Second Environmental Performance Review of Albania

146 Part III: Integration of environmental concerns into economic sectors and promotion of sustainable developmentsanitary inspection, and epidemiology. The publichealth laboratories, both microbiological andchemical, complement and support health-relatedactivities.IPH is the NRC and has the following core functions:to build expertise through conductingepidemiological surveillance ofcommunicable/infectious and non-communicablediseases, to manage the national disease registers andto undertake scientific research in public health. TheInstitute is responsible for introducing systems andpractices following international health advances, andis the National Focal Point for the InternationalHealth Regulations. It is also a training anduniversity education institution in public health. Thepublic health laboratories at the Institute are thereference laboratories for the country. They are beingaccredited by the National Centre of Quality,Security, and Accreditation of Health Institutions.The State Health Inspectorate within MoH is thebackbone of the public health infrastructure. It isheaded by the Chief Health Inspector andincorporates health inspectors of the public healthservices throughout the country, and IPH. TheInspectorate supervises and controls for compliancewith the regulations aimed at preserving andimproving public health. Traditionally, vis-à-vishygiene–health norms, it has covered a broad rangeof health risk factors related to the living andworking environment in the private and publicsectors at various establishments managed byphysical or legal persons, whether domestic orforeign, including those which provide health-careservices.With the ongoing health sector reform, there is aredefining of the scope of inspections and theirimplementation mode. For example, the State HealthInspectorate works jointly with the State LabourInspectorate on issues of health and safety at work.The State Labour Inspectorate under MLSAEO isresponsible for monitoring, control of and enforcinglegislation on health and safety at work by all naturaland legal persons, public or private. It has 12 regionaldirectorates and should expand further to 24 localoffices to yield a total of 36 offices throughout thecountry.Certain sectors, e.g agriculture, are excluded from thescope of authority of the Inspectorate, whichsubstantially affects the uniform implementation ofhealth and safety at work. The State HealthInspectorate controls and monitors workplace factorssuch as toxic substances, radiation, noise, vibrations,and inadequate microclimate with the aim ofprotecting employees from any adverse impact. It isalso in charge of the incidence of occupationaldiseases and work-related accidents. An industrialtoxicology laboratory should exist in each of theInspectorate’s structures throughout the country forthe assessment of environmental conditions inindustrial establishments.The State Labour Inspectorate’s capacity to enforcelegislation throughout the country is hampered by alack of equipment and by the fact that only one of the24 local offices planned has been established. Withinthe health sector there is also a lack of specializedcapacity in industrial hygiene in the country. Only afew regional services have fully fledged industrialhygiene sectors and dedicated toxicologicallaboratories.Regional public health directorates and IPH arespecialized institutions for the monitoring of urbanair quality and microbiological quality of drinkingand coastal bathing waters, and collaborate with theLGUs and the relevant regional agencies from theenvironment sector to prevent adverse health effectsfrom the environment (Chapter 2).The public health directorates’ epidemiology serviceon control and prevention of infectious diseases iscarried out together with the private and public healthservices and supported by the LGUs. The directoratessupervise the primary health care services in theimplementation of the national vaccinationprogramme and other anti-epidemic measures. Withrespect to dangerous infections which constitute apublic health emergency of international concern, ananti-epidemic sanitary service is organised at bordercrossingunits in pursuance of the InternationalHealth Regulations. The anti-epidemic sanitaryservice at the port of Durrës is certified by WHO forfull compliance with the Regulations’ provisions.The primary health care package includes diseasesurveillance – an important public health service. Theprimary care centres supply data on infectiousdiseases, as do hospitals, and it is understood that thecontracts of general practitioners include arequirement that they also report infectious diseases.This model of integrated service delivery and legallyspecified data flows has the clear advantage of a highreporting rate (95 per cent). The Albanian EarlyReporting Tool (ALERT) system further addsinfectious diseases data based on syndrome, whichare reported on a daily basis by a number of healthcentres such as primary care, social centres (nursinghomes and orphanages), emergency rooms, hospitalintensive care units and ambulances.