Albania’s has shown encouraging developments in recent years underlined by economic growth. At the same time the health sector is affected by a broad array of challenges, ranging from issues of health service financing, resource mobilization, health service management, as well as challenges regarding citizen’s participation, steering and governance of the sector. The country has a health system which is relatively wide-ranging but inefficient. Insufficient considerations are given to the demographic change and the raising burden of Non-Communicable Diseases (NCDs) such as diabetes or hypertension. Citizens and patients namely in rural areas have limited access to Primary Health Care (PHC) services due to low quality of care, imperfect availability and financial costs, in some cases. Home-based care is under-developed while the role of nurse in dealing with NCDs is ill defined.
Goal and expected outcomes
Embedded into the Albanian National Health Strategy 2016-2020, as well as the SDC Cooperation Strategy for Albania 2018-2021, the goal of phase 2 of the “Health for All Project (HAP) is that the Albanian population benefits from better health thanks to improved primary health care services.
Expected outcomes are:
- MoHSP and its regional entities manage more effectively and efficiently primary health care service
- Citizens in target regions have access and use effectively primary health care services of better quality
In line with the goal and outcomes it is expected at population level that improved PHC services and home-based care lead to into more frequent use of quality health services and translating into higher satisfaction of user and health of people covered. The Project will operate in selected geographical areas that belong to one or two regional directorates of the Operator without having the objective of supporting all municipalities in the two health territorial entities thereby building on established partnerships over phase 1 in Diber and Fier.
The prime beneficiaries of the Health for All Project (HAP) are; (i) General population, including adult women and men, adolescents and youngsters, as well as mothers and children,; (ii) patients with chronic diseases, especially elderly people and patients that need home-care assistance; (iii) poor and vulnerable population groups primarily in rural areas of Albania (such as elderly people), benefitting from better access to health services, and; (iv) PHC Services, namely family doctors, nurses and midwifes as well as health managers.
Secondary beneficiaries and partners of the HAP include (i) Ministry of Health and Social Protection and affiliated entities namely Institute of Public Health (IPH), the National Centre for Continuing Education (NCCE), National Centre of Quality, Safety and Accreditation of Health Institutions (NCQSAHI) and the Health Insurance Fund (HIF); (ii) Operator of health services (regional directorates) and the reformed Directorates of Public Health (Local Units of health services) in the geographical areas covered by the Project; (iii) Medical University with the Faculty of Medicine and Faculty of Technical medical sciences and University of Tirana with the Faculty of Economy in their role as training institutions; (iv) Local Government Units (municipalities), and (iv) professional orders and associations (nurses and family physicians).
Implementation strategy, scaling-up and exit strategy
The Project follows a “health system strengthening” approach, whereby various players in the health system are supported in a first instance on the supply side (PHC providers health managers both at local, regional and national level) but also to some extend on the demand side (current and potential users of PHC services).
Outcome 1 shall be achieved through (i) support to evidence-based planning and decision-making, (ii) rational health workforce planning for PHC services, and (iii) institutional and individual capacities in health management. In respect to outcome 2 the result chain foresees that citizens in regions covered shall have access to better quality PHC services through (i) the project’s continued support to professional development for PHC providers (including through the systematic use of clinical guidelines) and managers, (ii) new services models at the interface between social and health services (home based care), and (iii) fostering of transparency and accountability mechanisms in respect to health and health service delivery.
Outcome 1 is focusing on national level and national health sector actors plus academic training institutions. Their role is to steer and guide activities within the governmental sector respectively provide a framework for non-governmental actors and citizens so that interventions under outcome 2 can effectively be implemented. Outcome 2 is focusing on regional and local level as well as civil society organisations and patients/citizens. This includes support to the organizational development and capacity building of one or two regional directorates of the health service operator, within the limits and scope of the project. At service delivery level we will emphasise quality improvement through accreditation of health service providers, co-investments in improved PHC infrastructure and equipment and couple this to CME for PHC providers (doctors, nurses and mid-wives) through peer review groups. We propose to develop and test home-care based models on a limited scale in selected municipalities or groups of health facilities.
HAP phase 2 will emphasise the vertical scaling-up of innovations such as peer-review groups or models of home based care and further promote horizontal scaling-up thorugh the MoHSP. This process will require attention to be given to four dimensions: (1) dissemination and advocacy, (2) organisation process, (3) cost/resource mobilization, (4) monitoring and evaluation. Sustainability is a core principle and relates to interventions known for cost-effectiveness given the focus of investments in human resource development as well as PHC strengthening.
In respect to the exit strategy, the Project is conceived in way that interventions and activities of phase 2 can potentially come to an end or can be phased out by the end of the current phase while the introduced innovations shall be anchored in the system and sustain. The Project does not identify major risks in terms of financial sustainability and it assumed that this may stop by the end of the Project without negative implications.