Decentralization in Albania

Pamela Wyville-Staples

PHN SOTA

9 October 2002

Background on Albania

Former Communist Country (extreme isolationist form) with traditionally highly centralized government structures

Changed government in early 1990sApproximately 3.5 million people10,579 miles², $1,000 GNP/capita, and

$63 GNP/capita spent on health expenditures

Pre-1990s PHC Model

Presidency

Finance

National Health

Commune

Local Health

Current Control and Financing of PHC

Ministry of Finance

Ministry of Health

District Health Office

Non-MD Salaries: Accounts 600, 601

Medical Supplies: Account 602

Rx Drugs (reimbursed)

PHC Site

Prefecture

MD Salaries: Accounts 600,601

Health Insurance Institute

HII Enrollee Contr. – 3%

(3% for health)

HII Branch Office

Pharmacy

HII Enrollee Copay (~25%)

Ministry of Local Govt

Local Govts

Advantages of Decentralization

Albania has moved beyond an exclusively vertical structure

Decentralization has encouraged better governance throughout Albania, especially within the Ministries of Finance and Local Government

Greater interest by health care providers in participating in decision-making

Current Issues

Competing donor interestsTimingDecentralization in all social sectorsFlow of FundingSpecific health points

Fee payer system Health information system Pharmaceuticals

Roles of USAID & others in PHC reform

Ministry of HealthMinistry of Local GovernmentMinistry of FinanceWorld Bank/IMFUSAID

PHR+ AIHA Lezha/Pittsburgh Partnership

Current Issues

Competing donor interestsDecentralization in all social sectorsTimingFlow of FundingSpecific health related issues

Fee payer system Health information system Pharmaceuticals

Next Steps

Engage MOF, MOH, MOLG, World Bank/IMF, USAID, & others donors regarding proper decentralized structure

Engage MOH in designing and implementing useful PHR+ PHC pilot sites including HIS, costing tools, etc.

Ensure coordination by all PHC players

Thank you