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

Chapter 4
28
The strategy was finally endorsed at the level of the Ministry
of Health as a decree, without the commitment of the
Government. The document is a technical paper and as
such meets international standards, but without indicating
funding, implementation mechanisms and capacities. Thus,
the strategy has a limited reference value and there has
been no follow-up at government level.
2.2. Is there a broad national policy for tackling
NCD?
The main problem is related to the fact that such strategies
or policies in Albania are often not backed up by operational
planning and earmarked budgets. It seems that the
process of developing long-term policies lacks the crucial
components that could ensure the implementation of the
strategy. Strategies are often launched with the financial
support of donors such as the World Bank. After the first
steps, however, implementation collapses owing to a lack of
financial (and general) sustainability.
Long-term policy documents with important impacts are
not always based on building and getting consensus from
the opposition parties, thus jeopardizing successful future
implementation. Political consensus building was totally
neglected in the preparatory process for the Strategy on
Health Promotion and Disease Prevention, and there was
no involvement of key stakeholders at the various stages of
policy development.
In planning strategies that explicitly require interinstitutional
or/and interministerial cooperation, experts from different
institutions are among the members of the working groups.
Representatives of civil society can be members of these
groups as well. A good example was the involvement of a
large spectrum of actors in the development of the Drug
Demand Reduction Strategy in Albania.
The Second Albanian Conference on Public Health in late
2006 (4) probably offered a new opportunity to raise
awareness of the need for a more strategic modus operandi
in NCD prevention. The Prime Minister, in his opening
speech, gave at least rhetorical support for such a development.
Nevertheless, commitment at governmental level
is likely to remain weak, and none of the key stakeholders
seems to have a clear idea of how to develop (using the
existing document) more broad, consistent and sustainable
action. Without such a development, however, NCD
prevention and health promotion in Albania may remain
fragmented and basically inefficient. Because of the situation
described above, the existing mechanisms and capacities
cannot be considered as sufficient for implementing a
strategy framework.
2.3. Values, principles and main policies
The Albanian Constitution declares that equality in health
care is a basic human right for all citizens. This normative
type of declaration does not seem to reflect entirely the
real situation of the Albanian transition.
At parliamentary level, the Health Commission has an influence
on legislation covering such issues as health protection
and health care financing. At present, the Commission plays
a very limited role in health promotion and disease prevention.
Because of the low prestige of the Albanian Parliament
(related to the sharp political divides) its potential to build
consensus for policy development to tackle NCD remains
limited in the medium term.
Apart from the Ministry of Health, there are a number of
ministries whose activities influence health. These include
the Ministry of Social Welfare, the Ministry of Education,
the Ministry of Culture and Youth and the Ministry of
Transport, all of which are entitled to make decisions that
may influence the health of Albanians. A special adviser in
health issues assists the Prime Minister to assess the impacts
of his decisions on the health of the population. (The
present Prime Minister has a medical background, including
WHO experience.)
Case studies: policy development in countries for tackling noncommunicable diseases