People in many parts of North Macedonia are exposed to more toxic particulate matter air pollution than their neighbors in Western Europe. The burning of solid fuels for heating in homes and other buildings is a main driver of high ambient concentrations of particulate matter air pollution, particularly during the winter months. The high levels of air pollution in the country have significant negative effects on human health and the economy. The Government of North Macedonia has recognized air quality management (AQM) as a key building block toward sustainable economic development, acknowledging the link between AQM and energy policy and its significant co-benefits for climate change mitigation. The cost of inaction is high, and the need for more effective AQM is evident. The objective of this institutional and functional review (IFR) is to provide insights and develop recommendations for strengthening the legal, regulatory, and institutional framework and capacity for AQM, enabling national and local authorities to deliver better air quality for their citizens.