Together for Life Assocation organized a roundtable for the presentation of the main findings of the report "Healthcare and social protection sectors' expenditures monitoring report for 2022."
The event was attended by representatives from the Ministry of Justice, the State Supreme Audit, members of the Commission for Labor, Social Issues and Health, the Parliament of Albania, the Commissioner for Protection against Discrimination, representatives from GIZ Albania and Health for All Project, OSHC representatives, as well as professionals, experts, and other institutions interested in the field of public health.
The report prepared by Together for Life in framework of the project "Transparency and Accountability in the Healthcare Sector and the Role of Civil Society," supported by the National Endowment for Democracy, analyzes the actual expenditures for 2022 based on the expenditure categories and the products/projects of public investments, compared to the initial and revised budget planning of the Ministry of Health and Social Protection. The report examines deviations from the plan and their reasons for each budget program under the administration of this Ministry.
Budget planning for this sector is weak, which is evidenced by budget deviations from the budget planning phase to the implementation phase. The higher deviations of the budget plan compared to the initial allocations result in a decrease of 1.4 billion ALL in the "Public Health Services" budget program and a decrease of 1.2 billion ALL in the "Primary Care Services" budget program.

The activity was moderated by the expert Aurora Sulce, and was also commented by the attendees who considered the report to be of special importance.

Mrs. Argita Alikaj, Sector's Responsible at the Ministry of Justice, stated that: "The health sector is one of the sectors that is projected as a risk sector in the Strategy we have drafted for 2023 -2030 and in the list of foreseen activities are also those that highlight and address the problems encountered. We have identified the issues and we're addressing them to the respective directors in the field."

Mr.Kozma Kondakçiu, Director of the Information Technology Audit Department of State’s High Commission, stated that: "The health pyramid is a huge pyramid and if something moves, all voices have to move and budgets change. Exact planning cannot exist. Moreover, the pandemic and other conditions that our country has been through have made accurate planning more unstable. It is difficult for us as HCS to do a risk analysis in our annual planning and not every central institution can be audited every year. The Ministry of Health and the Compulsory Health Care Insurance Fund are institutions that are audited almost every year. There are other subsidiary institutions that for various internal reasons can be audited once every 2 years."

Mrs. Vilfrida Bushati, Director of the Commissioner for Protection from Discrimination estimated the cooperation with the organization and the facilitation that such reports and statistics derived make for their daily work in the field of investigation and audit, so that issues in the provision of services are addressed and resolved without the need to reach the court process. But even if they make it to the judicial level, to be fact-based.

Mr. Petrit Vasili, Member of the Parliament of Albania, stated that the presented report was professional and addressed the "heart of the problem" and will also serve the Ministry of Health to draw important conclusions. One of the interesting details that he pointed out during the presentation was the increase of number of the patients in the psychiatry: "This should not have happened, as deinstitutionalization is a process in interest of the state and the patients themselves, because institutionalization affects their state of health and also aggravates the health budget of the state". Health is underfunded, this is a fact - the point of reference according to him is the Supreme State Control as the supreme constitutional authority, which through the facts and findings presented in the reports must analyze and understand how citizens' taxes are administered. He emphasized that as long as the investment funds in health are lower and there has been a regression compared to other countries, it means that the funds are wasted. As one of the last but not the least important points, Mr. Vasili mentioned the collapse of the referral system, which means the overloading of some hospitals such as Mother Teresa University Hospital, the atrophy of services in cities, the increase in costs to receive health care in Tirana or obliging patients to refer to the private health system. This closed circle that is created has consequences that fall heavily on the patient.

Mr. Besar Likmeta - Investigative Journalist at BIRN Albania, focused on the need that the private health system, which is already widespread in a large percentage, should be monitored on the service it provides by control institutions. Regarding the expenses of the Albanian population on health, they are increasing, especially regarding “out of pocket expenses”. One of the examples presented by Mr. Likmeta was the spread of informal markets during the pandemic because the health system could not provide the services (such as selling oxygen cylinders online). "The pandemic should have served as a moment of reflection regarding the shortcomings of the health system in Albania. Every year we report the same repeated cases, either in the way the budget is spent on medicines or in the concessions that are also repeated". Among the main reasons for the departure of Albanians from Albania identified during the interviews they have conducted is precisely health, as citizens are aware that their needs for receiving services are not answered in Albania. On the other hand, a kind of uncertainty is expressed regarding the public health system and citizens are forced to turn to the private sector.

The active and reflecting engagement of the media in addressing the issues related to the management of the health sector and the foundations that keep the system standing, was among the highlighted points at the end of the meeting.

This roundtable discussion has been an important platform for exchanging ideas and emphasizing the need for transparency and accountability in the healthcare sector. The "Together for Life" Association is committed to improving public health and will continue to monitor and report on developments in this field.

In her closing speech, the Executive Director of Together for Life – Ms. Eglantina Bardhi, emphasized that all together, by putting a foundation stone, a change can be made and the reflection of the decision-making institutions in undertaking this change can be encouraged.

Health in Albania continues to remain the last in the region in terms of public expenditures in relation to general public expenditures, which continues to remain in place for 2022. Health and social protection policies remain underfunded, making that the public expenditures of the sector to be realized without being prioritized and without having the necessary attention of the government regarding the accountability of their use, thus risking the misuse of budget funds.