Primary Health Care Reform in Albania

47 Pages·2005·0.47 MB·English

Partners for Health Reformplus
Primary Health
Care Reform in
Albania:
Findings from
an Impact
Assessment of a
Pilot Project

June 2005

Prepared by:

David Hotchkiss, PhD
Tulane University

Linda Piccinino, MPS
Abt Associates Inc.

Altin Malaj, MPH, MD
Abt Associates Inc.

Andrés Berruti, MA
Tulane University
This document was produced by PHRplus with funding from the US Agency for
International Development (USAID) under Project No. 936-5974.13, Contract No.
HRN-C-00-00-00019-00 and is in the public domain. The ideas and opinions in this
Sujata Bose, MS
document are the authors’ and do not necessarily reflect those of USAID or its
employees. Interested parties may use the report in part or whole, providing they Abt Associates Inc.
maintain the integrity of the report and do not misrepresent its findings or present
the work as their own. This and other HFS, PHR, and PHRplusdocuments can be
viewed and downloaded on the project website, www.PHRplus.org.
Abt Associates Inc.
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Mission

Partners for Health Reformplus is USAID’s flagship project for health policy and health system
strengthening in developing and transitional countries. The five-year project (2000-2005) builds on
the predecessor Partnerships for Health Reform Project, continuing PHR’s focus on health policy,
financing, and organization, with new emphasis on community participation, infectious disease
surveillance, and information systems that support the management and delivery of appropriate
health services. PHRplus will focus on the following results:
Implementation of appropriate health system reform.
(cid:83)
Generation of new financing for health care, as well as more effective use of existing funds.
(cid:83)
Design and implementation of health information systems for disease surveillance.
(cid:83)
Delivery of quality services by health workers.
(cid:83)
Availability and appropriate use of health commodities.
(cid:83)

June 2005
Recommended Citation

Hotchkiss, David, Linda Piccinino, Altin Malaj, Andrés Berruti, and Sujata Bose. June 2005. Primary Health Care Reform in Albania: Findings from an

Impact Assessment of a Pilot Project. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc..
For additional copies of this report, contact the PHRplus Resource Center at [email protected] or visit
our website at www.PHRplus.org.

Contract/Project No.: HRN-C-00-00-00019-00

Submitted to: USAID/Tirana

and: Karen Cavanaugh, CTO
Health Systems Division
Office of Health, Infectious Disease and Nutrition
Center for Population, Health and Nutrition
Bureau for Global Programs, Field Support and Research
United States Agency for International Development

Abstract
This report describes results from the monitoring and evaluation of a primary health care (PHC)
pilot in Albania. Recent health sector reform efforts in Albania have focused on strengthening the
primary health care system. The Partners for Health Reformplus (PHRplus) Project provided
technical assistance to Albanian counterparts for the implementation and assessment of a pilot PHC
intervention in two Albanian districts with the hope that results from the pilot would inform the
design of a national PHC model. Components planned under the PHC pilot intervention were:
purchasing new equipment for pilot facilities; training providers in the implementation of clinical
practice guidelines; revising the medical chart system; building management capacity; improving
community outreach; and implementing health financing reform. The purpose of assessment was to
evaluate whether the intervention was carried out as planned and to measure its impact on
availability, utilization, and quality of PHC services, emphasizing reproductive and curative care.
Baseline and follow-up surveys were conducted of health facilities, individual providers, and
households in four intervention areas (in Berat and Kuçova districts) and two control areas (in Fier
district) between 2002 and 2004. The assessment showed that PHRplus was able to implement all of
the planned intervention components, with the exception of health financing reform. Key results in
intervention areas include: a sharp increase in modern contraceptive use; a significant decrease in
“bypassing” of PHC facilities; an overall increase in the percentage of clients using PHC facilities;
and evidence of increased use of data for clinical and managerial decision-making. This case study
suggests that making changes in the PHC system using a pilot approach is not only feasible, but that
pilot activities themselves have the potential to improve utilization and quality of care at PHC
facilities.

Table of Contents
Acronyms..............................................................................................................................................ix
Acknowledgments.................................................................................................................................xi
Executive Summary............................................................................................................................xiii
1. Introduction....................................................................................................................................1
1.1 Background on PHRplus.......................................................................................................1
1.2 Overview of Evaluation Study..............................................................................................2
2. Description of Pilot Intervention....................................................................................................3
2.1 Situational Analysis of Primary Health Care System............................................................3
2.2 Description of PHRplus-supported Intervention...................................................................4
3. Study Design and Methodology.....................................................................................................9
3.1 Household Survey...............................................................................................................10
3.2 Facility Survey....................................................................................................................11
3.3 Provider Survey...................................................................................................................12
4. Results..........................................................................................................................................13
4.1 Was the Intervention Carried Out as Planned?....................................................................13
4.2 Did the Expected Changes Occur?......................................................................................15
4.3 Are the Changes that Occurred Attributable to the Intervention?.......................................22
5. Conclusion....................................................................................................................................25
Annex A. Average Changes in Selected Population-based Indicators.................................................27
Annex B: Bibliography........................................................................................................................31
List of Tables
Table 3.1: Households in the Sampling Frame, by Study Group................................................................10
Table 3.2: Number of Households in the Sampling Frame and the Number Surveyed, by Sample Area.10
Table 3.3: Government Health Facilities by Type of Facility and by Study Group...................................12
Table 3.4: Providers by Facility Type and Region.....................................................................................12
Table A-1: Average Changes in Selected Population-based Indicators between Baseline and Follow-up
Surveys and between Intervention and Control Areas.........................................................................29

Table of Contents vii
List of Figures
Figure 2.1: Albania Health Care System Situation Analysis........................................................................4
Figure 2.2: PHRplus Albania Primary Health Care Strategy........................................................................5
Figure 4.1: Percentage of Acute Care Clients of Primary Health Centers Who Report that the Quality of
Care Received in the Past Month is Excellent or Good, by Urban/Rural Status.................................17
Figure 4.2: Percentage of Women of Reproductive Age Who Report Currently Using a Modern
Contraceptive Method.........................................................................................................................18
Figure 4.3: Percentage of Women of Reproductive Age Who Report Receiving Reproductive Health
Advice in the Past Year from a Health Care Provider.........................................................................19
Figure 4.4: Percent of Contraception Users Who Received Advice on Family Planning in the Intervention
Group, by Type of Person Who Provided Advice...............................................................................20
Figure 4.5: Percentage of Government Clients in the Past Month with a Cold or Flu Who Report First
Seeking Care from a Polyclinic or Hospital........................................................................................21
Figure 4.6: Percentage of Chronic Care Clients in the Past Month Who Received Care from Primary
Health Care Facilities..........................................................................................................................22

viii Table of Contents
Acronyms
CPG Clinical Practice Guideline
GP General Practitioner
HII Health Insurance Institute
HIS Health Information System
INSTAT Institute of Statistics
IRD Intensive Research and Demonstration
MOH Ministry of Health
PHC Primary Health Care
PHRplus Partners for Health Reformplus
PRIME Partnership in International Medical Education
USAID United States Agency for International Development

Acronyms ix