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

In the last seven years, Albania has developed two main
macro-level strategies with a direct focus on health:
• the Strategy on the Development of the Health System;
and
• the Strategy on Health Promotion and Disease
Prevention.
Other strategies and policy documents with a direct impact
on health include:
• the Drug Demand Reduction Strategy;
• the Mental Health Reform Policy Paper;
• policy documents related to alcohol and tobacco
control; and
• the Infectious Diseases Control Strategy.
During 2006/2007, at the request of the Ministry of Health,
WHO, the International Agency for Research on Cancer
(IAEA) and other international agencies supported Albania
in developing a National Cancer Control Programme,
but this did not appear to progress to concrete action and
implementation.
Other comprehensive strategies have been developed with
a clear link to tackling the social and economic determinants
of health inequalities. These strategies are not focused
directly on health but include components that reflect the
health of the population and health interventions. Such examples
are the Strategy for Social Inclusion and the Strategy
for Economic Development (5).
These latter two strategies are good examples of comprehensive
development policies fully incorporating the
broader determinants of health. The principles of equality in
health are embodied and explicitly expressed in both. The
frequent political crises of the 1990s and rapid changes in
the social structure were the greatest challenges to closing
the health equality gap and to achieving a coherent policy
for health and development in Albania. These conditions
pushed the political decision-making system towards crisis
management and unfavourable practices. The prerequisites
for long-term strategic thinking were often missing. Sometimes
long-term policies were clearly urged by foreign partners,
as in the case of World Bank projects. The example
of Albania clearly represents the dilemma of tackling crises
and emergency situations while introducing developmental
strategic elements into decision-making. In such conditions,
the process of policy development lacks the necessary dynamism
and commitment from Albanian stakeholders, thus
jeopardizing the sustainability of the process and successful
implementation.
There seems to be a high level of awareness among experts
and lower ranking civil servants of the need for comprehensive
approaches to health, involving various institutions and
tackling not only disease but the broader determinants as
well. This might be a good base for building stronger coordinative
mechanisms in the near future.
Taking all the above-mentioned factors into consideration,
in reality Albania is far from having a strategy-driven, coherent
process at government level for initiating a policy to
tackle NCD.
2.4. Structures and processes for implementation
2.4.1. The Ministry of Health: agent of change?
The Ministry of Health remains the major sponsor and
provider of health care services in Albania. The Ministry has
been reorganized, and it continues to assume the leading
role in most areas of health care. It “owns” most health
services, with the partial exception of primary care.
The Ministry of Health devotes most of its efforts to health
care administration rather than to policy and planning. Many
health care institutions (especially in tertiary care) are under
the direct administrative control of the Ministry of Health
and its small and overloaded staff, which makes it difficult
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Case studies: policy development in countries for tackling noncommunicable diseases