noted in only one secondary that violence occurred more frequently within school in the western part of the country. Only the child protection system than it did outside a few of these cases were referred on to the of it. This is worrying given that about 28,000 relevant teams and institutions. However, survey children are estimated277 to be within the wider participants from the northwest region estimated social protection system and therefore should be that there were more cases – from three or four deemed to be at some risk. instances of teacher violence against children per month up to an estimate of three or more cases The government has adopted an ambitious per week. National Strategy on Deinstitutionalisation (2018-2027) and is committed to ensuring Professionals from the educational sector and that no child under 18 years of age will be social workers expressed the opinion that institutionalised. Institutions are gradually

272 GFK Skopje Survey on parents’ and caregivers’ Knowledge, Attitudes, Practices & social norms associated with Violent Forms of Child Discipline UNICEF (2017) Skopje associViolent Forms of Child Discipline 273 Minton SJ et al Identifying, Assessing and Making Recommendations for State Response Mechanisms in the Prevention, Identification, Reporting, Referral and Protection of Cases of Violence against Children in the Child Protection System in the Former Yugoslav Republic of Macedonia UNICEF (2018) Skopje hereafter VAC 2018 274 Ibid 275 Minton SJ et al (2018) op cit 276 Ibid 66 277 UNICEF TransMONEE data (2007) quoted in Minton SJ (2018) op cit

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA being reformed and the large-scale residential in place to ensure that all children in state care units are being replaced with small group are protected by applying safeguarding policies, homes, for use when children cannot be practice and mechanisms that are checked reintegrated with their families, adopted or regularly through independent inspections and placed in foster care. The number of children in public accountability. institutions fell from 182 in 2017 to 43 in 2019 and there were 384 children in foster care as There is a significant dearth of documentation of March 2019278. Deinstitutionalisation has on children detained in prisons or correctional not just transformed the nature of alternative centres280 in North Macedonia, but there residential care – it has also promoted is a history of violence and abuse against development of community based social care. children in them. The 2012 Annual Report of Additional community-based services are the Ombudsman281 documented incidences being developed, including a Centre for Early of insults and physical violence by guards Intervention for Children with Disabilities, against juveniles in penitentiary and correctional Centres for Support to Families, Centres for institutions. US State Department’s Macedonia Foster Care Support, as well as transformation Human Rights Report in 2016282 reported a lack of the Day Care Centres into support and of accountability for child neglect and abuse in resource centres to facilitate inclusion of CWD orphanages, shelters, and detention centres. The into mainstream preschools and schools, etc. 2018 report283 noted that the country still had 11 This undoubtedly reduces the risk of violence prisons and three juvenile correctional facilities to children but the potential for abuse and that failed to meet international standards. Seven neglect exists in all forms of alternative care. of these prisons held pretrial detainees. The Committee for the Prevention of Torture (CPT)284 While the VAC 2018279 respondents employed in its 2017 report noted that legislation in North in institutions for children defined ‘violence’ Macedonia still allowed the possibility of 10 days in the same way as other professionals in the of solitary confinement as a disciplinary sanction study, they did not recognize neglect as being for juveniles. The CPT recommends that solitary a form of violence and many were insufficiently confinement as a disciplinary punishment for familiar with the protocols and national guidelines juveniles be abolished. The CPR 2019 noted285 regarding dealing with violence against children, that there had been no improvements in the instead referring to internal protocols. Some had material conditions and availability of education attended training on violence against children, for detained children and that poor conditions in but even these participants acknowledged police stations, social care facilities and psychiatric significant knowledge gaps. Most institutions institutions needed to be urgently addressed. were monitored externally by the responsible government ministries, but supervision was Global Detention Project’s (GDP) 2017 usually undertaken internally and there was no assessment286 noted that there were no consistency between institutions in this regard. provisions prohibiting the detention of minor This reinforces the need for a system to be put migrants or asylum-seekers (accompanied or

278 Figures received from UNICEF Skopje. Accurate as of 30 June 2019. Number in foster care accurate as of March 2019. 279 Minton SJ et al (2018) op cit. 280 There were 24 such children in June 2019 according to UNICEF. 281 Annual Report 2012 Republic of Macedonia On the level of respect, promotion and protection of human rights and freedoms Ombudsman Republic of Macedonia (2013) Skopje available at https://www.theioi.org/ioi-members/europe/ macedonia/ombudsman 282 See https://www.state.gov/2016-17-advancing-freedom-and-democracy-report/#_ednref33 283 Macedonia 2018 Human Rights Report US Department of State (2019) Washington available at https://mk.usembassy. gov/wp-content/uploads/sites/249/NORTH-MACEDONIA-2018-HUMAN-RIGHTS-REPORT.pdf 284 Committee for the Prevention of Torture Report to the Government of “the former Yugoslav Republic of Macedonia” on the visit to “the former Yugoslav Republic of Macedonia” carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 6 to 9 December 2016 Council of Europe (2017) Strasbourg 285 North Macedonia 2019 Report European Commission op cit. 286 Global Detention Project Former Yugoslav Republic of Macedonia Immigration Detention Profile GDP (2017) Geneva 67

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA unaccompanied) or trafficked persons. Even social security of its citizens in accordance though minors who are not seeking asylum with the principle of social justice. The are to be assigned a legal guardian and the country has signed up to the Council of respective embassy or consular mission is to Europe Convention on the Protection of be informed, they are nonetheless placed in Children against Sexual Exploitation and detention. Of the 361 migrants detained at Sexual Abuse (known as the Lanzarote the Reception Centre for Foreigners in 2018, Convention)290 and ratified the Council 55 were children, 37 unaccompanied287. They of Europe Convention on preventing were detained in order to ensure their witness and combating violence against women statements in court cases against smugglers. and domestic violence (the Istanbul This is totally contrary to the stipulation of the Convention)291 in March 2018. The Family joint 2017 statements288 from the CRC and the Law and the Child Protection Law both offer Committee on the Protection of the Rights of specific measures of protection for children All Migrant Workers and Members of Their against violence, abuse and neglect. Only Families, clarifying that detention of children is one participant in the VAC 2018 study292 never acceptable in a migration context. saw any need for further legislative reform Given the evidence, however scattered it may but most identified a gap between what be, of violence within the child protection should happen in law, and what existing system; the range and variety of settings resources permit to actually happen in where children may be constrained in any practice. Lack of intersectoral collaboration way by officers of the state and the terms is also a key gap. and conditions of their stay; and the acute lack of up-to date, contextual research and The Criminal Code is broadly in line with analysis, it might be appropriate to introduce European standards and criminalises trafficking a national framework289 for regular, on-going in human beings and online child pornography. and independent monitoring and reporting on Following recommendations from the all children in state institutions of any kind in Lanzarote Committee of the Council of Europe, North Macedonia, that can run in tandem with amendments were adopted in December 2018 the national strategy to reduce the number that expanded the definition of violence to of children in institutional care and promote include psychological violence, online violence community based alternative care. and peer violence. Other recommendations received from the Committee were related b. The framework of child to prevention of violence, awareness-raising protection services and screening of professionals in contact with children. The national Coordination Body The Constitution specifies that the State for Protection of Children from Abuse and provides for the social protection and Neglect was established to monitor violence

287 MYLA (2019) Skopje op cit 288 CRC/Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families Joint general comment No. 3 (2017) of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families and No. 22 (2017) of the Committee on the Rights of the Child on the general principles regarding the human rights of children in the context of international migration OHCHR (16 November 2017) Geneva available at http:// www.refworld.org/docid/5a12942a2b.htmlhttp://www.refworld.org/docid/5a12942a2b.html and CRC/Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families Joint general comment No. 4 (2017) of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families and No. 23 (2017) of the Committee on the Rights of the Child on State obligations regarding the human rights of children in the context of international migration in countries of origin, transit, destination and return OHCHR (16 November 2017) Geneva available at http://www.refworld.org/docid/5a12942a2b.html 289 Defence for Children International (DCI) Belgium has already developed such a framework. See Grabdfils S. et al PRACTICAL GUIDE Monitoring places where children are deprived of liberty DCI Belgium (2016) Brussels 290 See http://www.europeanrights.eu/public/commenti/BRONZINI-12_-_Lanzarote.pdf 291 See https://www.coe.int/en/web/istanbul-convention/-/-the-former-yougoslav-republic-of-macedonia-ratifies-the- istanbul-convention 68 292 Minton SJ et al (2018) op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA against children but CPR 2019293 noted a comprehensive and cost-effective family need for improved coordination and stronger support service, and these links do not seem enforcement of legislation. to be in place in the current model. Thus, while there are some inter-agency initiatives at Both the Family Law and the Child Protection local level, they tend to develop occasionally Law assign the primary mandate for child rather than as any part of a planned strategy protection to the local Centres for Social Work that supports a holistic approach and enables (CSWs). There is a network of thirty CSWs consistent rationalisation, expansion and nation-wide with authority and responsibility development of services for children and to take action based on their own professional families, and best use of limited resources for assessment or on reports by police, health and clients’ benefit. education institutions, parents or neighbours. Based on SSO data (2015), the VAC 2018 Child protection is just one element of a study calculated that the CSWs employed broader responsibility for provision of social 586 professional staff throughout the country services that also includes administering - 267 social workers, 60 educators, 80 of the cash benefits system. Previously, psychologists, 37 special education teachers, social workers’ time was disproportionately 50 sociologists, and 92 lawyers. The CSWs’ taken up with social welfare applications and remit spans three areas – preventive services; monitoring, and they had few resources to care and counselling services; and statutory draw on, other than residential homes and and protection services. institutions. The social welfare payment process has now been streamlined and Although municipalities have responsibilities automated to a great extent, and there has for provision of social services, the CSWs been significant development of community- have not been devolved and remain under based care and protection units in the past few direct management of the Ministry of Labour years. Two community-based housing units and Social Policy (MLSP). Most cover more have been made available to accommodate than one municipality. Directors of CSWs children from the Special Institution for are directly accountable to Skopje, although Disabled People in Demir Kapija and other their commitment is to provide quality local community-based housing units for children, services. Municipalities are represented on including foster family accommodation, have CSWs’ steering committees, but research294 been founded. In 2018 alone, three new crisis indicates that in many CSWs, the steering centres for victims of sexual violence were committees do not function at full capacity, established in Skopje, Tetovo and Kumanovo. and some municipalities do not nominate a There have also been changes in working representative to the steering committee at all, practices with the introduction of case or the municipal representative is not officially management to the CSW teams, but the CSW appointed by the municipal Government system is still overloaded and staff morale (and so lacks municipal authority). This is among CSW staff is reputed295 to be poor. unfortunate because, while certain aspects of social protection and care may require strong Despite the recent developments in central management, strong formal, statutory community-based care, the VAC 2018 study296 and mandatory links with the municipality indicates that North Macedonia has one of and other service providers at local level the lowest foster parent/guardian care rates in are essential for provision of a holistic, the region. It also noted that the country has

293 North Macedonia 2019 Report European Commission op cit 294 Bogoevska N. Analysis of the Institutional Framework of the Social Protection System in the Republic of Macedonia and proposals for Legislative Changes World Bank (2017) Skopje 295 See Ruda S. . Silva A./BIT Applying Behavioural Insights to Teachers’ and Social Workers’ Motivation UNICEF (2019) Skopje op cit 296 Minton SJ et al (2018) op cit. 69

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA the second highest rate of children in conflict The government identified nine victims with the law in the region. TransMonEE297 including six victims of sex trafficking in 2018. (Transformative Monitoring for Enhanced All nine were female and three were children. Equity) data298 for 2017 indicates a total of The government and NGOs also identified 104 1,586 registered juvenile offenders during the potential victims including 79 children. The year; 554 children charged with an offence, Ministry of Labour and Social Policy maintains including 19 girls; and 368 children convicted. mobile identification teams comprising social There continues to be an emphasis on workers, inspectors, and psychologists in five punishment and custodial sentencing, rather regions for vulnerable populations, including than prevention and rehabilitation. Judicial trafficking victims, which identified all 104 reform has been ongoing for some years, and potential victims and assisted 390 individuals. a national probation service is planned, which MLSP also dispatched social workers to would definitely improve standard of quality screen vulnerable populations at border social work services available to children. crossings and migrant and refugee camps The CPR 2019 notes299 that the rollout of but did not identify any victims through these probation was further delayed in 2018 until efforts. CRP 2019301 notes that additional probation officers were recruited for 26 basic shelters for victims of sexual and gender- courts. However, following the adoption of the based violence and human trafficking will be relevant secondary legislation in May 2018, the needed to meet the standards of the Istanbul courts have slowly started issuing alternative Convention. sanctions to detention. c. Equity North Macedonia was placed in Trafficking in Persons300 Tier 2 in 2018 as the government There are regional and urban/rural disparities was adjudged to have not fully met the between CSWs and although most social care minimum standards for the elimination of teams include social workers, psychologists, trafficking but was acknowledged to be making pedagogues and lawyers, not all these significant efforts to do so and demonstrated professionals are available in every CSW. The overall increasing efforts compared to the job descriptions of social welfare professionals previous reporting period. These efforts in the CSWs were overhauled after adoption included investigating, prosecuting, and of new legislation on social protection in convicting more traffickers; identifying more 2019. Many CSWs do not appoint managers potential victims; increasing resources for of sectors, and this reflects on the quality victim protection; and amending the penal and organization of the work302. Teams do code to include a non-punishment clause for exchange staff members and share resources trafficking victims. However, judges continued as required on a case by case basis and some to issue weak sentences, and corruption posts cover more than one municipality. and official complicity in trafficking crimes But resources and facilities are not evenly remained a significant concern. Furthermore, distributed, and some municipalities are better the government did not award grants to anti- resourced than others. The VAC 2018 study trafficking NGOs for the fourth consecutive also implies that there are regional disparities year, despite relying heavily on their support. in professionals’ understanding of child abuse

297 UNICEF’s Transformative Monitoring for Enhanced Equity database – statistics on women and children in Europe and Central Asia 298 Available at http://www.stat.gov.mk/TransMonee_en 299 North Macedonia 2019 Report European Commission op cit 300 Trafficking in Persons Report 2018 US Department of Labor (2019) Washington DC available at https://www.state.gov/reports/2019-trafficking-in-persons-report-2/north-macedonia/ Unless otherwise stated, the figures and data in the following two paragraphs come from the TIP 2019 report and are based on official data. 301 North Macedonia 2019 Report European Commission op cit 302 Bogoevska N. World Bank (2017) op cit. See also Mihajlova N. et al Assessment of alternative forms of care and family support services for children with disabilities UNICEF (2016) Skopje available at 70 https://www.unicef.org/northmacedonia/media/3726/file/MK_AlternativeCareCWD_Report_ENG.pdf

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA and in their commitment to reporting, or municipality and are therefore not subject to acting on, incidents of violence. This obviously professional standards or supervision, which impacts on the caseload of the local CSW. has implications in terms of children’s safety Most CSWs are responsible for at least one and the quality of the service supplied. day care centre for persons with disabilities, Given the passivity of many professionals or for older persons, shelters for victims of outlined in the VAC 2018 study, it is important domestic violence, group home or some that children themselves are empowered to such facility. However, data from field report violence against them. At present there research303 indicates that some of the day is no statutory mechanism of complaint for care centres are not open at all or have children, even in the Ombudsman’s office, stopped working. The access of children although children are frequently left to resolve with disabilities to the family support issues between themselves or are expected services is limited. Day Care Centres (DCCs) to report violence themselves directly to the tend to be concentrated in the bigger cities. teachers or psychologist. Such mechanisms Families of children with disability in rural should be developed in all child-related areas lack conveniently located services. institutions as a matter of urgency. Transport is only available to some of the While research305 indicates that many DCCs, and there are issues around area children in North Macedonia are at risk of of coverage, timing for picking up and abuse, particularly corporal punishment306, dropping off. In the majority of centres the and public campaigns and education are physical access via transportation is at a urgently required to redress this, some low to medium level of accessibility. Some children are definitely more vulnerable than DCCs are also catering to mixed groups others. It is generally acknowledged by of children and adults at the same time, all stakeholders that Roma remain at the which has safeguarding implications. The highest risk of poverty and deprivation and programmes for work are outdated in many are more likely to suffer discrimination, centres, and centres tend to focus on care social exclusion and prejudice than any other rather than supporting the child’s inclusion ethnic group. The Ombudsman’s Office307 in kindergartens and schools304. reports about 337 child beggars recorded on the streets in 2017, of whom 328 are There is a total of 4112 children with disability Roma of all age groups, including babies. registered by Centres for Social Work, i.e. One glance at the indicators308 in relation to 0.71% of the total population of 0 - 26 age Roma children explains why they are by far group. The actual number is likely to be the group most exposed to risk of violence, much higher, however, as many children abuse and exploitation in North Macedonia. with disability are not registered. The majority (92 per cent) of the children with Protection for children with a disability is disabilities live with their biological families. also acknowledged to be inadequate and Family support services are particularly weak in October 2018, the UN Committee on for children below 6 years of age; children the Rights of Persons with Disabilities from the autistic spectrum; children with recommended further efforts to guarantee mild to moderate disabilities. Many of those non-discrimination, to repeal provisions employed in Care Centres are not paid by the allowing involuntary deprivation of liberty,

303 Ibid. 304 See also Mihajlova N. et al Assessment of alternative forms of care and family support services for children with disabilities UNICEF (2016) Skopje op cit. 305 See Minton SJ et al (2018) op cit. 306 See GFK Skopje Survey on parents’ and caregivers’ Knowledge, Attitudes, Practices & social norms associated with Violent Forms of Child Discipline UNICEF (2017) Skopje 307 North Macedonia 2019 Report European Commission op cit 308 See Regional Roma Survey 2017. Country Fact Sheets Macedonia UNDP (2018) Bratislava available at https://www.eurasia.undp.org/content/rbec/en/home/library/roma/regional-roma-survey-2017-country-fact-sheets.html 71

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA to improve accessibility, to ensure inclusive Although official welfare statistics by ethnic education, etc. In 2018, the Ombudsman’s group are not available, the findings of the Office reported309 21 complaints related 2017 Survey on Quality of Life311 make it to discrimination against children with possible to correlate household ethnicity and disabilities. Children in migration, children living conditions. Ethnic Albanian households remaining in institutions and children in constitute more than 40 per cent of the detention are also particularly vulnerable to poorest quintile, with disposable incomes violence, abuse and exploitation although only two-thirds of their ethnic Macedonian there is insufficient data or documentation peers. Half of this difference persists even of their situation. after controlling for other sociodemographic characteristics. The Roma population is not 6.5 The right to survival only concentrated in the bottom 40 per cent and development but is also far below ethnic Macedonians in labour market outcomes, human capital, and Convention on the Rights of the Child310 Article other nonmonetary poverty indicators. 26.1: States Parties shall recognize for every child the right to benefit from social security, Among those with reason to feel left behind including social insurance, and shall take are rural families, those living in the northern the necessary measures to achieve the full regions, and ethnic minorities. Unemployment realization of this right in accordance with their is the most important predictor of poverty national law. and vulnerability in North Macedonia - high structural unemployment and low labour force a. Children living in poverty participation mean that half of all working-age and deprivation Macedonians have no work and, according to World Bank estimates312, ethnicity does Between 2009 and 2015, 240,000 citizens more to explain inequality in access to job of North Macedonia moved out of poverty, opportunities in North Macedonia than expanding the middle class from 29 to anywhere else in the region. Most of the live in 40 per cent of the country’s population. the north of the country. In both Northeastern However, despite its middle-income status, and Polog regions, in the extreme northwest North Macedonia is still poorer than most and northeast, poverty was close to 40 per EU countries, and almost one third of cent while poverty rates in Skopje, the capital, its population are considered vulnerable. and the Southeastern region remained close to Macedonians themselves seem to think the national rate, and poverty in the remaining there has been little progress in economic regions has fallen to 10 to 14 per cent. Poverty mobility and equal opportunities and the is also higher in rural areas313. 2016 EQLS noted that the standard of living (rated at 5.2 out of 10) is well below the Official figures indicate that remittances EU28 average (7.0). More than half of the contribute relatively little to household incomes respondents said that, due to persistent in North Macedonia. The World Bank calculate poverty and unemployment, they found it that in 2016 personal remittances represented hard to make ends meet, which is above the only three per cent of GDP, whereas in Albania, EU28 average. Bosnia and Herzegovina, and Georgia, the

309 265 Annual Report, 2018 Ombudsman of the Republic of Macedonia (2019) Skopje op cit. 310 https://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf 3 11 The Survey of Quality of Life in Macedonia was collected in May–June 2017. It was designed by the think-tank Finance Think and covered both individuals and households. It collected data on demographics, socioeconomic conditions, consumption, income, and labour market indicators, among other areas. See http://www.financethink.mk/models/ survey-on-quality-of-life-in-macedonia-2017/ It is quoted in Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank Group (2018) Washington 312 Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank (2018) op cit. 72 313 Ibid

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA figure was closer to 11 per cent314. According to exploitation and abuse. Children living in to SILC data315, in 2015 barely two per cent of poverty are those who experience deprivation Macedonian household incomes came from of the material, spiritual and emotional remittances. Yet a recent survey316 found resources needed to survive, develop and that youth migration from North Macedonia thrive, leaving them unable to enjoy their is to some extent related to demands of the rights, achieve their full potential or participate household economy, and that the pressure to as full and equal members of society319. A migrate is greatest amongst those marginalised rights-based analysis of child-poverty, therefore, by poverty – the unemployed; Roma; and young examines not just hard economic data but also people living with disability. Amongst the 44 access to services and children’s experience of per cent of families who received money from social exclusion and deprivation. The country’s children working overseas, about a third rely indicators in these areas are not positive and on that income for half or more of the family there is some evidence that households may livelihood. be finding it hard to protect themselves in cold seasons - in 2012 only 51.6 per cent of Children are clearly at high risk of poverty in North households were able to keep their homes Macedonia. Based on the Survey on Income and adequately warm320. Living Conditions (SILC)317, the State Statistical Office calculated the at-risk-of-poverty rate in In terms of social exclusion, various studies321 North Macedonia to be 22.2 per cent in 2017. But have found that the gap between rich and the at-risk-of-poverty rate was almost 30 per cent poor has widened in the last 10 years and for boys and girls aged 0-17, higher than for any only about 8 per cent of Macedonians other age grouping. When judged on the basis believed that their position on the income of household composition, the poverty rate was distribution continuum had improved between lowest (5.7 per cent) in single-person households 2010 and 2016, a period when poverty was of one adult, 65 years or older, and 14.2 per cent being reduced. Almost 60 percent think that for households without dependent children. inequality is rising. In 2016, North Macedonia However, it rose to 26 per cent for households scored 2.7 out of 5, on the Social Exclusion with dependent children and to 37.5 per cent Index (SEI) of the EQLS survey322, which is for single parent households with dependent based on questions about feeling left out of children. The highest poverty rate by far (51.25 society, experiencing complications in life per cent) was for households with three or more and feeling recognised. This is well above the children318. EU28 average (2.1).

However, children experience poverty differently b. The framework of social than adults because of their vulnerability, their protection services developmental needs, and because opportunities lost in childhood cannot be regained later in life. The design and administration of social Children in poverty are also particularly vulnerable protection measures is the primary

314 Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank Group (2018) Washington 315 Quoted in Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank Group (2018) op cit. 316 ZIvetz L./ Navanti (2019) op cit. 317 Sustainable Development 2018 SSO (2018) Skopje p70-77. The source for poverty calculations is incomes and the poverty threshold is defined at 60 per cent of median equivalised income 318 Ibid 319 State of the World’s Children, UNICEF, NY 2005 320 See Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank (2018) op cit 321 See for instance the Survey of Quality of Life in Macedonia available at http://www.financethink.mk/models/survey- on-quality-of-life-in-macedonia-2017/ and Seizing a Brighter Future for All Former Yugoslav Republic of Macedonia Systematic Country Diagnostic World Bank Group (2018) op cit. 322 Eurofound (2019) op cit. 73

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 74

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA responsibility of the Ministry of Labour and education, only 25 per cent of it relates to Social Policy. In North Macedonia, social children325. Conversely, North Macedonia’s protection is provided through a combination spending on social assistance, at 1.2 per cent of cash benefit programs and social support of GDP annually for 2014–17, is well below the and care services. In addition to this, social average (2.2 per cent) for the ECA region. protection can be supplemented by specific measures in employment, housing, child The administration of social cash benefits, protection, health, and education. Measures and the provision of social support and care in the area of social protection for children services is the mandate of the network of fall under four programmes implemented Centres for Social Work and other social and overseen by the Ministry of Labour and welfare institutions, as regulated by the Social Social Policy - child protection; social benefits Protection Law, the Child Protection Law, and assistance; institutional care; and extra- the Family Law, and related bylaws. Strategic institutional protection323. These programmes documents such as the National Strategy for are designed to work together to improve all Alleviation of Poverty and Social Exclusion children’s standard of living and quality of life, for 2010–20, the National Programme for the while at the same time creating conditions for Development of Social Protection 2011–21, care and protection of children from vulnerable and the Employment and Social Reform families and families at social risk. Programme 2020, set social protection objectives and specify what must be done to The Child Protection Programme includes four achieve them. inter-linked elements – statutory protection of children’s rights and professional support The main social assistance benefits to vulnerable families; access to community- administered326 by MLSP are - Guaranteed based support services; care and education minimum assistance; Disability allowance; of preschool children; and institutional and Allowance for assistance and care from community based alternative care options. another person; Salary supplement for part- The overall budget of the Ministry of Labour time work (due to the care of a child with and Social Policy takes a significant portion physical or mental disabilities); Other social of the overall state budget and deals with a allowances; Child allowance; Special child wide range of expenditures and investments allowance; Parental Allowances; Education ranging from social protection (which includes allowance; Social pension; Compensation in social assistance and social insurance) to early case of unemployment. learning, child protection and labour market policies. At about 14 per cent of GDP324, In May 2019, the country adopted a new Law North Macedonia’s total spending on social on Social Protection. The new law maintains protection, including social insurance, social non-conditionality, creates further financial assistance, and labour market programmes, is rights and integrates these with the social high compared to peer countries but at 10.5 services on offer. There is as yet insufficient per cent of GDP in 2017, pension spending research on the impact of the benefits package (old age, disability, and survivors’ pensions plus and administrative measures on family poverty, health contributions for pensioners) makes up but it has streamlined benefits to people with most of the total spending on social protection. disability, including children and families. Although total expenditure on social protection One of the most important changes brought is almost twice the total expenditure for about by the new law is the disentanglement

323 For a much fuller description and analysis see Bogoevska N. World Bank (2017) Skopje op cit. and Finance Think Policy Brief No.30 How much does the state allocate for education and social protection of children? UNICEF (2018) Skopje 324 Unless otherwise stated, figures in this paragraph are taken from World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit. 325 Finance Think Policy Brief No.30 (2018) op cit. 326 For a full overview of social protection programmes in North Macedonia see this link - http://www.financethink.mk/models/social-system-of-macedonia/ 75

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA of various disability benefits and the creation rearing tasks and involve financial transfers of a single disability allowance. This new to the child’s parent or guardian in the benefit extends the coverage to persons with community. However, there are also specific moderate and severe intellectual disability. financial assistance measures within the The placing of this right outside the group of social protection budget aimed at ensuring category-based and means-tested procedures care and development of children without is an important step towards universal full and proper parental care, or whose disability rights. The new disability allowance parents have lost or given up their right to incorporates two previously existing disability guardianship. The programme for extra- allowances – the Blindness and Mobility institutional protection covers two measures allowance, and the Deafness allowance. As a for children - placement in a foster family; and result of the new Law, people with disabilities organised living with support. The purpose of who live on a low income can also receive these measures is to ensure protection and the guaranteed minimum assistance, with an care of children in need of care, supervision increased equivalence scale. and assistance, and who lack adequate conditions for growth and development within Equally important are legislative changes their own families. related to social services for people with disabilities. The law introduces personal c. Equity assistance, home assistance and care services. Personal assistance is provided A significant share of North Macedonia’s up to 80 hours a month, and the potential social welfare budget goes to non-means beneficiaries are persons with severe and tested programmes. While spending on the profound physical disability and those who are non-means tested parental allowance has completely blind. Home assistance and care significantly increased since 2008, it has failed is also provided up to 80 hours a month, and to stimulate the birth rate as intended. There potential beneficiaries include: persons with was also a significant increase in allocations a profound disability, persons with combined for non-means tested disability-related social disabilities, completely blind persons, the benefits, although not to the same extent as elderly and others who need help and parental allowance, and it is unclear if this will care at home. Support for both personal continue under the new measures. Overall assistance and home assistance and care can spending on means-tested programmes fell be combined with one of the two financial from 0.82 per cent of GDP in 2008 to 0.6 per disability benefits: the disability allowance or cent in 2017 while spending on non-means the personal assistance and care allowance. tested programmes more than doubled.

Other social services introduced by North Macedonia’s high poverty rate, combined the new law include - rehabilitation and with the limited employment opportunities reintegration of persons with social and/or available to poor and vulnerable families, health problems; and respite care for family contra-indicates this shift in social protection members taking care of dependent family funding. Although poverty has declined post- members. It simplifies the system, which is an crisis and the living conditions of the poor have improvement for people with disabilities and improved somewhat, poverty and inequality are for the administration. still high compared to regional peers and most Most measures within the social protection EU countries327. According to SILC data, North system aim to support parents in their child Macedonia’s relative poverty rate328 was 22

327 Poverty Reduction, Shared Prosperity, and Inequality in North Macedonia in the Post-Crisis Period (2009-2013) World Bank (2016) Washington 328 The poverty rate is set at the 20th percentile of population distribution, which makes it possible to compare results over time and across countries. It is measured as the share of the population living below 60 per cent of the median 76 household per adult equivalent income.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA percent in 2016 but only about five per cent of Maximising social protection’s cost- Macedonians live in households where at least effectiveness and impact on children and one member receives targeted social assistance families would likely require a significant or related benefits. increase in coverage of families in the lower quintiles, and a massive redirection of funds Although social assistance coverage of the towards children and families generally and lowest quintile widened considerably from poorer children and families in particular. 27.2 to 33.9 per cent between 2010 and Social protection expenditure, as a share of 2016, generally, North Macedonia does not GDP and of total expenditure, increased by compare well with its regional peers. Other 30 per cent since 2010, and accounted for countries whose social assistance spending 20 per cent of total expenditure in 2018. The is similar, or even much lower, have much child protection element of the budget has better coverage rates and targeting of the had a very high growth intensity - it increased poorest quintile. For example, coverage of the more than three times, compared to the 39 poorest quintile is 80 per cent in Latvia and 90 per cent rise in wages. But this rise in the per cent in Romania. proportion of the budget allocated to children is most likely due to the introduction of the World Bank has calculated that without parental allowance for a third and fourth child, social transfers North Macedonia’s poverty which started in 2009, and whose costs have rate would almost double, reaching 41 per grown exponentially each following year. Other cent329. The withdrawal of pensions would programmes targeted at poor and vulnerable be felt most, even though pensions are children and families, accounted for only 6.6 not designed as anti-poverty measures. If per cent in the total social protection funds old-age pensions were discontinued, the allocated in 2010, and their share had fallen poverty rate would grow to 38 per cent to 3.9 percent in 2018. This includes funds but the termination of government social allocated for child protection institutions; and child protection benefits would have a construction, equipment and maintenance of more limited impact. This is due to the low child protection facilities, day-care centres and budget allocated to family and child related shelters for extra-institutional social protection, programmes. and conditional cash transfers.

329 See footnote 283 above 77

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA DRIVERS INEQUITIES RECOMMENDATIONS HUMAN RIGHTS SOCIAL EXCLUSION AND INEQUALITY POLICY AND BUDGET EDUCATION CHAPTER 7 HEALTH CONCLUSIONS AND CULTURE RECOMMENDATIONS PROFESSIONALS AND PRACTITIONERS STRUCTURES AND SERVICE DELIVERY CHILD PARTICIPATION EARLY CHILDHOOD DEVELOPMENT78 CHILDUNICEF PROTECTION AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 SOCIAL POLICY 7.1 Drivers of inequities constituency of support for children’s rights in North Macedonia. a. Lack of a human rights culture Although modernisation, particularly rapid North Macedonia’s transition to a democratic, urbanisation, is gradually changing traditional middle-income, pluralist state is well advanced, family structures, extended family remains and the political, legal and administrative a vitally important resource for mothers and frameworks are all in place to support children in North Macedonia and constitutes equitable, sustainable and rights-based the primary building blocks of the child’s development. But although it has adopted protective environment. However, social legislation, policies and strategies in line with norms in relation to children are neither rights- international norms and standards in every based nor necessarily child-focused, and many sector, progress towards achievement of parents have insufficient comprehension these standards is slow. Society generally of children’s rights and the value of a child- has not yet developed a human rights culture, rights framework for family life. Traditional and child-rights are not embedded in social gender roles still prevail in most families in behaviour or service planning. Although it is the country, with women held responsible a young state, it is an ageing society with a for care of the home and children, and men falling birth rate and much of its human capital contributing little practical help. Families’ eroded through migration. Children are not a expectations about women’s availability as high priority within government administration unpaid carers inevitably reduces demand for or wider society. The country lacks an agreed policy reform or service provision for children and explicit national strategy for promoting e.g. when child minding is available within the and protecting children’s rights and the wider family, parents tend to settle for that statutory body charged with oversight of the rather than advocate for more ECE places, Convention’s realisation appears to be defunct. which might bring greater benefit to the Civil society is still quite weak and there is child. These expectations, when combined no strong children’s lobby among NGOs, with concerns about social stigma, probably academia or the media. Much work remains exert a lot of pressure to maintain children to be done to strengthen and extend the with disability at home. There is a clear need 79

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 2019 for strong public education campaigns about and social exclusion attached to poverty, so the value and benefits of a child rights-based relationships between duty-bearers and rights approach to child rearing and family support in holders are often tainted by misunderstanding, North Macedonia. lack of empathy and stigma.

Children themselves are not really considered Although North Macedonia aims at being a rights holders in the families or communities. truly pluralist society, at present it remains They are usually perceived as passive divided geographically and socially by ethnicity, recipients of care and protection, rather than and most families still live in relatively tight young citizens and their views are seldom communities, with only minimal interaction sought. There are very few mechanisms for with members of other ethnic groups. This them to input into decisions that affect them is particularly the case for Roma families. and even these are often ignored by adults. Interaction between Albanian-speakers A growing number of youth organisations are and Macedonian-speakers is increasing in challenging this mindset, but their focus tends response to government initiatives, but ethnic to be on young adults rather than children. segregation in schools and communities Children’s views are seldom sought when is still the norm. There are also a strong planning services and, as a result, programmes urban/rural differential, and significant, and are seldom planned or delivered in either widening, socioeconomic gaps between a child-focused or rights-based way, which regions, particularly between Skopje and the inevitably reduces their efficiency, relevance rest of the country. While regional and rural/ and cost effectiveness. Although the new urban gaps are noted in official statistics, law on public education mandates expanding differentials based on ethnicity are less openly opportunities for young people to input into acknowledged. It is important that ethnic decisions that affect them, the potential for differentials and inequalities are explicitly children’s voices to be heard is still quite identified and addressed, at least in relation to limited and this needs to be addressed children, in order to ensure that equity gaps within a wider movement to strengthen and are closed and that the spirit and letter of extend active public participation in policy Article 2 of the Convention is fully respected in development and programme planning. North Macedonia.

b. Segregation, social exclusion Despite an explicit constitutional and and inequality political commitment to equality, gender inequality is still very much a social norm Although the small size of the country and impeding progress towards a human-rights population gives an impression of social culture in North Macedonia. Women’s cohesion, the Republic of North Macedonia is roles, responsibilities and authority in family, quite a segregated and stratified society whose community and society are clearly subordinate Gini coefficient indicates a high level of inequality. to men’s, and this cuts across all population Community still tends to be defined by ethnicity, categories, age groups, socioeconomic and social norms and patterns reinforce ethnic groupings, geographic regions, and ethnic segregation rather than social inclusion, although divides. In practice, this means that women some social institutions are consciously seeking and girls carry a larger share of the burden to redress this. Tradition emphasises family of poverty and multiple deprivation, and thus kinships and community solidarity over social benefit more slowly from rising prosperity. networks, and traditional gender differentials Gender stereotyping is also a significant are widely accepted. The EQLS 2016 study330 enabler of the domestic and gender-based confirmed high levels of perceived stigma violence that is still far too prevalent among

80 330 Eurofound (2019) op cit.

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Macedonian families. The situation may be child-focused analysis of North Macedonia’s changing gradually, especially in relation to budgeting processes, funding allocations women’s and girls’ participation in the formal and expenditure is urgently required. One institutions of the country but there is still local study333 has calculated that total budget some way to go in relation to the gender pay funds allocated to programmes for children in gap and employment opportunity, family roles 2018 were MKD 22,976 million, or EUR 374 and community expectations. There needs to million. This is an absolute rise by 42 per cent be a significant investment in gender equality compared to 2010, but when calculated as a and the equal opportunities institutions need share of GDP, the allocations to programmes to be strengthened considerably, if North for children declined from 3.6 per cent in 2010 Macedonia is to benefit as it should from to 3.2 per cent of GDP in 2017, and 10.2 per women’s full, active and equal participation cent of total expenditure. in the country’s development. Changing boys’ and girls’ attitudes towards gender The cost-effectiveness of the current spending stereotyping and gender imbalance has to be patterns among child-related services raises an important element of any change strategy as many concerns as the inadequacy of in this area. their budgets. Government funds in some instances subsidise higher earners, rather than c. Legislation, policy and budget supporting families in need e.g. subsidies to kindergartens. These instances raise concerns In general, the necessary legislative and policy about planning, budgeting and decision-making frameworks are in place to facilitate children’s processes generally, and the quality of the data access to their rights, although, inevitably, not underlying them. Although areas like health all of them are fully aligned with the principles and education are generally well researched and provisions of the UN Convention on the and have solid baselines and data collection Rights of the Child331. Policy formulation and processes in place, vulnerable groups like development has improved considerably in the children with disability or Roma children lack past years, but previously legislation was often the necessary data in the required format. developed and adopted at a very fast pace, Long-term development and opportunity with little input from practitioners, experts costs and benefits of particular services or civil society, sometimes in response to are seldom factored in, and the ability to external pressure. It may be that legislative cost alternative models of delivery is largely reform is still needed in many areas but missing. As a result, service development the main thrust of the CRC’s Concluding often comprises adaptation or reshaping of Observations332 on legislation was the need existing models rather than introduction of to ensure that it is implemented in practice. entirely new concepts or practices. Better Literature review and key informants both quality data is needed for evidence-based confirm that this is still the major issue in policy making, particularly cost/benefits relation to law and policy. analyses of existing programmes and alternatives models of delivery. Insufficient budget is a significant barrier to implementation. Although North Macedonia The current government has introduced is relatively poor by EU standards, it has measures to combat corruption and strengthen now achieved middle-income country status. transparency and accountability, but these However, it still allocates proportionately principles are not yet embedded in organisational less of its budget to children’s sectors than culture, and resource allocation processes are equivalent countries in the ECA region. A full still not totally protected from political influence.

331 See Davitkovski B. et al Comparative Review of Legislation in the Republic of Macedonia and the Convention on the Rights of the Child, Ministry of Justice Republic of Macedonia, Skopje, May 2010 332 Concluding Observations: former Yugoslav Republic of Macedonia CRC (June 2010) Geneva op cit 333 Finance Think Policy Brief No.30 (2018) op cit. 81

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA North Macedonia registered the lowest average Another significant factor impacting negatively trust in national institutions, particularly local on the realisation of children’s rights is the fall in government, among all the candidate countries the quality of professional education available in in EQLS 2016334. A proposed functional review key child related areas. North Macedonia spends of government institutions may be a good less on tertiary education than peer countries – an opportunity to introduce child-centred, family- estimated 0.4 percent of GDP in 2015 compared friendly and rights-based principles, concepts with an OECD average of 1.1 per cent337. As a and models of service delivery into North result, universities lack the infrastructure and Macedonia’s public service structures, systems resources they need to improve their teaching and institutions. quality, and this inevitably impacts negatively on the professional degree or qualification obtained d. Personnel, professionals by graduates. This needs to be addressed and practitioners. urgently before the absence of quality entrants combines with retirement of experienced staff The politicisation of public services acts as to literally hollow out services’ capacity to deliver a major bottleneck in terms of developing, child-related services at all. implementing and accessing services. Public appointments, resource allocation and Government initiatives to improve the ethnic programme development can be influenced representativeness of the public service by political processes, and even if they are are proving successful but it may be some not, the public perception that they are time before there is a sufficient cohort of inevitably acts to mute complaints of bad skilled, qualified and experienced staff able to service or discriminatory practice. Eighty- properly service ethnic minority communities. seven per cent of respondents in the CYSA It is important to establish creative interim survey335 believed that it would be difficult to arrangements that not only provide a full and get a job in the public service if their family proper service but also address the underlying did not have the right connections, and the inequalities between ethnic groups. public service is seen by young people336 as bloated, with staff whose qualifications e. System, structures and are poorly matched with their jobs. The service delivery Law on Public Sector Employees stipulates merit-based recruitment, but it is not fully Significant barriers to children’s access to applied. Despite considerable investment their entitlements occur at the interface in public service reform, an effective and between centrally-defined legislative, policy comprehensive performance management and strategy frameworks and local service- system is still not fully in place. The grounds delivery mechanisms and management for dismissal are opaque and no decision has systems. Devolution of responsibility, resources been taken yet on how to deal with public and authority for service development to employees not showing up for work. Other the municipalities is a key element of the factors that impede policy formulation and government’s development model and a service delivery in every sector include an programme338 for implementing decentralisation ageing workforce, poor staff morale and rigid, has been in place since 2011. But service hierarchical and centralised management provision remains patchy at local level and chains that disempower local managers and different sectoral models of decentralization professionals. apply to different children’s services, impeding

334 Eurofound 2019 op cit 335 Ibid 336 ZIvetz L./ Navanti (2019) op cit 337 See World Bank North Macedonia Public Finance Review: Sowing the Seeds of a Sustainable Future op cit. 338 Programme for Implementation of the Decentralisation Process and Local Self-Government Development in the 82 Republic of Macedonia 2011-2014, Ministry of Local Self-Government (2011) Skopje

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA development of a holistic, integrated rights-based f. Children left behind approach to meeting children’s needs. The whole framework for realising children’s Criticism at central level tends to rights in North Macedonia needs to be emphasise political patronage and overhauled and reinvigorated, to ensure municipalities’ reluctance to raise revenue that all children are given the opportunity to or rationalise service provision, but develop to their full potential and experience there are also real problems with budget the love, affection and support that is their distribution formulas and mechanisms for due. However, some groups within the child selecting which municipalities get what population require intense, concentrated and funds. The current system for transferring urgent action to mitigate the poverty, exclusion funds from central to local level does and overt discrimination they are enduring. not address the social and economic Roma children have to be a priority‑. Eighty- disparities between municipalities caused seven percent of Roma children born in by location, population size, expenditure North Macedonia will face severe material needs, differing economic bases and deprivation compared to 55 per cent of non- capacity to generate revenues. Many Roma children living in the same vicinity. The municipalities are unable to finance some breadwinner in their family is three times of their basic functions, and critical services more likely to be unemployed and they are like education are underfunded. Revenue twice as likely to live in an overcrowded home, from local taxes represents only one third with only a 75 per cent chance of having an of municipalities’ revenue, and the balance inside toilet. Twenty-eight per cent of Roma has to be met with transfers from central families live in poor neighbourhoods, in badly government. Block grants account for about constructed housing that often lacks formal 80 per cent of these transfers and for about registration. A Roma child is also more likely half of municipalities’ total revenue but their than a non-Roma child to lack the full series value as a percentage of GDP has declined, of vaccinations and the frequent absence of and the current level of funding they adequate drinking water, electricity, heating or provide is inadequate. sanitation contributes to widespread ill health.

Local taxes and fees have not been able to A Roma child has only a 1 in 7 chance of keep pace with the devolution of responsibility attending pre-school compared with a 1 in 3 for expenditure to local level, especially in chance for their non-Roma neighbour. Roma rural and small municipalities with small children are highly likely to suffer bullying and tax bases. Action to address these gaps discrimination and one Roma child in ten will has to include building capacity for raising, drop out of school. Two out of five will attend a accessing, absorbing and using funds, segregated school and receive a poorer quality but also developing mechanisms for inter- education than their non-Roma peers. Only sectoral and inter-municipality cooperation one in three will complete secondary school to share and consolidate children’s services. and only three in every hundred will complete There is at present no agreed mechanism university – less than one tenth the proportion or format that allows local government units of non-Roma graduates. Three quarters of to plan children’s services holistically or Roma youth are unemployed or not in training even strategically in a way that facilitates compared with less than one third of non- coordinated and cost-effective provision Roma youth, and so the generational cycle of for families in local communities. It would poverty continues. These issues cannot be be valuable for key actors to discuss the resolved solely through the National Strategy development of a child-friendly budgeting and for Roma Inclusion, which is not a child- planning format with the Association of the focused document. Meeting the State’s and Units of Local Self-government of the Republic society’s legal obligations to Roma children of North Macedonia. requires introduction of programmes of 83

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA special measures in all sectors, designed and Commission on the Rights of the Child developed in cooperation with Roma families (NCRC) needs to be revived, strengthened and communities. and resourced. The administrative set-up, structure, authority and mandate of the Other children in need of special programmes National Commission must be reassessed of protection and support include children and adequately adjusted to serve its with disability, particularly those remaining important role in the entire child rights in institutions. Although the government’s eco-system. One of the Commission’s programme of deinstitutionalisation has been core tasks should be extending the successful, experience from other countries constituency of support for children’s is that a small number of children remain rights and engaging a wider range of in residential care for considerable periods duty-bearers in research, advocacy and of time. The risk of abuse and exploitation programming for and with children. All remains high for these children, together duty-bearers should seek to engage the with children in jails, correctional centres, burgeoning business sector in promotion reception centres and other less visible places and protection of children’s rights and of detention, psychiatric hospitals and other lobby with them for a fairer and more institutions, and this risk is usually exacerbated equal society that supports every child to by social isolation and reduced visibility. A realise her or his full potential. strong monitoring framework needs to be put in place as soon as possible, as well as access 2. The second recommended priority for to independent complaints mechanisms, to the NCRC is leading public education ensure that their best interests are placed at campaigns to explain to key decision- the core of any and all services designed for, or makers and the general public how delivered to, them. adopting a rights-based, equity-focused approach to meeting the State’s Children in migration and those who have commitment to children under the UN been returned as failed asylum seekers Convention on the Rights of the Child are also particularly susceptible to abuse can bring benefits to everyone in North and exploitation, and existing services do Macedonia. The Commission should, in not adequately serve their needs. These particular, strongly promote investment in are vulnerable child populations that could MCH, ECD and social inclusion initiatives potentially expand rapidly in the next few years that have a high rate of return for society. but it is not clear that this has been sufficiently factored into service and resource planning. 3. The NCRC should develop a strategy for Children and young people who identify as improving the quality of statutory decision- LGBTI also seem to be at high risk of violence making processes relating to children, and abuse, but there has been insufficient and set out clear expectations for all research undertaken to establish the extent Ministries and Departments in relation or nature of the threat to them. The current to consultations with children, family and statistical base may need to be amended to civil society; inter-sectoral coordination; enable proper and adequate service planning accountability and transparency; for all these groups. addressing gender inequality and other differentials; and promoting social 7.2 Recommendations inclusion. The NCRC should also facilitate development of clear cross-sectoral a. General recommendations strategies to address the social exclusion of particularly vulnerable populations of 1. A new National Action Plan for Protecting children including Roma children, children the Rights of the Child needs to be with disabilities, migrant children and developed urgently, and the National children in detention or institutional care. 84

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA 4. The Government needs to urgently active part in public discourse and to develop and implement a child friendly make their opinions and ideas known. Emergency Preparedness Plan (EPP) The number and scope of organisations that prevents and mitigates the impact and initiatives in North Macedonia that of potential climate related or man-made facilitate children’s involvement in public disasters on children and strengthens life is quite limited, so all development families’ and communities’ resilience and actors need to proactively support capacity to avoid, survive and recover from the expansion of current mechanisms the consequences of such disasters. and models for children to participate in decision-making that affects them. 5. All duty-bearers need to cooperate to Child participation should be promoted avoid a potential workforce crisis in and facilitated as an approach, and an children’s services and devise a strategy essential strand of public discourse and to improve the standard, qualification service planning. and capacity of young professionals joining children’s services or agencies, 2. Special attention should be given to and to retain experienced staff. The ensuring that models and mechanisms strategy also needs to address how of child participation are inclusive and do to build management and professional not follow existing patterns of inequality. capacity and accountability; boost staff Particular initiatives are required to morale through ongoing, expanded and facilitate interaction and dialogue across regularised professional development; and ethnic divides and extra resources are remove existing barriers to good practice required to address the barriers to full and full access to quality services. participation in society faced by girls, Roma, children with disability, children of 6. All institutional stakeholders need to poor families and children living in rural improve and expand the range of guidance areas. The NCRC should ensure that these available to families about how to access groups have opportunities to feed into their entitlements. In line with Article 2 national strategy planning. of the UN convention on the Rights of the Child, all material related to children’s 3. Despite the existence of child-rights rights and entitlements should be modules in local media education and published in Macedonian and Albanian and training courses, children’s rights to translation into other minority languages privacy continue to be abused in the should always be available. media, while child-related issues and situations continue to be marginalised, 7. National data collections systems and misrepresented and sensationalised. mechanisms need to be upgraded to Children and young people should be ensure that there is sufficient data supported to challenge poor practice available to support evidence-based policy in the media and should be enabled formulation, programme planning and to actively shape, design and lead a service development related to children, campaign to raise press standards around and particularly in relation to vulnerable children’s rights. populations of children e.g. Roma children, children in detention, migrant children. c. Early childhood development

b. Child participation 1. Given the low level of enrolment in pre-school education, public education 1. In order to develop a genuine human campaigns need to continue to promote rights culture, children and young people the importance of appropriate care, support need to be supported to take a more and stimulation in the early years of life. 85

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA One strand of this campaign should aim at being and social development should be creating a strong demand for appropriate concretely acknowledged by significantly quality ECE services, by creating awareness increasing the proportion of the national of their immediate and long-term benefits to budget assigned to education, to at least the child. A second strand should emphasise bring it into line with EU averages. the social benefits to communities and society generally and demonstrate the 2. Every school development plan should existence and value of appropriate models incorporate a specific strategy to reduce that can be replicated quickly and cost- the non-attendance rate, especially by effectively. Their value in promoting social Roma children. Special budgets could inclusion and ethnic integration should be a be allocated at central and local levels key message. that provide incentives to schools and municipalities to increase attendance and 2. A range of ECE approaches should be completion rates of children from poor and promoted including reform of the existing marginalised communities. kindergarten network and development of private, NGO and community ECE 3. There should also be at least one child- centres. There needs to be a specific friendly complaints mechanism in each programme to develop ECEs in minority school and addressing such complaints areas that address the particular linguistic should be a mandatory duty of both the and cultural needs of children of minority School Board and the Children’s Council. populations. The use of ECE assistants Child representatives and teaching staff from local ethnic minorities should be should receive training and support in developed and should be mandatory in any developing mechanisms for enabling municipality with a substantial minority participation and dialogue. population. Minority populations should also be supported to develop their own 4. The current teaching module on Children’s local ECD centres using teachers and Rights should be strengthened to promote assistants from their own and the majority gender equality, social inclusion, multi- populations. However, the curriculum, culturalism and pluralism. Students management arrangements and staff of and teachers should be encouraged to all ECE centres should be able to facilitate undertake specific initiatives around these the needs of all excluded children and topics as part of the child-rights module. promoting social integration, socio- emotional development, diversity and 5. All schools should aim to be multi-ethnic, multi-culturalism should be built into all multi-cultural and to eliminate segregation ECE-related curricula, material and training. of pupils based on mother tongue or disability within a short period. Curricula, 3. Kindergarten curricula needs to be adjusted textbooks and materials should be to allow for a greater allocation of time and reviewed and revised in the spirit of Article resources to educational and developmental, 29 in order to prepare ethnic majorities as opposed to child-minding, activities. for greater inclusion of minority groups, A special programme may be required and to promote diversity in society. There to develop ECE modules, materials and will need to be significant investment in equipment designed to address the needs of teacher-training, to ensure that children children with disability. master the language of instruction and that teachers are trained in how to assist d. Education children in mastering it. The current programme to expand the number of 1. The value of basic education in terms ethnic minority teachers should be fully of promoting equity, prosperity, well- supported by all stakeholders, but while 86

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA it progresses, municipalities should be should allow for, and ideally aim at, full obliged to provide Teaching Assistant integration of every child into mainstream posts to schools with significant ethnic classes eventually. minorities, children with disability and other special needs children. 10. Legislation is required to confirm social inclusion. It may be that financial support 6. Given national commitments to enrol all is required to facilitate transformation of children with disability into regular schools existing segregated schools into multi- and to enable migrant children to access ethnic classes, but mechanisms and schooling, teacher-training needs to materials also need to be developed prioritise cultural sensitivity, multicultural that promote respect, tolerance and teaching and how to combat prejudice and acceptance and proactively challenge stereotyping in the class. prejudices and ethnic stereotypes among students, families and staff. Teachers’ 7. The Ministry of Education and Science need for further training and greater should strictly enforce regulations in professional support around special needs relation to school transfers to prevent should be accommodated as a mandatory excessive leakage from Roma inclusive element of mainstream teacher-education, schools. There also needs to be more in-service training and support systems. public education and advocacy challenging non-Roma perceptions of Roma children 11. An independent analysis should be and families and calling out stigma against conducted of the disparities between Roma schoolchildren. municipalities and how these impact on students’ education. This should inform 8. The number of children with disability a comprehensive review of the existing attending local schools should be noted formula and processes for allocating annually, as well as the numbers of block grants that focuses on how best children not attending school at all, and a to guarantee every child a quality, special review should be initiated if these inclusive education. stray too far from the national average. This assessment should also analyse e. Health the number of Roma children attending special classes and whether or not this is 1. Given the significant impact that disproportionate. environmental, social and economic factors have on children’s health, 9. Given the adoption of the ICF a national plan to address poor air assessment format, the whole special- quality and other environmental health needs assessment procedure needs to concerns in North Macedonia is required be brought into line with international urgently. This will require a strong best practice, particularly the criteria equity focus to address regional and and techniques used by the assessment urban/rural disparities, but the housing commissions. Safeguards need to and environmental conditions of Roma be put in place to ensure that factors families should be prioritised and may relating to the child’s language, lifestyle, require discrete initiatives to bring culture or ethnicity are recognised and children’s housing up to established are not allowed to skew assessments acceptable standards. Provision of clean inappropriately, particularly when drinking water for all families should be a Roma children are being assessed. The priority objective. procedure should focus on development of individual educational plans for 2. There needs to be an increased budget every child subject to annual review. It allocated to health in order to bring it up to 87

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA the EU average, and a reallocation of funds and the lack of any formal coordination within the overall budget is needed to or interaction between patronage nurses strengthen MCH services and to address and primary healthcare physicians acknowledged disparities in health and (gynaecologists) needs to be resolved as a well-being indicators based on geography, matter of priority. socioeconomic status and ethnicity. In particular the comprehensive package of 6. Reproductive health, mental health, and MCH entitlements should be clarified, adolescent health all lag behind other publicised and enforced consistently sectors in terms of resources, personnel through all regions and municipalities. and service delivery. While strengthening MCH services has to remain the priority, 3. Those health projects that successfully it will be important to balance health reached out to Roma as part of the reform to ensure that the health needs Decade of Roma Inclusion initiative, e.g. of older children, adolescents and young Roma Health Mediators and vaccination people are also addressed adequately and campaigns, should be mainstreamed satisfactorily. to address the institutional problems blocking access to health services for f. Child protection many Roma families. In view of the Roma community’s extremely poor health 1. Capacity development and management indicators, the employment of Roma structures need to be upgraded and Health Mediators should be regularized, adapted to ensure adequate response to and the service should be extended to all the needs of children and families in the those municipalities with significant Roma child protection system. Further resources minorities as soon as possible. are required to bring child protection professionals up to full strength and 4. The process of allocating primary health professional accountability, monitoring care staff and resources, and particularly and evaluation, and quality control gynaecologists, needs to be examined mechanisms need to be strengthened urgently and a system developed that within the system. ensures fair and equal distribution of medical and nursing personnel across 2. Although, notable progress has been every municipality. The agreement made in adopting strategic documents between the Ministry of Health and the and reforming legislation, progress in medical associations may have to be implementation is still limited and without updated to ensure that the government sufficient budget allocations. Further can fully meet its commitment to universal investments are required to ensure a health care and safe motherhood. strong and fair justice for children system in the country. The management and 5. The capacity of the community nursing coordination mechanisms must be put and midwifery services, including in place to support children’s equitable patronage nursing, needs to be increased access to justice and provide clarity of significantly, and the coverage, scope, roles and accountabilities, while access reach and quality of the service should be to adequate staff, services, facilities strengthened and extended. The nursing and information should be available for service’s role, remit and authority within all children. In addition, it should be the MCH system should be clarified, ensured that procedures and practices updated, upgraded and expanded as in the justice system and related appropriate. Urgent measures need to support services adhere to national and be put in place to develop and maintain international quality standards. Even a suitable cadre of professional expertise more, social norms should be conducive 88

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA to children’s equitable access to justice, reception centres and other holding while the individual beliefs and practices of facilities and insist that any facility where both providers and the population support children are held in State care has an children’s equitable access to justice. independent complaints mechanism, easily accessible to children. 3. Ministry of Labour and Social Policy should cooperate with local authorities, 7. Targeted interventions need to be put in the Ministry of Education and Science and place to provide protection to the most other ministries, parents’ associations vulnerable children, including children and disability organisations to establish in the streets, children forced into early the location, situation, needs and marriages, children affected by migration, care arrangements of the CWD not both statutory and community-based, yet registered with social services. In depending on the specific context of the developing and expanding the national child and the family. network of community-based services available to CWDs, it is recommended that 8. The sense of mandate, ownership and a priority is given to transforming Day-Care accountability amongst all professionals Centres into support services to facilitate across sectors needs to be reinforced children’s inclusion in mainstream to ensure best protection of children at education and access to support services. all stages. This includes intersectoral collaboration, information and data sharing, 4. Development of a strong NGO sector referral and multi-sectoral interventions. concerned with protection of children should be supported in cooperation with g. Social policy other stakeholders, including children, parents and communities. MLSP may need 1. Since the social protection system is to develop or adapt a regulation, monitoring likely to be the main support of many and support framework to encourage poor families for some time to come, the NGOs to undertake research and develop overall allocation of resources to it, and the services in this particular area. distribution of resources within it, need to be reviewed in order to ensure a more 5. Education and awareness-raising child focused and family friendly approach campaigns aimed at public and to social protection, and a more effective professional audiences should continue use of available funds. In particular, there and expand. There should be a is a need to measure the impact on family particular campaign aimed at helping poverty of newly instituted changes that teachers, medical personnel and other target families in the lower quintiles. professionals to recognise abuse and report suspicions of abuse and respond 2. There is a clear need for a mechanism to accordingly. Trauma-informed capacity ensure effective linkages between social development for professionals, parenting protection programmes and the other support programmes for families and social sectors e.g. education, health, caregivers, and safe reporting and referral child protection. mechanisms for children (at home and in institutional settings) needs to be 3. There is also a clear need to generate supported to break intergenerational knowledge on child poverty to help policy transmission of violence. makers understand the nature of child poverty and the challenges that poor 6. Stakeholders should develop a strong, families face. Further research is needed independent monitoring framework to explore how child poverty relates to the for children in detention, institutions, overall poverty situation in the country; the 89

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA geographic distribution of child poverty; whole application process and timing of groups that are more likely to be poor; the the decision. major drivers of child poverty, etc. 6. There needs to be a comprehensive but 4. There needs to be consistent production in-depth analysis of Government spending and dissemination of accurate, on children – or on social sectors where comprehensive and easily understood children are key beneficiaries – that information related to entitlements and identifies areas of potential savings where benefits. This should include production of money could be transferred to child-related/ printed material in the relevant languages family and child benefitting budgets, as as well as print and media campaigns well as funds within current child-related related to specific entitlements. budgets that could be better-used. Information should be updated regularly in the electronic and print media. Information 7. A child-focused analysis of the current issued should include details of charges, decentralisation process is required costs and conditions. Municipalities and that identifies blockages and barriers to CSWs should also establish information adoption of a rights-based, child-focused, centres in key locations, modelled on the holistic approach to meeting children’s Roma Information Centres. needs at local level. As part of this review, municipalities should be asked to 5. Eligibility criteria for social benefits or examine the effectiveness and efficiency assistance should be standardised across of child-related health, education and the country and assessment procedures social services within their boundaries should be consistently applied. All social and recommend practical options to assistance programmes should use the improve their targeting, coverage, quality, same method of calculating the income of effectiveness and efficiency. Analyses of applicants and consider the same sources existing service delivery models should of income, the same household/family help build municipalities’ capacity to members and identical equivalence of develop new models that address local scales. To achieve this, all CSWs need to imbalances and inequalities. have their full quota of qualified staff to deal with the demand. Understaffing is Kevin Byrne a major barrier to access that affects the October 2019

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UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Annex 1: List of key informants

No. Name Agency Role

UNICEF

01 Ben Perks UNICEF Country Representative

02 Elspeth Erickson UNICEF Deputy Country Representative

03 Aleksandar Lazovski UNICEF Social Protection Specialist

04 Olimpija Grozdanovska UNICEF Child Protection Officer

05 Aleksandra Ivanovska UNICEF Child Protection Officer

06 Vera Kondikj Mitkovska UNICEF Education Specialist

07 Bore Pucoski UNICEF Programme Officer (Education)

08 Ardita Zekiri UNICEF Programme Assistant (Education)

09 Danche Gudeva Nikovska UNICEF Health and Nutrition Officer

10 Marija Makrova UNICEF CRM Specialist

11 Susie Pappas Capovska UNICEF Communication Officer

Government

12 Sanela Shkrijelj Ministry of Labour and Chief of Cabinet of Social Policy Minister

13 Biljana Trajkovska Ministry of Education and State Advisor to the Science Minister

14 Simona Atanasova Ministry of Health and Cabinet of the Minister Nutrition

15 Aleksandra Grozdanova Ministry of Health and President Nutrition - Immunization Committee

16 Ana Markova Committee for the Safety President of Motherhood and Infant Health

17 Natasa Stanjevik CSW Skopje Director

18 Ana Panceva CSW Skopje Head of Child Protection

19 Elena Ivanovska MoES Head of Sector Primary Education

20 Cena Caloska State Council for Vice president Prevention of Juvenile Delinquency

21 Mitko Cheslarov EBD Head of Sector 99

UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA Civil Society

22 Kiril Soleski ADICD CEO

23 Kiril Soleski Macedonian Medical Association

24 Dijana Despodov American Chamber of Dijana Despodov Commerce (AMCHAM) Executive Director AmCham Macedonia

25 Nadica Janeva ECD-COR

26 Biljana Ancevska ECD-COR

27 Aleksandra Temenugova Institute for Program Coordinator Communication Studies

28 Zaneta Trajkoska Institute for Director Communication Studies

29 Nikica Kusinikova Konekt CEO

30 Gordana Lazetic Ss. Cyril and Methodius Professor, Faculty of Law University

31 Vesna Turmakovska HERA Director

32 Lazar Nanev SPPMD Judge

33 Velka Lukic Macedonian Association of President Nurses and Midwives

34 Svetlana Crvenkoska MYLA Project Manager

35 Gordana Kolova National Youth Council Project Coordinator

Donors

36 Lela Jakovleska USAID Senior Education Specialist

37 Annabelle Regal EUD Programme Manager, Justice and Anti-corruption

Others

38 Vaska Bajramovska Ombudsman’ Office Deputy Ombudsman for the Protection of Children’s Rights

39 Ivica Stefkovski Entrepreneur/Parent

40 Filip Lokvenec Family Physician

41 Dzenifer Dzeladin Central European Roma researcher University

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UNICEF AN ANALYSIS OF THE SITUATION OF WOMEN AND CHILDREN IN THE REPUBLIC OF NORTH MACEDONIA United Nations Children’s Fund (UNICEF) Orce Nikolov 74, 1000 Skopje tel: ++389 2 3231150 fax: ++389 2 3231151 e-mail: [email protected] Follow UNICEF MK on Facebook, Twitter, YouTube and at www.unicef.mk