Gaining health : analysis of policy development in European ...

Chapter 4
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Albania
Péter Makara & Zsófia Németh
1. Country profile
Albania is located in south-eastern Europe. It is bordered
by Greece, Montenegro, Serbia and the former Yugoslav
Republic of Macedonia. Unlike most of the inhabitants of
neighbouring countries, Albanians are mainly Muslims and
the official language, Albanian, belongs to the Latin family of
languages.
Albania has an area of 28 750 km 2 and a population of 3.1
million. More than half of the population live in rural areas.
Around a third of the inhabitants are under the age of
15 and 40% are under 18. The population grew by 1.2%
per year in the period 1980–1999, and the fertility rate in
1999 was 2.4 children per woman of childbearing age. The
fact that, according to the latest census, the population of
Albania fell slightly in the period 1989–2001 can only be
explained by extensive emigration.
Albania is divided into twelve administrative areas known as
prefectures, which are subdivided into several districts.
1.1. Socioeconomic development
Together with the Republic of Moldova, Albania is one of
the poorest countries in Europe. It enjoys impressive economic
growth but the proportion of the population living
in poverty, the unemployment rate and school enrolment
are nevertheless among the worst in Europe. Following
severe economic and social crises and emergencies in the
1990s and substantial emigration to neighbouring countries,
the political and economic situation stabilized somewhat.
The rate of unemployment fell from 10% to about 7% in
2005 and the proportion of those living in poverty fell from
25.4% in 2002 to 18.5% in 2005. Despite the great strides
taking place in development, the rural population is generally
still very poor, electrical supplies are insufficient and,
owing to regular power cuts, water supplies to households
suffer shortages. Nevertheless, government action has
resulted in a massive reduction in poverty, especially since
2002. This has been accompanied by significant regional
convergence, and poverty rates across broadly defined regions
have narrowed substantially. The Gini index had risen
to 30% by 2006, indicating an inequality level in the distribution
of income similar to other European countries (1).
1.2. The people and their health
Albania’s health outcomes lag behind those of other countries
in the WHO European Region. Life expectancy for
Albanians is lower than the European average, while infant
and maternal mortality rates (particularly in rural areas)
remain higher than the European average.
Poor living conditions, including overcrowding, polluted
environments and poor nutrition, result in low health status,
to which the health care services are unable to respond
effectively. Tuberculosis, eradicated during the communist
era, has reappeared as a result of poverty and overcrowding
in major cities. Albania is facing an increasing incidence
of NCD as the population ages. The greatest burden of
disease for men comprises the effects of tobacco and
alcohol use and high blood pressure, while that for women
comprises high blood pressure and obesity (2).
1.3. The main features of the health system
A basic PHC system was established prior to 1990 but in
1991 and 1992, and again in 1997, many PHC facilities were
closed. According to the Statistics Unit of the Ministry of
Health, the number of health centres fell from 702 in 1994
to 564 in 2000, while the number of health posts decreased
from 1973 to 1582 during the same period.
In rural areas, a typical health centre is staffed by up to
three PHC doctors plus some nursing staff. Most of the
Case studies: policy development in countries for tackling noncommunicable diseases