1993 reforms and its effect on child mortality rate in Albania

Albania is one of the poorest countries in Europe. Before the Second World War, Albania had few doctors, most of whom had trained abroad, and a small number of private hospitals and institutions run by religious groups. In 1932, for instance, there were 111 medical doctors, 39 dentists, 85 pharmacists and 24 midwives in the country. Most of the population did not have access to health care facilities, which were mainly based in urban areas. Access improved after 1945 when a health care system was developed based on the Soviet “Semashko” model. The first medical school opened in Tirana in 1959. Many medical experts also trained in the Soviet Union and other eastern European countries.

By the 1980s, the Ministry of Health provided and regulated all health services in every district. District administrators received instructions from the district executive committee of the Labour Party, and had very limited power in terms of budget utilization and personnel management. Health services were organized in programmes controlled from the centre and administered at the district level by separate directorates responsible for medical care.

The quality of services was poor, there was little continuing medical education, and hospitals were kept overstaffed by keeping salaries low. The level of medical technology was also very low and the equipment outdated because capital investment in the health care system had dropped in the 1980s. Thus, at the beginning of the 1990s, the average age of medical equipment in Albania was 25 years. The continuing high rates of infant mortality and the outbreaks of infectious diseases in the 1980s highlighted the inability of the system to respond effectively to health care problems.

However, two public administration reforms have affected health services. First, after the 12 regional prefectures were created in 1993, some administrative authority has shifted to

them from the centre. Each prefecture comprises an average of three districts, and each district is responsible for administering district hospitals and polyclinics, specialist hospitals (such as tuberculosis hospitals) and PHC centres. The second reform was aimed at strengthening the role of local government. The 1993 law On Local Government regulated the election of local authorities and their responsibilities, functioning and relationships to the national government. In the area of health care, the law also shifted some responsibility for PHC to rural areas.

We can see clearly in our mortality rate graph that after reformation the healthcare facilities have improved, leading to decrease in mortality of the child.

Description reference: Besim Nuri - Health Care Systems in Transition.2002

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