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FY 1997 Assistance to Central Europe Request: $30,000,000
When democratic elections were held in March 1992, Albania, the poorest country in Europe, emerged from a 47-year legacy of almost total isolation and repressive communist dictatorship. The new government immediately embarked on an ambitious macroeconomic and structural reform program for which donor support continues to be critically needed. Supporting a peaceful and sustained democratic, and economic transition in Albania contributes to the U.S. foreign policy objective of promoting stability in the Balkans.
The Development Challenge.
Albania faces all the challenges of an economy in transition from an authoritarian, command-driven system to one which is democratic and market-oriented. With a per capita gross domestic product (GDP) of approximately $400, Albania also faces the challenges common to many poor, developing countries.
The Albanian economy suffered a 50% decline in real output during 1990-1991, which included a 70% drop in industrial production and a 30% decline in agricultural output. Unemployment levels are very high, having peaked at about 40% in 1993 and currently standing at 13%. Much of the economic downturn is attributed to supply and transport bottlenecks associated with collapse of the central planning system and to disruption associated with the spontaneous mass privatization and fragmentation of land.
In July 1995, Albania's debt to commercial banks was reduced by $371 million through a debt buyback which cost $96.5 million. Albania contributed $55 million of its own resources, the IDA's Debt Reduction Facility and other donors picking up the remainder of the cost. Another $130 million in commercial debt was converted into long-term bonds. In addition, rescheduling agreements have been signed with bilateral creditors and all payments due under the Paris Club agreements have been made.
While much progress has occurred since 1992 in establishing democratic institutions, there have been increasing concerns about the performance of the Albanian government in the democratic reform area. Institutionalizing certain democratic concepts -- rule of law, independence of the judiciary, executive oversight by the parliament, independence of the media, and decentralized governance -- is critical at this stage of Albania's development.
USAID expects that Albania may not have the institutional and other resources to continue its own transition. Current plans are to phaseout Support for Eastern European Democracy (SEED) Act assistance within the next several years and pursue other means of continuing cooperative assistance in the future.
Other Donors.
USAID and the donor community pledged over $400 million in FY 1995 for development activities in Albania. The United States is the second largest bilateral partner. Other major contributors include Italy, Germany, the World Bank, the European Investment Bank, the European Bank for Reconstruction and Development, the International Monetary Fund, the International Fund for Agricultural Development, and the EC PHARE.
FY 1997 Program.
Strategic Goal: Economic Restructuring
Agriculture continues to dominate the Albanian economy by providing over 50% of the GDP and employment. A major amount of USAID's assistance continues to focus on this sector. Our efforts have supported increases in agricultural production by assisting suppliers to obtain credit and import fertilizer, seeds and other vital inputs that can not be produced locally. A USAID-supported agricultural input dealers association and a national farmers' association successfully lobbied for reducing a turnover tax on fertilizer. With USAID's assistance, over 92% of the land is in private hands. Land registration offices are now open in 15 districts and 335,000 legal certificates which establish secure tenure have been issued to farm families. A law allowing for the buying and selling of agricultural land has been passed and will soon be implemented. This will allow for consolidation of fragmented parcels into economically viable holdings.
In addition, the small and medium enterprise sector is rapidly expanding. Of the 48,000 registered non-agricultural enterprises, over 90% employ only one or two persons. With USAID assistance over 13,500 potential entrepreneurs have been trained in various fields. In March, 1995 the Albanian-American Enterprise Fund was incorporated, opened for business in Tirana and New York in August, and has just recently approved its first two loans. The mass privatization program was recently initiated and the first auctions were held in September. Coordinating with the World Bank and other donors, USAID provided advisors to the charter and auction working groups for that process.
In the area of urban services, USAID has assisted the Ministry of Construction and three cities to privatize solid waste collection, and to develop a strategy to implement water privatization in Tirana and other cities.
With virtually all the agricultural land, housing, and most small and medium enterprises privatized, the FY 1997 program will target improved productivity and quality in agriculture, increased access to credit and skills training for the private sector and privatization.
The underpinnings on which to base economic sustainability include completion of the mass privatization of SMEs and larger enterprises, capital markets development, improved quality of urban and infrastructure services, and resolution of issues related to the status of state commercial banks. One or more new private banks should be opened. On the macro level the potential for spillover of the unrest in former Yugoslavia into Albania in the form of refugee flows from Kosovo (or, worse, engagement of Albanian and Serb military forces in Kosovo or Albania) constrains international investor interest in the country. If significant refugee flows do occur, the effects on Albania's weak economy would be devastating. The lack of physical infrastructure (power, water supply, highways, telecommunications, etc.) also indefinitely constrain Albania's overall transition to a market-based economy. A weak and non-transparent legal system and continuing disputes between current and former land owners deter foreign investors.
Strategic Goal: Democratic Transition
The basic concepts underpinning democracy -- popular representation and participation in government, diversity in ideas and sources of information, rule of law and respect for human rights -- have been introduced in Albania, but support for their institutionalization is very much needed. To aid Albania's transition, the SEED-funded National Democratic Institute has worked closely with the Society for Democratic Culture to oversee election activities, recruit and train election monitors, and encourage citizen participation. NDI and SDC are refining a comprehensive plan to include voter education, public opinion polling for the 1996 Parliamentary elections. The International Republican Institute has provided training in party organization and in civic participation to potential women political leaders. A new Democracy Network project is encouraging the development and institutional strengthening of public NGOs involved in democracy, the environment, economic growth, and social safety nets. ABA/CEELI advisors haveassisted in the establishment of a Women's Legal Group as a women's rights advocacy group and a women's bar association and in the development of a code of legal ethics. They have developed, published and now distribute professional journals and have established a publicly accessible law library. A new Law and Democracy program will concentrate on disseminating to all courts the body of laws, codes, regulations and judicial decisions; revamping the court system administration; reforming criminal justice procedures; and improving law enforcement training approaches. A new public administration activity will focus on local municipalities fostering economic development, improved public management capacity, and training of local government officials.
Continued commitment by senior government officials to democratic reform is critical if USAID democracy activities are to be effective. If conflicts with neighboring Greece, Former Yugoslav Republic of Macedonia, or Serbia and Montenegro occur, the government may divert attention from its domestic democratic reform agenda.
Strategic Goal: Social Stabilization
Access to primary health facilities declined dramatically in the 1990's due to the closure of many rural health and maternity clinics. To address the problem USAID funded a hospital partnership with The Jacobi Hospital (Bronx, New York) and the Ministry of Health, the University Hospital Center, the Maternity Hospital and the Trauma Hospital. Its focus is on emergency medicine, women's health and health administration and management. Extensive in-country training in health care administration and management has been offered to Ministry and hospital administrators, managers and financial officers. The next step will be for Jacobi Hospital to accelerate its program of exchange and training in order to strengthen Albanian hospital care capacity at the three Tirana hospitals. Financial management advisors will reform hospital payment systems and will seek to develop sustainable health insurance mechanisms. A new partnership in health management will be initiated between the University of Tirana and New York University.
|
Strategic Objectives |
Economic Restructuring |
Democratic Transition |
Social Stabilization | Cross-cutting / Special Initiatives | Total |
| Privatization | |||||
| Fiscal Reform | |||||
| Private Enterprise | 18,000,000 | 18,000,000 | |||
| Financial Reform | 3,000,000 | 3,000,000 | |||
| Energy | |||||
| Citizens' Participation | 2,300,000 | 2,300,000 | |||
| Legal Systems | 3,000,000 | 3,000,000 | |||
| Local Government | 2,500,000 | 2,500,000 | |||
| Crises | |||||
| Social Benefits | 1,200,000 | 1,200,000 | |||
| Environmental Health | |||||
| Cross-cutting / Special Initiatives | |||||
| TOTAL | 21,000,000 | 7,800,000 | 1,200,000 | 30,000,000 |
USAID Representative: Dianne Blane
Purpose: Accelerated development and growth of private enterprises.
Background: Albania had one of the most centralized and repressive regimes in the world from the mid-1940s until late 1990. The collapse of communism in Albania came later and was more chaotic than in other Central and Eastern European countries. Attempts at reform only began in early 1992 after real GDP had fallen by over 50% from its peak in 1989. The democratically-elected government, which assumed office in April 1992, launched an ambitious economic reform program to halt economic deterioration and put the country on the path toward a market economy. Key elements included price and exchange system liberalization, fiscal consolidation and monetary restraint. These were complemented by a package of structural reforms including privatization, enterprise and financial sector reform, and creation of a legal framework for a market economy and private sector activity.
USAID Role and Achievements to Date: Led largely by the private sector, the Albanian economy is the fastest growing in the CEE region. GDP is projected to have grown by seven percent in 1995. Inflation, which was 16% in 1994, decreased to nine percent in 1995. The Albanian lek has remained stable against the dollar. Agriculture, one of the first sectors to privatize, dominates the economy by providing over 50% of GDP and employment. USAID support has been vital in setting up a network of input supply dealers to provide fertilizer, seeds and other critical inputs. USAID has also taken the lead in implementing a property registration system to provide secure tenure to farm families and in establishing a fledgling land market, which will allow for consolidation of small parcels into economically viable holdings. The small and medium enterprise sector is also rapidly expanding. Technical assistance to small and medium enterprises is being provided in two major secondary cities. In other non-agricultural areas, over 14,000 potential entrepreneurs have been trained in English, computers, secretarial skills, cosmetology, auto mechanics, business and other areas. Many graduates have started their own businesses, while others have found higher paying jobs. Assistance has been provided to the Government of Albania (GOA) in establishing and improving the policy, legal and regulatory framework required to support the private sector.
Description: Over 60% of USAID/Albania's FY 1996 and proposed FY 1997 resources are in support of this activity. Given the importance of agriculture, a substantial proportion of these resources has been directed to this sector. U.S. firms and universities provide assistance to the GOA in agricultural policy, research, statistics, forestry and in changing university economics curricula to teach free market principles. Agribusiness support is provided directly to entrepreneurs by U.S. firms and NGOs, as is support to non-agricultural small and medium enterprises. Technical training of potential entrepreneurs is provided by a U.S. NGO through a joint GOA/USAID operated school, which will pass entirely to Albanian control in 1997. U.S. universities lead support to the GOA in setting up a property registration system and in the establishment of Albania's first MBA program. Support is provided by the U.S. Department of Commerce to the GOA in trade policy, trade association development and in accession to the World Trade Organization. U.S. NGOs and firms provide training and technical assistance in legal areas such as commercial/business and collateral law and bankruptcy.
Host Country and Other Donors: Other major donors, especially the EU and World Bank, are active in many of the sectors USAID supports. In some cases, USAID/Albania has activities which are closely linked with theirs. These include support to small and medium enterprises and implementation of a property registration system. USAID/Albania collaborates effectively with donors in other areas as well. In agriculture, USAID and EC-PHARE are the major donors. USAID is reorganizing the agricultural research system, while EC-PHARE is working on the development of an extension service. In another example, EC-PHARE has set up mechanization centers and helped develop herbicide and pesticide imports, while USAID has helped set up private fertilizer dealerships and assists with fertilizer imports. USAID support of private farm forestry is complemented by Peace Corps work in forestry extension and World Bank support to the Forestry Directorate. USAID/Albania is a partner with the Government of Albania in all activities. Government support is in the form of personnel, facilities and a demonstrated willingness to make policyand legal changes required to support the private sector.
Beneficiaries: Rural families, which make up approximately 60% of the population, are the major beneficiaries of this activity. USAID support to the agricultural sector and property registration system affects virtually all of them. Other significant beneficiaries of training and technical assistance are entrepreneurs engaged in small and medium enterprises in both Tirana and secondary cities.
Principal Contractors, Grantees, or Agencies: USAID implementors include: Department of Commerce, Urban Institute, ABA/CEELI, Coopers & Lybrand, DAI, Chemonics, International Fertilizer Development Center (IFDC), Winrock International/VPI&SU, University of Wisconsin Land Tenure Center, VOCA, American ORT Federation, Peace Corps, Land O'Lakes, Fultz Foundation, PIET, and the University of Nebraska.
Major Results Indicators*:
Number of business associations advocating on behalf of private sector initiatives, needs and growth requirements
Volume of business support services available to private enterprises from self-sustaining local institutions
Number of private sector businesses operating
* These are illustrative indicators. ENI Missions are in the midst of the complex process of developing meaningful, measurable, country-specific indicators and targets, which will be completed by June 1996.
PROGRAM: ALBANIA
TITLE: Financial Reform, 180-S001.4
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: 3,000,000 SEED Act
INITIAL OBLIGATION: FY 1991; ESTIMATED COMPLETION DATE: FY 1999
Purpose: A more competitive and market responsive private financial sector.
Background: The banking system in Albania is virtually insolvent from bad loans to moribund enterprises. Furthermore, capital markets are still in an embryonic stage and not capable of fulfilling their function. Constraints to lending to entrepreneurs include the inability of banks to undertake secured lending, to take control of assets through bankruptcy procedures, and the non-existence of credit reference services. Though state assets are being divested to the public, the shallowness of capital markets impedes the efficient distribution of those assets among those best able to maximize their potential.
USAID Role and Achievements to Date: USAID's support includes assistance to the Ministry of Finance in privatization of the state banks, to the Central Bank in bank supervision and bank licensing and to both institutions in setting up the Share Registry for the stock exchange. USAID has also set up the Albanian-American Enterprise Fund (AAEF) to increase foreign (especially U.S.) and domestic investments in promising Albanian enterprises. As a result, a new Chart of Accounts for banks is being adopted, new private banks -- foreign and domestic -- are being considered for licenses, the ability of the central bank to undertake on-site bank examinations has been increased, and citizens can now register the shares in companies they received as part of the voucher privatization, thereby significantly reducing the potential for fraud and abuse in the privatization and capital market formation processes.
Description: To increase the ability of the Albanian financial sector to effectively, efficiently, and legally mobilize capital towards its most productive use, both through banks and capital markets development, U.S. resident advisors are providing expertise in policy formation and analysis, as well as drafting legislation and regulations. Short-term assistance has focused on hands-on, discrete activities. Credit, equity investments and investment guarantees will be provided directly to investors and entrepreneurs.
Host Country and Other Donors: An International Monetary Fund advisor assists the central bank governor on financial sector policy. The World Bank has a $5 million credit line and has provided considerable technical assistance to the Albanian Rural Commercial Bank to make long-term loans to farmers. The German aid organization, GTZ, has provided technical assistance to the National Commercial Bank and will provide training in bankruptcy procedures as well as expertise in drafting commercial laws.
Beneficiaries: Beneficiaries include: U.S. exporters and investors wishing to do business in Albania who rely on the technical ability of the banks to carry out financial transaction; all depositors and borrowers who rely on the banking system; entrepreneurs seeking capital for development and expansion of private businesses; and institutional investors domestically and abroad seeking either to diversify risk or for growing markets.
Principle Contractors, Grantees, or Agencies: USAID implements these activities through the U.S. Treasury Department, the AAEF and U.S. firms.
Major Results Indicators*:
Number of licensed viable private banks.
Amount of funds for equity/credit provided to small and medium-sized businesses from private commercial banks.
Amount of investment, both from domestic and foreign sources.
* These are illustrative indicators. ENI Missions are in the midst of the complex process of developing meaningful, measurable, country-specific indicators and targets, which will be completed by June 1996.
Purpose: Increased, better-informed citizens' participation in political and economic decision-making.
Background: Attempts at democratic reform in Albania only started in early 1992 when the newly-elected government began to develop the legal and political framework necessary for effective citizen participation in the political process. Since that time, Albania has held several elections and a national referendum on a proposed constitution. A parliamentary election is scheduled for May 1996. Moreover, with the arrival of democracy in Albania, there has been a surge in formal and informal associations. Unheard of and unimaginable during the previous regime, except when used as instruments of the state, it is now possible for citizens to participate in the affairs of society. Over 300 new organizations have now registered with the government. Strapped for cash and lacking experience, most of them have not developed the capacity for concerted action. Government policy toward the NGOs has been generally supportive but, with a few notable exceptions, these organizations are fragile, underfunded and often ineffective. Independent broadcast media have not yet been established in Albania.
USAID Role and Achievements to Date: USAID provided the Parliament with an electronic voting system, a sound system, computers, two printing presses and associated technical assistance. During the past year, USAID advisors carried out political party-building sessions in Tirana and the secondary cities with the political parties, plus separate leadership training sessions with politically active women and their organizations and support groups. A Parliamentary Guidebook was published containing comprehensive information on Parliament, its deputies and organization, government ministries, the Office of the President, the court system, political parties, etc. Since 1991, USAID has supported the Society for Democratic Culture (SDC), an Albanian election-monitoring and democracy-
promoting organization. USAID advisors have sponsored public opinion polls. An assessment of the nature, problems and needs of the Albanian NGO community has been completed, and initial institution-building grants have been awarded to about 15 NGOs. Political party spokespersons have been trained in campaign management, and a group of journalists have been trained in election coverage.
Description: USAID advisors are encouraging the democratic organization of Parliament and its committee and political party structure with material and technical assistance. Advisors are also supporting citizen participation, voter education and democracy-building activities of the SDC. USAID advisors are also supporting the Albanian NGO community by encouraging the institutional strengthening of public policy-oriented NGOs involved in four priority sectors: democracy, the environment, economic growth and social safety nets. To assure a sound legal foundation for the NGO community, USAID advisors will research, publish and distribute a handbook on Albanian NGO law. As a catalyst for permanent collaborative linkages between Albanian NGOs and their counterpart organizations in other countries, a series of NGO internships, exchanges, and information-sharing opportunities are being offered. Assistance is being provided to the press and broadcast media to encourage their independence and viability.
Host Country and Other Donors: Some of the political parties are receiving support and assistance from their equivalent party organizations in Western Europe. Denmark's Dialogue Development is supporting the Albanian Civil Society Foundation which, in turn, is also supporting Albania's NGO community.
Beneficiaries: These efforts will benefit the broad spectrum of politically active citizens by strengthening the organization of political parties, the network of non-governmental organizations, and the print and broadcast media.
Principal Contractors, Grantees, or Agencies: USAID implements these activities through cooperative agreements with the National Democratic Institute, the International Republican Institute, the National Forum Foundation, the International Center for Not-for-Profit Law, the Organization for Rehabilitation through Training, and the International Research and Exchanges Board (IREX).
Major Results Indicators*:
Number of changes made to government policy as a result of citizen participation
Number of new federations, organizations, coalitions, etc. formed to promote/oppose specific policies/legislation
Number of NGOs representing women's issues
Existence of laws protecting freedom of association, assembly and speech
Rating of elections as free and fair by local and international monitors
* These are illustrative indicators. ENI Missions are in the midst of the complex process of developing meaningful, measurable, country-specific indicators and targets, which will be completed by June 1996.
Purpose: Legal systems that better support democratic processes and market reforms.
Background: Albania is undergoing a dynamic process of transformation from a communist dictatorship, which was overturned in 1991, to a democratic society characterized by rule of law, respect for human rights, independence of the judiciary and free access to information and ideas.
USAID Role and Achievements to Date: USAID's rule of law program in Albania is aimed at promoting reform in the judiciary, the legal profession, legal education and commercial law. Work is progressing on establishing a law library at the Court of Cassation and the collection of donated books continues to grow. USAID advisors are also assisting in drafting the governing statute and code of ethics for the National Chamber of Advocates. The USAID advisors have assisted the European Law Students Association in publishing the inaugural edition of the University of Tirana Law Review. They have continued to work with the Council of Europe on distribution of over 900 copies of the Criminal Procedure Code throughout Albania. The advisors have also presented continuing legal education workshops on the private practice of law, contracting, etc.; supported and participated in a study tour for judges and legal professionals; and offered comments on the proposed constitution and various draft statutes. Law enforcement training aimed at helping the Albanian police achieve international human rights standards has also recently begun with assistance from the U.S. Department of Justice.
Description: Four areas of emphasis help assure that laws and legal institutions support democratic processes: 1) Judicial: an ongoing program to support the Albanian Association of Judges to become a respected and effective representative of the country's judges. 2) Legal: Continuing efforts to help the national and regional bar associations formulate a governing statute; the establishment of the Women's Legal Group as a women's rights advocacy group and a women's bar association; and the development of a code of legal ethics. 3) Legal Education: the development of professional journals including their publication and distribution; the establishment of a publicly-accessible law library; the establishment of a law journal at the University of Tirana's Law School. 4) Commercial Law: the presentation of continuing education courses in commercial law; the preparation of a series of workshops and a handbook on women's legal and commercial rights; and the development and implementation of modern commercial laws. In addition, a new Department of Justice program will offer a series of training opportunities for Albanian police in community relations, international crime prevention and anti-narcotics interventions.
Host Country and Other Donors: The Council of Europe is providing legal expertise, training, furnishings and equipment for the establishment of a Magistrates School in Tirana to train and retrain the Albanian judiciary. The Government of Albania is refurbishing the building to house the School and other courts at a cost of $1 million. Additional donors to Albania's legal reform process are the Soros Foundation, Danida (Denmark) and GTZ (Germany).
Beneficiaries: The direct beneficiaries of these activities are a significant percentage of the Albanian judiciary, including judges, lawyers, prosecutors and law students, and indirectly every member of the public that comes in contact with the legal system.
Principal Contractors, Grantees, or Agencies: USAID/Albania implements this activity through the American Bar Association's Central and East European Law Initiative project and the U.S. Department of Justice.
Major Results Indicators*:
Percent of population knowing/understanding specific rights
targeted laws are:
up-to-date
published in a timely manner
available to all judges and court officials organized in a manner which expedites research
* These are illustrative indicators. ENI Missions are in the midst of the complex process of developing meaningful, measurable, country-specific indicators and targets, which will be completed by June 1996.
Purpose: More effective, responsive, and accountable local government.
Background: There is no tradition of decentralized authority in Albania and the public has no experience with a local government able to act on its own authority. The public expects most decisions to be made in Tirana, not by officials at the local level. In addition, current law and practices leave the local governments overly dependent on central government transfers. Albania recently passed legislation which is intended to guarantee that local government becomes an effective means of resolving public problems in order to overcome the general lack of public confidence in local administration and the tendency of the citizenry to address problems at the central level. Nevertheless, Albania is just beginning the process of decentralization of decision-making and resistance to local empowerment and decentralization remains strong.
USAID Role and Achievements to Date: Limited support in public administration has been provided under a housing and urban development activity. With USAID assistance: (1) the City and District of Tirana, the Ministry of Construction and the National Planning Institute formed a task force to develop a 70-hectare site, identify new sites for development, and address legal and policy issues related to residential upgrading, (2) the Concession Law for Public Services was passed in July 1995, (3) procurement procedures for contracting solid waste have been adopted by the Government of Albania (GOA) and Tirana has contracted with two private firms for solid waste collection while Korca and Durres have started the procurement process, (4) the GOA has agreed to privatize its water services, and (5) the GOA is creating a regulatory body for public utilities (power, water, telecommunications) within the Ministry of Mineral Resources and Energy. In late 1995, a new Public Administration activity to provide assistance to local governments was initiated.
Description: Training and technical assistance are provided to both the central government and local administrations in the areas of urban infrastructure privatization and regulation, housing and urban land use planning. The new USAID-
funded Public Administration activity will work directly with local governments to build public management capability to better serve the public and encourage government responsiveness to local constituencies. This activity will focus on: (1) five local municipalities (already selected) with an economic development potential which can be fostered through better public management, (2) improved public management capacity, particularly for budgeting, accounting, procurement, street maintenance, etc., and (3) development of a capacity in local institutions to implement a training program to transfer knowledge gained in working with the five pilot cities to municipalities throughout the country.
Host Country and Other Donors: The EC-PHARE is providing material support, principally computers, and some technical assistance to selected municipalities. A bilateral Italian program and the World Bank provide support in major infrastructure (water, sewerage, etc.). The German Government has provided some technical assistance and training. USAID support is focused on major secondary cities which do not receive similar assistance from other donors. Government of Albania support is principally in the form of personnel and facilities.
Beneficiaries: By spreading the results of successful programs in pilot cities, local authorities in all municipalities will benefit. The citizens they serve, residents of Tirana and secondary cities, will benefit from improved local administration and municipal services. The central government will benefit by turning over to the municipalities many of the duties they are currently responsible for.
Principal Contractors, Grantees, or Agencies: USAID/Albania implements this activity through DAI/Mendez-England and the Urban Institute.
Major Results Indicators*:
Number/percent of local governments that have active systems in place for publishing/disseminating information
Percent of national revenue flowing to local government
Passage of legal, fiscal and procurement reforms that empower local governments
Percent of local populations that believes management and delivery of services at the municipal level are (a) improved, (b) more cost effective, and (c) responsive
* These are illustrative indicators. ENI Missions are in the midst of the complex process of developing meaningful, measurable, country-specific indicators and targets, which will be completed by June 1996.
ACTIVITY DATA SHEET
PROGRAM: ALBANIA
TITLE: Social Benefits, 180-S003.2
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $1,200,000 SEED Act
INITIAL OBLIGATION: FY 1991; ESTIMATED COMPLETION DATE: FY 1999
Purpose: Improved sustainability of social benefits and services.
Background: After nearly a half-century of economic and political isolation, Albania's legacy is the least developed public system of social infrastructure among the Eastern European nations. Many of its health care facilities are seriously dilapidated and outdated. The GOA is quite aware of the urgent need to revitalize and modernize its health care system. Moreover, due to the lack of alternatives brought on by isolationism, an official pronatalist policy and poor information, abortion has been the predominant form of family planning resulting in high mortality and morbidity rates for women. For women carrying to term, prenatal delivery, and postnatal services are woefully inadequate.
USAID Role and Achievements to Date: Working with USAID advisors, key health care administrators have acquired the knowledge and skills needed to manage more efficiently and effectively at the central level (the Ministry of Health) and at the district, hospital and polyclinic levels. Two hospitals, the Durres Hospital and the University Hospital Center of Tirana, were selected to implement hospital operations improvement techniques and to serve as models for the rest of the hospital system. The number of hospital beds, reflecting vacancies, has consequently been reduced. At the Durres Hospital, where the main hospital building collapsed last year, a strategic planning process has been instituted which will match available resources with a long-range plan for a replacement hospital. At the University Hospital Center, administrative and medical records were computerized. In both hospitals, pharmaceutical and medical supply purchasing and distribution are being computerized. A national conference was held in November 1995 to share the information and management techniques developed at the pilot hospitals with over 80 hospital managers and administrators from all over Albania. The hospital partnership program has carried out a number of exchanges of medical personnel, sponsored a obstetrics conference in Tirana, and is opening a maternal and child health resource center at the Tirana Maternity Hospital.
Description: USAID is focusing its efforts on the areas of health management and administration. The partnership established between the Jacobi Hospital in the Bronx and four hospitals in Tirana has a focus on emergency medical services, women's health care, and health administration and management, all key areas of need in Albania. The American International Health Alliance (AIHA) has developed a new partnership between New York University's Robert F. Wagner Graduate School of Public Service and the University of Tirana's Medical School to introduce a health management program into the curriculum and to sustain the gains made at two pilot hospitals in the areas of: strategic planning, financial management and cost accounting, medical records and pharmaceutical group purchasing. A modest program of assistance to Albania's Health Insurance Institute will allow the Institute to study the possibility of including hospital services in the proposed health insurance program. A new two-year effort will improve the knowledge of physicians, nurses, midwives and pharmacists in providing quality family planning services and counseling, increase the number of service delivery points in both the public and private sectors, and enhance the ability of Albanian families to make informed decisions regarding fertility and family planning through information, education and communication activities.
Host Country and Other Donors: The World Bank is supporting the reconstruction of rural hospitals throughout Albania and the University of Montreal and the Paris Hospital System are providing planning assistance and management training to the Ministry of Health. The UNDP is providing health care manuals to medical facilities. The Swiss are providing assistance to the nursing school. EU Phare has a Public Health Facilities Maintenance project and is supporting capacity-building at the Ministry.
Beneficiaries: Medical professionals (doctors, nurses, technicians and managers) are the primary beneficiaries and that portion of the population of Tirana requiring hospital care are also benefitting. Women throughout Albania will benefit from access to family planning information and improved counseling and care.
Principal Contractors, Grantees, or Agencies: USAID implements these activities through the American International Health Alliance and a PASA with the U.S. Department of Health and Human Services.
Major Results Indicators*:
Number of services privatized (e.g., pharmacies, hospitals)
Incentives for private (profit and non-profit) exist for quality service delivery
Percent of public with confidence in private service delivery
Change in numbers of public/private partnerships
Market reforms in place and introduced to various sub-sector service deliverers
* These are illustrative indicators. ENI Missions are in the midst of the complex process of developing meaningful, measurable, country-specific indicators and targets, which will be completed by June 1996.