» Increased and more equitable access to quality basic services

Recent trends reveal poor health, development and education outcomes for children, an inadequate health status for the general population and the absence of a comprehensive safety net system. Internal migration into urban centres has resulted in deteriorating access to essential services such as birth registration, immunization and other child health services, school enrolment and regular school attendance.

Health. The health system in Albania is facing serious challenges including disparities in access to health services. During instability in the 1990s, widespread damage was inflicted on health care infrastructure and essential services, including immunization and surveillance. Reforms, which began in the mid-1990s, have made limited progress; Albania’s healthcare still lags behind those of other countries in South-eastern Europe.

The disease pattern in Albania is typical of a country in transition, with high infectious disease rates and non-communicable diseases on the rise. While overall sources show some improvement in key health indicators over the past decade, communicable diseases are still much higher than the EU average.

Government spending remains low, as does the quality of services, particularly for mothers and children. Private out-of-pocket funding for health care has created unequal access. Government priorities will address strengthening capacities to manage services more efficiently, including improvements to health care financing.

Support from the United Nations has included technical assistance for policy reform and strategy development, community-based mental health services, establishment of standards and indicators for hospital care, a national tuberculosis programme, and health financing. Other areas of support have included strengthening of vaccination services, primary health care, mother’s health and holistic care and treatment of children. In order to eliminate iodine deficiency, support has been provided to the Government to iodize salt.

The One UN Programme is supporting development of standards of care to improve the quality of services for marginalized groups. Special attention will be given to poverty and health – environmental risks, reproductive health, maternal and child health, mental health and healthy lifestyles (HIV/AIDS and tuberculosis prevention, and reduced use of tobacco and alcohol). Capacity development will focus on improving the skills of health providers to deliver quality health services. The UN supports immunization services, as well as epidemic alerts and response.

Education.

Social protection. Over the past 14 years, political and socio-economic changes in Albania have increased the vulnerability of children to violence, exploitation, abuse and neglect. Drastic demographic shifts have weakened traditional community-based protection networks and new pressures on vulnerable families, including growing socio-economic exclusion, limit their ability to provide a protective nurturing environment for children. The result has been an increase in the number of children in need of social protection.

There is no comprehensive child protection system in place in Albania. Existing protection structures are limited and fragmented; and coordinated mechanisms for identification, assessment, referral and provision of appropriate support services are inadequate.

Technical expertise is limited, in terms of the provision of specialized services as well as institutional mechanisms, planning and management at national, regional and local levels. The limited resources channeled to this sector pose a challenge.

The Law on Social Assistance and Services has led to increased assistance to families, and the Government recognizes that the lack of a social safety net is becoming an issue, especially in rural and suburban areas. National priorities focus on vulnerable groups such as Roma, Egyptians, people with disabilities and victims of trafficking – with the ultimate goal of protection from abuse, violence and exploitation. Parliament recently adopted a law to regulate response measures against domestic violence, and the Government is finalizing the National Strategy on Anti-Domestic Violence.

One UN support goes towards putting into place standards and institutional frameworks for improved social services, child and family protection, and juvenile justice. Special attention will be given to supporting the development of child protection legislation, policies, and standards. Strengthened coordination, monitoring and revision of human rights policies will help to combat domestic violence. The UN is continuing with support to disadvantaged areas of the country through community centres that provide basic services and information on health issues, childcare, education, drug and alcohol prevention and communicable diseases.

The UN supports development of an integrated model for basic health, education, and social services for groups and individuals at risk.