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

Chapter 4
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for these organizations, and for the administrative districts,
to make quick decisions.
After the fall of communism, the Ministry of Health went
through a process of reform. It is now supposed to transfer
most of its managerial powers to the lower levels of the
health system, focusing instead on the macro-level regulation
of services and engaging in policy formulation and
long-term health development. In practice, it is still engaged
in many small administrative problems and conflict management,
which diverts attention away from long-term policy
development.
Interministerial and interinstitutional bodies improve the
coordination of policy implementation. These structures are
organized in committees covering such areas as nutrition,
water, drug prevention and third age issues. Most of these
structures operate under the leadership of the Ministry of
Health, but in some cases another ministries take the lead.
This happened, for instance, in the case of the Drug Demand
Reduction Strategy: after five years of failure, political
coordination was taken over by the Ministry of Public Order.
Nevertheless, interministerial bodies can be very fragile
structures with limited efficiency in decision-making. They
cut across the power hierarchy and lack a clear structure.
In the Albanian context, the development of strategies on
HIV/AIDS prevention (6) and reducing the demand for
drugs can be considered success stories in terms of involving
many stakeholders and incorporation of a broader vision
on health determinants.
The Mental Health Policy and Action Plan (7) will use existing
health and other social sector resources, including local
government, to provide access to mental health services
compatible with international standards. Activities include
the deinstitutionalization of psychiatric hospitals by expanding
mental health services to provide multidisciplinary care
in the community. Six mental health services are operating
on the basis of a community mental health approach supported
by donors.
The Government has pledged a high-quality and honest
health service with guaranteed access for all, and this will be
the aim of the new Health Sector Strategy.
2.4.2. Planning, regulation and management in the Ministry of
Health
The formulation and development of policies and plans
in the Albanian health sector have been affected by two
important factors.
1. Several consecutive crises (financial, social, political
and regional) have had a significant impact, forcing the
Ministry of Health to adopt a more reactive approach in
order to cope with the dramatic events of recent years.
2. The weak technical capacities of the staff in the Ministry
of Health have made it extremely difficult to formulate
policies, strategies and plans for the health sector.
Despite these difficulties, the policy-making and planning
process has slowly advanced, strengthened by a substantial
amount of external assistance and driven mainly by bilateral
and multilateral agencies.
The establishment of the Department of Policy and Planning
in 2000 was an important step in strengthening the planning
capacities of the Ministry of Health. The main considerations
in establishing this new department were as follows.
• As part of the decentralization process that has begun
in the country, the role of the Ministry of Health should
shift in the direction of policy-making, planning, regulation
and coordination.
• By developing a national policy and a comprehensive
strategic plan for the health sector, the Ministry of
Health will be more able to justify increased spending
on health care. The resulting policy and plan will also
Case studies: policy development in countries for tackling noncommunicable diseases