Strengthening Governance to Improve Access to Quality Health Care

The USAID-funded Enabling Equitable Health Reform in Albania (EEHR) project has worked closely with health institutions and civil society at the national, regional, and facility levels to strengthen governance, thereby supporting reform implementation and oversight with the ultimate goal of increasing access to quality health care. The poor of Albania face obstacles in health care, including high out-of-pocket expenditures, potentially catastrophic expenses for secondary care, inadequate medical supplies, and poor quality of services. The Government of Albania has made significant strides in enacting laws and reforming health care policies to reflect its priorities of improving access to quality care for the population and increasing the effectiveness of health care delivery. However, turning ambitious policy into action is a challenge for any government. The laws recognize the Ministry of Health (MOH) as responsible for policy, oversight, and coordination of the sector among a number of auxiliary health institutions, but at the outset of EEHR, the formal institutional relationships and managerial systems that would allow the MOH to fulfill its role were lacking. At the sub-national levels, roles of public health and Health Insurance Institute (HII) offices were somewhat unclear, and there was little coordination or information sharing. Policies indicated secondary care facilities would soon be more autonomous and paid on performance. Operational and management changes were needed to prepare for these imminent realities. A compounding challenge is that with each change in government, leadership changed – even at the hospital level – causing disruption, delays, and sometimes changes in direction. The Monitoring and Evaluation (M&E) function of the health sector had a strong foundation with the major health institutions working together to report against mutually-agreed annual targets. EEHR worked collaboratively with national and regional government institutional bodies, civil society representatives, and three pilot hospitals – Lezhe and Korce Regional Hospitals and Queen Geraldine Maternity Hospital – to institutionalize the engagement of stakeholders at all levels to increase transparency, accountability, and responsiveness. To this end, the role of civil society, including patient groups, provider groups, academic and research organizations, and the media, was strengthened with inclusion in each mechanism at every level. In addition, the project developed the capacity of regional and national groups to collect and analyze data policy groups to consider when making decisions. The Health Reform Implementation Support Group (HRSIG) was established by Ministerial Order in October 2011, with membership comprised of all key health institutions and civil society representation. The HRSIG has reviewed and approved Annual Performance Reports of the health sector, as measured against annual Milestone Reports with indicator targets for the health sector. Data for these reports is provided by an inter-institutional technical M&E group, which has benefited from EEHR training. The HRSIG has reviewed tools and mechanisms successfully piloted at pilot hospitals and proposed to MOH for consideration to roll-out nation-wide, including Visitor Control policies, New Employee Orientations Guidelines, Hospital Board By-laws, human resources policies and standards, and the establishment of Hospital Environmental Standards. The HRSIG serves to strengthen the oversight role of the MOH while providing a forum for health sector institutions to clarify roles and responsibilities, review strategies, coordinate activities, and hold one another accountable for fulfilling responsibilities.