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

Chapter 4
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The directorates are accountable to both the IPH and the
Ministry of Health.
Health directorates used to be organized around separate,
vertically integrated services, such as maternal and child
health, but they have been replaced with a hospital directorate
and a PHC directorate. The directorates are administered
primarily through the Ministry of Health district
bureaucracy.
Following a government decree of July 2000, a new model
was introduced in the Tirana Prefecture (which includes
two districts) with the assistance of the United Kingdom
Department for International Development and the World
Bank. PHC services and public health programmes have
been integrated under the TRHA, a single organization
that is responsible for their planning and management. A
Regional Health Board has been set up to endorse the
proposed regional policies, plans and budgets. It is hoped
that this model will pave the way for the Ministry of Health
to delegate more authority and power to regional bodies.
2.4.5. Local government
The local authorities of all 315 rural communes now own
their PHC facilities and are thus partly responsible for
PHC. The Ministry of Finance gives them grants earmarked
for equipping, maintaining, operating and upgrading PHC
centres and posts, as well as for paying some staff salaries.
In urban areas, district offices of the Ministry of Health still
own and administer such services.
According to the report of the Second Albanian Conference
on Public Heath in 2006 (4), in some 9 months, 131
health promotion teams in 16 Albanian districts conducted
1834 health promotion activities reaching thousands of
villagers in need of information. Nevertheless, these actions
were fragmented, in most cases simply distributing poorquality
leaflets.
3. Smoking: a potential success story in
specific NCD policies?
Efforts to draft a law on tobacco and health began in 1999.
Since then it has been reviewed several times, but owing
to the lack of appropriate political commitment it was
not approved until 6 November 2006, when the Albanian
Parliament finally gave its blessing. This law, entitled “For the
protection of health from tobacco products”, was drafted
in the light of the WHO FCTC, which was ratified by the
Albanian Parliament on 26 April 2006.
In essence, this law represents a powerful effort by the
Ministry of Health to protect the health of citizens from
the harm caused by smoking and involuntary exposure to
tobacco smoke. It also aims to protect consumers from
more harmful tobacco products and to involve as many
stakeholders as possible. The key actors in attaining this
progress were a few committed and skilled prime movers
on behalf of government and NGOs, using the momentum
of the WHO FCTC and the beginning of Albania’s process
of accession to the EU.
The forthcoming challenge, perhaps even larger than the
approval itself, will be implementing the law, which will
require the serious commitment of all governmental structures.
The situation is still far from satisfactory: the prevalence
and public acceptance of smoking remains very high,
advertising is omnipresent, and cheap cigarettes are on sale
everywhere on the streets. The tobacco industry and trade
in tobacco products, including illegal trafficking, are backed
by very powerful vested interests.
Three surveys have already been carried out in the country
in collaboration with WHO and the Centers for Disease
Control and Prevention (CDC): a nationally representative
survey on smoking (8), gyTS (Global Youth Tobacco
Survey) and GHPS (Global Health Professional Survey) (9).
Thus a comprehensive information base for further policy
planning is available.
Case studies: policy development in countries for tackling noncommunicable diseases