Background: A number of studies proved that social networks and social participation have beneficial health effects in Western countries. However, the evidence from Southeast European region is scant. We aimed to assess the extent of social networks and social participation and their relationship with self-perceived health status among older people in post-war Kosovo. Methods: A nationwide cross-sectional study was conducted in Kosovo in 2011 including a representative sample of 1890 individuals aged epsilon 65 years (949 men, mean age 73 +/- 6 years; 941 women, mean age 74 +/- 7 years; response rate: 83%). Social networks were assessed by means of number of friends and family members that participants had contacts with, whereas social participation by involvement in social groupings/organizations. Information on self-perceived health status and demographic and socioeconomic characteristics was also collected. Results: Overall, 93% of study participants reported that they had at least weekly contacts with more than one family member, and 97% reported daily contacts with their respective friends. Conversely, only 14% of participants reported engagement with social groupings. Generally, individuals who had contacts with friends and/or engaged with social organizations reported a better health status. Conclusion: Our findings point to strong family ties in this patriarchal society. Conversely, levels of social participation were considerably lower in Kosovo compared with the Western European countries. The low participation levels in social groupings and their putative deleterious health effects should raise the awareness of policymakers to improve the conditions and increase the degree of social participation among older people in transitional Kosovo.