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

The NGO “For a tobacco-free Albania” (10) has played a
prominent role in bringing the need for tobacco control into
the public domain. The NGO will play a continuing role in
reporting on the implementation of the tobacco control
law.
4. Infrastructure and resources for policies
to tackle NCD
4.1. Human, technical and financial resources for
health promotion and for policies to combat NCD:
a fragile basis
Human resources in health promotion and NCD prevention
are partly inherited from the previous health system.
The rest has been recently recruited through a “negative
selection” process from people trained in traditional medicine.
Before the 1990s, GPs in PHC were directly involved in
health promotion activities. Now, despite formal contracts
with the Institute of Health Insurance or the local health authority,
they focus only on curing patients because of their
basic interest in out-of-pocket payments.
The current Albanian education and training mechanisms
for preparing professionals in this field lag far behind European
standards. Despite an acute need for formal (advanced
postgraduate) and continuous (supervised development
of practical skills) training, little was done before 2005.
Before 2000, the traditional specialization after qualifying for
a diploma in medicine was a two-year course in hygiene and
another in epidemiology. There were only weak attempts
to broaden the vision and to develop skills consistent with
a modern understanding of health promotion and disease
prevention.
Health care staff do not receive adequate in-service training
to perform their job, while continuous professional development
is spontaneous or nonexistent for most. There is also
a lack of skilled health care managers, leading to inefficient
allocation and management of resources, both human and
financial. Another problem is the emigration of specialists.
There is a clear need for more systematic training for a
larger number of participants and for improving the working
conditions of those who stay in Albania.
A five-month course in health planning and management by
the Institute of Public Health and the University of Montreal,
organized in 2003, provided just a partial answer to
these needs.
A significant change is expected to be brought about by the
introduction in Albania of Master of Public Health training
to ASPHER 1 standards. This academic course is open
not only to medical graduates but also to professionals in
other fields. The long process required to set up such a
project requires a lot of coordination to overcome barriers
imposed by the traditional academic system and the rigid
nature of various institutions (i.e. the Ministry of Education
and the Ministry of Health). Within this framework a new
bachelor training course started in 2007.
As a consequence of the decentralization process in Albania,
the financing of public health services was temporarily
transferred to local authorities, which proved to be unprepared
and to lack sufficient awareness of the importance of
these services. Now the reform has excluded public health
services from the decentralization process, thus lowering
the risk of draining public resources in programmes other
than health promotion.
Nevertheless, it seems that this centralized model will not
be able to make use of local resources for some time to
come. On the other hand, the necessary involvement of
local professionals in decision-making, strategy formulation,
1
ASPHER: the Association of Schools of Public Health in the European
Region.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases