Guidance

Country information note: medical and healthcare provision, Albania, May 2023 (accessible)

Updated 12 July 2024

Version 3.0

May 2023

Preface

Purpose

This note provides country of origin information (COI) for decision makers handling cases where a person claims that to remove them from the UK would be a breach of Articles 3 and/or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition.

It is not intended to be an exhaustive survey of healthcare in Albania.

For general guidance on considering cases where a person claims that to remove them from the UK would be a breach of Article 3 and/or 8 of the European Convention on Human Rights (ECHR) because of an ongoing health condition, see the instruction on Human rights claims on medical grounds.

Country of origin information

The country information in this note has been carefully selected in accordance with the general principles of COI research as set out in the Common EU [European Union] Guidelines for Processing Country of Origin Information (COI), dated April 2008, and the Austrian Centre for Country of Origin and Asylum Research and Documentation’s (ACCORD), Researching Country Origin Information – Training Manual, 2013. Namely, taking into account the COI’s relevance, reliability, accuracy, balance, currency, transparency and traceability.

The structure and content of the country information section follows a terms of reference which sets out the general and specific topics relevant to this note.

All information included in the note was published or made publicly available on or before the ‘cut-off’ date(s) in the country information section. Any event taking place or report/article published after these date(s) is not included.

All information is publicly accessible or can be made publicly available, and is from generally reliable sources. Sources and the information they provide are carefully considered before inclusion. Factors relevant to the assessment of the reliability of sources and information include:

• the motivation, purpose, knowledge and experience of the source

• how the information was obtained, including specific methodologies used

• the currency and detail of information, and

• whether the COI is consistent with and/or corroborated by other sources.

Multiple sourcing is used to ensure that the information is accurate, balanced and corroborated, so that a comprehensive and up-to-date picture at the time of publication is provided of the issues relevant to this note.

Information is compared and contrasted, whenever possible, to provide a range of views and opinions. The inclusion of a source, however, is not an endorsement of it or any view(s) expressed.

Each piece of information is referenced in a brief footnote; full details of all sources cited and consulted in compiling the note are listed alphabetically in the bibliography.

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Information about the IAGCI’s work and a list of the documents which have been reviewed by the IAGCI can be found on the Independent Chief Inspector’s pages of the gov.uk website.

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Country information

Section 1 updated: 3 November 2022

1. Sources

1.1.1 This note makes extensive use of medical country of origin information (COI) compiled by Project MedCOI, which was set up and operated by the immigration authorities in Belgium and the Netherlands until 31 December 2020, and since then by the European Union Agency for Asylum (EUAA).

1.1.2 The EUAA MedCOI sector website explains how the project has and currently operates:

‘EUAA MedCOI relies on a worldwide network of medical experts that provides up-to-date medical information in countries of origin. Based on this information and combined with desk research, the EUAA MedCOI Sector produces responses to individual requests from EU+ countries, general medical country reports, and maintains a portal with a specific database where the information can be found… The database is only accessible to trained personnel in EUAA and the EU+ countries’ relevant administrations…

‘The high quality and medical accuracy of the information is guaranteed by specifically trained medical advisors and research experts who also provide guidance to the users of the portal.

‘The MedCOI Sector at EUAA has incorporated all services that were previously delivered by project teams in Belgium and the Netherlands in an ERF/AMIF funded project until 31/12/2020 (MedCOI4).’^{[footnote 1]}

1.1.3 The UK Home Office ceased to be able to make requests to or access the database of MedCOI on 31 December 2020.

1.1.4 The UK Home Office has, however, retained copies of all MedCOI documents referred to in this note should they be required in individual cases.

Section 2 updated: 3 November 2022

2. Basic indicators

Total population (million)	3,095,344 (2022 est.)[footnote 2]
Urban population as % of total population	63.8% of total population (2022 est.)[footnote 3]
Life expectancy at birth	79.47 years (2022 est.)[footnote 4]
Maternal mortality rate	15 deaths/ 100,000 live births (2017 est.)[footnote 5]
Infant mortality rate	10.82 deaths/ 1,000 live births (2022 est.)[footnote 6]
Current health expenditure	5.2% (2018)[footnote 7]

2.1.1 Regarding transport to healthcare facilities, the World Health Organisation (WHO) noted in 2018 that:

‘The distance between PHC centres [Primary Healthcare Centres] ranges from 10 to 25 km. This can comprise an obstacle for the population to visit GPs [general practitioners] but also for the GPs to make home visits and/or to consult patients at more distant health post–ambulatories [note: post- ambulatory is a term used for everything affiliated with PHC centre facilities]. GPs serve the population on their lists and the schools located in the catchment area of the PHC centre.

‘The centres visited did not have vehicles. The condition of the roads and public transport availability within the areas with PHC centres influence the accessibility to PHC services, especially in winter.’^{[footnote 8]}

2.1.2 The U.S. Department of State’s Overseas Security Advisory Council (OSAC) noted in its Albania Country Security Report published in October 2021, that ‘Healthcare is a grave problem in Albania. Medical care is inadequate in some areas, and emergency medical services are very limited. There are no trauma hospitals outside of Tirana. Individuals under continuing medical supervision should consult their physician prior to travel. Albania has few ambulances. Injured or seriously ill individuals may need to take taxis or other vehicles to the nearest hospital.’^{[footnote 9]}

Section 3 updated: 5 May 2023

3. Healthcare system

3.1 Structure

3.1.1 Fufarma, a pharmaceutical company for the import and distribution of medical tablets, syrups, sprays, sachets, creams, capsules, drugs, and other products, and medical equipment in Albania, noted in its undated health system review that ‘… the state provides most of the health care services offered to the population as in the field of promotion, prevention, diagnosis, and treatment. The private sector covers mostly pharmaceutical and dental services and some specialized diagnostic services mainly concentrated in Tirana…

‘The diagnostic and curative health services are organized in three levels: primary, secondary, and tertiary health care services. Public health services and promotion are provided in the primary health care and supported and supervised by the Institute of Public Health, the 12 Regional Directorates of Health and the 24 Directorates of Public Health.

‘The health system in Albania is supported by a number of national institutions, which depend directly on the Ministry of Health. Basic public health services are coordinated and mostly provided by the Institute of Public Health.’^{[footnote 10]}

3.1.2 In an article published in Sage Journals on 7 October 2020, Jonila Gabrani, Christian Schindler and Kasper Wyss from the Swiss Tropical and Public Health Institute, University of Basel, Switzerland, noted that ‘… Albania, a south-eastern European country with a health system in transition, most health care providers continue to be owned by the Government. They have a 3 tiers level structure: primary, secondary, and tertiary healthcare…

‘Albania has been engaged for several years in improving PHC services to better address health system challenges.’^{[footnote 11]}

3.1.3 In 2019, the International Trade Administration (ITA), led by the Under Secretary for International Trade, stated:

‘The healthcare system in Albania is mostly public [free], although private healthcare has become increasingly popular. The public healthcare service is organized at the primary, secondary, and tertiary service levels. Approximately 413 public healthcare clinics offer primary and secondary healthcare services and 42 public hospitals offer tertiary healthcare services. Pharmaceutical and dental services are almost entirely private…

‘Public healthcare spending is partially financed by compulsory health insurance contributions by employees and employers (a 3.4 % health insurance contribution, divided evenly between employer and employee, is imposed on salaries) and subsidized by the state budget. The Compulsory Health Insurance Fund (ISKSH), funded by the health insurance contributions and subsidized by the state budget, reimburses the prescription drugs for the insured and pays for the public healthcare services as well as some approved hospital healthcare services provided by the private healthcare providers.’^{[footnote 12]}

3.1.4 MedCOI: The Asylum and Migration Integration Fund (AMIF) financed project to obtain medical country of origin information (MedCOI) noted in March 2019 that in Albania’s health system ‘The diagnostic and treatment health service is organized in three levels: primary care [PHC], secondary hospital service, and tertiary hospital service.’^{[footnote 13]}

3.1.5 Expatfinder, a website aimed towards fee-paying foreign visitors but also citing public health care procedures available for Albanian citizens, noted:

‘By law, all Albanian citizens are entitled to get equal access to healthcare in the country. The public healthcare system is controlled by the state and is divided into three tiers. The first level corresponds to primary health care, including health, hygiene, maternity and paediatric clinics, health education centres, local emergency rooms and rural hospitals. The next level caters to secondary care and is made up of diagnostic and medical services in hospitals and polyclinics. The last level administers tertiary care and consists of scientific research medicine, which includes four national university centres equipped with diagnostic services.

‘Funding for the public healthcare scheme comes from contributions from employers, employees and self-employed individuals.’^{[footnote 14]}

3.1.6 A joint report on the monitoring of Albania’s state health budget in 2021 by Together for Life (TFL), Westminster Foundation for Democracy (WFD), and the UK Government, published in August 2022, stated that ‘The Ministry of Health and Social Protection (MoHSP) administers and manages public funds according to seven approved programs, as follows:

1. Planning, Management and Administration

2. Primary Health Care Services

3. Secondary Health Care Services

4. Public Health Services

5. National Emergency Medical Service

6. Social Services

7. Rehabilitation of the Politically Persecuted’^{[footnote 15]}

3.1.7 The same source added that ‘In the total MoHSP budget for 2021, the main weight is carried by the “Primary Health Care Services” Program with 40.7%, followed by “Social Services”, with 36% and “Primary Health Care Services”, with 10.7%.’^{[footnote 16]}

3.2 Doctors and specialists

3.2.1 In 2018, the WHO report noted that ‘The composition of PHC teams varies according to the centre. GPs specialize either in adults (15 years and older) or in children. However, in small rural areas, GPs provide services to people of all ages. Urban areas have paediatricians performing check-ups of healthy children and paediatricians caring for sick children. A similar division of labour applies to nurses. Nurses are often subspecialized, with a narrow scope of services.’^{[footnote 17]}

3.2.2 The 2018 WHO report added that ‘In Tirana, the organization of the PHC centre includes diagnostic services staffed with specialized doctors, such as cardiologists, rheumatologists, orthopaedic surgeons, surgeons, obstetrician-gynaecologists and ophthalmologists.’^{[footnote 18]}

3.2.3 The Computer and Enterprise Investigations Conference (CEIC), founded in 1992 by a team of expert analysts and economists to provide analytical data for economic and investment research, indicated in an undated report there was a ratio of 1.216 physicians per 1000 people from data collected in 2016^{[footnote 19]}.

3.2.4 The pan-European media network specialised in EU policies, Euractiv, which was founded in 1999 by the French media publisher Christophe Leclercq, noted in a report dated 5 May 2022, that ‘A recent report has detailed how thousands of health workers fled to Germany in 2020, while Prime Minister Edi Rama has dismissed concerns about the loss of skilled workers in key sectors.

‘The European Training Foundation published a report last week detailing the mass exodus of skilled workers, including a high number of young people. The situation is particularly concerning for doctors and nurses and also includes psychotherapists, dentists, and pharmacists, all of which are in demand in Albania.

‘Albania has the lowest number of doctors and nurses per capita in Europe, data from 2020 shows. In 2019, 18% of qualified medical staff worked abroad, of which 765 Albanian doctors were working in Germany – a 21% increase from the year before. More are believed to have left since then as the number of emigrants from Albania stood at 42,000 in 2021.

‘This shortage was felt acutely during the COVID-19 pandemic, with hospital capabilities stretched to breaking point.

‘The World Health Organisation has also noted that Albania has one of the lowest rates of doctors-to-patients globally.’^{[footnote 20]}

3.3 Pharmaceuticals

3.3.1 Expatfinder noted that ‘Generally speaking, the pharmaceutical industry in Albania is predominantly privatised. This country has a total of 1,020 pharmacies and 42 hospital pharmacies. Most of the drugs sold in Albania are imported and usually, international brands represent the market. It is the duty of the Ministry of Health to supervise the local pharmaceutical industry while the National Agency of Drugs and Medical Equipment handle the registration process.’^{[footnote 21]}

3.3.2 A list of pharmaceutical companies in Albania in alphabetic order can be found on the undated international conference of harmonisation of technical requirements for registration of pharmaceuticals for human use (ICH GCP), the Good Clinical Practice Network^{[footnote 22]}.

3.3.3 Privacy Shield, an organisation designated by the U.S. Department of Commerce, in conjunction with the European Commission and Swiss Administration, to support transatlantic commerce within data protection requirements under EU Law, noted that:

‘Albania’s pharmaceutical sector includes 200 pharmaceutical warehouses, one thousand pharmacies, 210 pharmaceutical private agencies, and 42 pharmacy hospitals. Imports dominate Albania’s drug market and most major international brands are present in the country. Locally manufactured products, while growing recently, continue to account for a small share of the total market. In 2018, domestic production accounted for around 10% of market share.

‘The Ministry of Health monitors the pharmaceutical industry, and all drugs must be registered with the National Agency of Drugs and Medical Equipment. The government sets profit margins for actors involved in the distribution chain for both reimbursed drugs and non-reimbursable drugs.’^{[footnote 23]}

3.4 Private and public hospitals

3.4.1 Expatfinder noted that ‘The private health sector in Albania is still also under development, and mostly covers dental and pharmaceutical services. Most of the private medical facilities are concentrated in Tirana including the Hygeia Hospital, American Hospital and German Hospital.’^{[footnote 24]}

3.4.2 Also see the UK Government website list of medical facilities.

3.4.3 See the Hospitals Worldwide Guide for a list of public hospitals in Albania.

3.5 Recent developments in healthcare

3.5.1 MedCOI noted the following in March 2019:

‘The state provides most of the services offered to the population in the field of promotion, prevention, diagnosis, and treatment. The private sector is still strengthening and covers most of the pharmaceutical service, dental service and some specialist diagnostic clinics that are mainly concentrated in Tirana. In the public sector, the Ministry of Health and Social Protection is responsible for the policies and strategies of the health system, its regulation and coordination of all actors within and outside the system.’^{[footnote 25]}

3.5.2 The 2018 WHO report also notes that:

‘In Albania, PHC is organized through a public network of providers of health services. …. On average, one PHC centre offers services to 8000–20 000 inhabitants, varying for urban and rural areas, registering a doctor: patient ratio of 1:2500 and nurse: patient ratio of 1:400. All PHC centres are responsible for 24/7 duty…

‘All PHC centres are under the direct supervision of the Ministry of Health and Social Protection, which recruits the medical and non-medical personnel and is responsible for investing in infrastructure and equipment. In most cases, the buildings and land are the property of the Ministry of Health and Social Protection or of the local governments. Each PHC centre has a chief physician, who is usually a general practitioner (GP).’^{[footnote 26]}

3.5.3 The European Social Charter on Albania joint report, published in March 2022, the Council of Europe (CoE) and the European Committee of Social Rights (ECSR) noted that measures to ensure the highest possible standard of health ‘… indicates that the following strategies/programmes have been developed: the National Health Strategy 2016-2020, Primary Healthcare Services Development Strategy 2020-2025, National Programme for the Prevention and Control of Non-Infectious Diseases 2016-2020, Cervical Cancer Screening Programme, National Programme for Breast Cancer Screening.’^{[footnote 27]}

3.5.4 The United Nations Office for Project Services (UNOPS), a United Nations agency dedicated to implementing infrastructure and procurement projects for the United Nations System, international financial institutions, governments and other partners around the world, noted in a report published on 13 September 2022, that ‘As a part of its support for Albania’s COVID-19 emergency response, UNOPS, in partnership with the Ministry of Health and Social Protection, is renovating the Infectious Diseases Clinic (IDC) within the Mother Teresa Hospital in Tirana.

‘Funded through a €12.8 million World Bank loan [£11.2 million as of 21 October 2022’^{[footnote 28]}], the works will transform the facility into a state-of-the-art health clinic serving more than 10,000 patients a year.

‘Upon completion, the clinic will include 16 new emergency beds, 8 intensive care units and 87 ward beds – helping medical staff to improve life-saving medical services to people in need…

‘“It will have twice as many intensive care beds, contemporary medical equipment, a laboratory, a lecture hall for university students and waiting areas for the patients’ relatives,” she added during a recent joint inspection with the Prime Minister of Albania, Edi Rama.

‘As part of the project, UNOPS has also procured and delivered essential hospital equipment including 20 ambulances, computed tomography (CT) scanners at the hospital in Korca as well as Shefqet Ndroqi and Trauma University hospitals in Tirana X-ray rooms were also installed in hospitals in Lac, Vore and Paskuqan.

‘A further 13 hospitals across the country will be provided with new, advanced diagnostics equipment – including digital X-ray systems, CT scanners and all-purpose ultrasound machines – among others. This project will ensure local residents can receive timely and high-quality medical services.’^{[footnote 29]}

3.6 Impact of COVID-19

3.6.1 In an undated report, the Organisation for Economic Co-operation and Development (OECD) noted that ‘COVID-19 had an impact on Albanian citizens and its economy, but the authorities acted quickly to contain the spread of the virus…

‘Albania has experienced several waves of the pandemic. The economy reported the first case of COVID-19 on 8 March 2020. Two and a half months later, there were around 300 cases and 10 registered deaths per million inhabitants…

‘The prime minister declared a state of natural disaster throughout the economy on 25 March 2020. The government then prolonged the state until 23 June 2020 and took a series of measures to control the epidemic…

‘Albania had in place policy framework that provided a basis for dealing with the outbreak. It includes the National Civil Emergency Plan of Albania, the Ministry of Health and Social Protection Emergency Operation Plan, the National Pandemic Influenza Preparedness and Response Plan, and the Infectious Diseases Hospital Crisis Prevention Plan, Focused on Pandemic Flu H1N1.’^{[footnote 30]}

3.6.2 The WHO coronavirus disease (COVID-19) live dashboard (with vaccination data) noted that ‘In Albania, from 3 January 2020 to 9 December 2021 there have been 202,641 confirmed cases of COVID-19 with 3,126 deaths, reported to WHO. As of 5 December 2021, a total of 2,035,191 vaccine doses have been administered.’^{[footnote 31]}

3.6.3 OECD further noted that ‘The government has put in place numerous measures (amounting to 4% of GDP) to support the healthcare system, enterprises and households affected by the confinement measures…

‘It received emergency financing support from the International Monetary Fund, the European Union and other donors to help assist with the crisis response…

‘The short-term risk to human life from the COVID-19 has been curtailed thanks to authorities’ early response and citizens’ respect of confinement orders. Registered case and death numbers in Albania are among the lowest in the Western Balkans region.’^{[footnote 32]}

3.6.4 In an undated report, the COVID- 19 Health System Response Monitor (HSRM) which is supported by the WHO, the European Commission and the European Observatory on Health Systems and Policies, stated that:

‘Measures have been implemented to reconfigure service delivery in an effort to increase treatment capacity. Elective procedures are deferred, and capacities at the two hospitals designated for COVID are freed from other medical services which have been transferred to other public hospitals (general surgery and urology to the Trauma Hospital, and TB to the Elbasan Regional Hospital). There is no evidence (positive or negative) of the implications of these efforts.

‘The COVID-19 designated hospitals that are meant to deal exclusively with COVID-19 patients are the Infectious Disease Services at the University Hospital Centre “Mother Tereza” (120 beds), named Hospital COVID 1, and the University Hospital “Shefqet Ndroqi” (193 beds), named Hospital COVID 2.

‘The role of primary care providers with regard to COVID-19 cases consists of:

• Supporting the surveillance teams in case detection and contact tracing.

• Responding on the phone to questions and concerns of people who are in their jurisdiction. Give advice, support, and medical assistance as needed.

• Following up with isolated and quarantined individuals; make sure they follow the medical advice and make sure they are transferred on time to COVID hospitals by the Medical Emergency Service, in case of a deterioration of their condition.

• Following up with convalescent/recovered cases after they are discharged from the hospital.

‘There is an increased availability of video, telephone or other alternative consultations for health services, including TeleMedicine Platform, E-referral, and E-prescription.

‘Measures to ensure additional inpatient capacities for COVID-19 cases include the following:

• Decision of the Council of Ministers No. 244 of 26 March 2020: “On the placement at the disposal of the Ministry of Health and Social Protection of the building of the former “Crystal” University”

• Normative Act No. 3 of 15 March 2020 “On special administrative measures during the COVID-19 infection period: Depending on the dynamics of hospitalization of people affected by COVID-19 infection, private hospitals, outpatient services, accommodation facilities, auto-ambulances and relevant health and support staff shall be made available to MoHSP for facing COVID -19, upon the Order of the Minister responsible for health”.

‘Measures were also taken to prohibit the export of medicines and medical equipment from the Republic of Albania. Permission to export medicines and medical equipment is granted only by authorization from the Minister of Health and Social Protection (Order of the Minister of Health and Social Protection No. 131 of 8 March 2020: “On the prohibition of the export of medicines and medical equipment”).’^{[footnote 33]}

3.6.5 The CoE and ECSR report published in March 2022 ‘…indicates that a “Covid-19 Action Plan for Albania: Prevention, Preparation and Response against Covid-19” has been adopted and updated regularly. With regard to treating those who are ill, the report indicates that measures were taken to increase the capacity of hospitals.’^{[footnote 34]}

3.6.6 The same source added:

‘Although the COVID-19 pandemic has eased since the end of 2021 and the wave detected so far in 2022 is milder, the long-term consequences of the pandemic continue to be felt and are expected to harm the population in the medium term as well. Many affected people are suffering from “long-term COVID”, while they will have to face the possibility of being infected for the second time. They are suffering from the direct and indirect consequences of the disease such as lung damage, chronic fatigue, damage to the nervous system, and mental disorders. Such consequences last 4-5 months, but beyond that, even after the infection has passed, there is what is being described by the health systems as “post-COVID” syndrome, or “prolonged COVID”.^{[footnote 35]}

Section 4 updated: 5 May 2023

4. Cost of medical treatment and drugs

4.1 The Compulsory (Mandatory) Health Insurance Fund

4.1.1 The International Trade Administration (ITA) noted that the Compulsory Health Insurance Fund (ISKSH), funded by the health insurance contributions and subsidized by the state budget, reimburses prescription drugs for the insured and pays for public healthcare treatment services, as well as approved hospital healthcare services provided by private providers^{[footnote 36]}.

4.1.2 The Compulsory Health Insurance Fund (CMIF) was established under Law no.10383 of 2011. It covers most medical treatment services, including:

a) medical check-ups, examinations and treatment in public primary health care centers and public hospitals;

b) medical check-ups, examinations and treatments in [approved] private primary health care and hospital providers.

c) drugs, medical products and treatments by contracted providers of health services.

Patients have free choice of a doctor^{[footnote 37]}.

4.1.3 Compulsory healthcare insurance and related contributions payments are mandatory for all economically active persons residing permanently in Albania as employees, self-employed persons, unpaid family workers and other economically active persons^{[footnote 38]}.

4.1.4 Compulsory healthcare insurance also covers the following categories of economically inactive persons, whose payment contributions are financed by the State:

• Persons who benefit from Social Insurance Institute

• Persons who receive social assistance or disability payments in accordance with relevant legislation

• Persons registered as unemployed

• Children under 18 years

• Pupils and students under the age of 25 years, provided they do not have income from economic activities

• Categories of persons as defined by special laws.

Any persons who are not already included in Compulsory Health Insurance are entitled to voluntarily join the scheme^{[footnote 39]}.

Section 5 updated: 5 May 2023

5. Specific medicines available in Albania (as of April 2022)

5.1 Drugs reimbursable from the Compulsory Health Care Insurance Fund

5.1.1 The Ministry of Health and Social Care published a list of drugs (currently at: Vendim nr. 230, date: 13/04/2022) which are registered and approved for marketing in Albania, and are sold in state hospital pharmacies, and for which the cost is reimbursable to the patient from the Compulsory Health Care Insurance Fund^{[footnote 40]}; ^{[footnote 41]}(note: Click on the above link for a full list of medicines in this category).

5.2 Drugs registered in Albania, for which the cost is not reimbursable from the Compulsory Health Care Insurance Fund

5.2.1 As of 6 June 2022, a total of 4,067 drugs had been registered for use in Albania^{[footnote 42]}. Of these, about 30% are on the ‘reimbursable drugs’ list^{[footnote 43]}. Patients or doctors are able to purchase any ‘non-reimbursable’ medicines if they are available at a pharmacy in Albania, but would be required cover the cost of these ‘out of pocket’^{[footnote 44]}.

5.3 Full list of drugs registered in Albania

5.3.1 A complete list of drugs that are registered for use in Albania, as of June 2022, can be found on the website of the National Agency for Medicines and Medical Devices (‘Agjencia Kombetare e Barnave dhe Pajisjeve Mjekesore’)^{[footnote 45]}.

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The information in this section has been removed as it is restricted for internal Home Office use only.

The information in this section has been removed as it is restricted for internal Home Office use only.

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Section 6 updated: 3 November 2022

6. Cancer treatment (oncology)

6.1 Prevalence and available treatment facilities

6.1.1 With support of the WHO and the Regional Office for Europe, Albania’s Ministry of Health published the National Cancer Control Program 2011- 2020 in April 2011. The program noted that nine of the most common cancers in Albania were:

• Breast.

• Central nervous system.

• Larynx.

• Lung.

• Rectum.

• Skin.

• Stomach.

• Urinary tract.

• Uterus^{[footnote 46]}.

6.1.2 Albania’s National Cancer Control Program noted that ‘The National Committee for Cancer Control is fully functional and currently leads the National Cancer Control Program (NCCP). For the four key components: prevention, early detection, diagnosis and treatment, and palliative care, responsibilities and specific tasks are designed.

‘The National Cancer Control Program document is developed and reviewed by all actors involved in the fight against cancer in Albania.

‘The 10- year action plan (2011-2020 which includes activities, timelines and budget is developed based on national priorities.’^{[footnote 47]}

6.1.3 The same source added that ‘The cancer registry is based on hospital records of the “Mother Teresa” University Hospital Center in Tirana (TUHC). The computerization of data has started in 2008. The data collected from 36 districts are then sent to TUHC. The cancer and risk factors surveillance is based on the institutional collaboration between TUHC and the Institute of Public Health.^{[footnote 48]}

6.1.4 Albania’s National Cancer Control Program further stated that ‘The National Oncology Service is part of “Mother Teresa” Hospital and the only specialized public institution in the country, with a multi-disciplinary team which deals with cancer diagnosis and treatment. This service has 111 beds, 31 physicians and consists of surgery pavilion (where surgery of breast, colon and rectum, soft tissues and bones, testicles, skin, and melanoma are performed), radiotherapy, chemotherapy, pathological anatomy, and diagnostic radiology pavilions.

‘University Clinics within “Mother Teresa” Hospital are: General Surgery, Urology, Surgery of the Thorax, Otorhinolaryngology, Maxillofacial Surgery, and Neurosurgery. These services provide primarily surgical treatment for tumors of the stomach, urinary tract, lung, head, neck, and brain.

• ‘Regional hospitals: generally, are not equipped in a modern way and have less qualified medical personnel to diagnose and treat cancer.

• ‘Primary Health Care Centers and Specialties’ Policlinics: in Tirana and other districts across the country there are such centers for patients who initially go there for cancer diagnosis. These centers also include other sections for ambulatory patients diagnosed and treated for cancer (Oncology centers). These services are available in the main districts of the country (Tirana, Durres, Shkoder, Fier, Vlore, Lezhe, Elbasan, Kruje, Kavaja and Korca).

• ‘Private services: there is only one private complex hospital center in Tirana, Hygeia hospital, which provides a high quality multi-disciplinary complex service in oncology including radiotherapy with 2 linear accelerators, but every service is provided against direct payment from the patient. The American hospital also provides modern diagnostic service, as well as surgery and chemotherapy treatment, also against direct payments from the patients.’^{[footnote 49]}

6.1.5 The same source continued: ‘Cancer drugs, according to priority can be divided into the following groups:

• ‘Curable cancers and those cancers where the cost-benefit rate clearly favors the treatment with anti-tumor drugs and that can be managed properly with basic treatment regimen, based on relatively few drugs, which can be found in the market at relatively low cost as generic medicines. The widespread availability of these drugs should be the number one priority of health policy.

• ‘The second group of drugs may have some advantages in certain clinical situations.

• ‘Based on current evidence, the third group of drugs (new drugs) is considered as not essential to real effectiveness in cancer care. Numerous new drugs are “aggressively” introduced into the market, but most of them are expensive and of limited benefit.’^{[footnote 50]}

6.1.6 The media outlet Albania Daily News reported in an article entitled ‘Albania Lacks Access to Innovative Treatments on Cancer’ on 24 September 2022 that ‘Statistics show a rapid spread of cancer and the burden of disease, but funding for reimbursement remains stagnant…

‘From 2017 to 2020, the European Union has approved about 160 new drugs that treat various diseases, but in Albania, during the same period, only 5 of them were included in the reimbursement lists…

‘Because the market for expensive medicines is directly related to the reimbursement list, large pharmaceutical companies are reviewing their position in Albania, with the prospect of closing subsidiaries.’^{[footnote 51]}

6.2 Breast cancer

6.2.1 The Government of Albania’s Instituti i Shendetit Publik (ISHP) noted in 2017 that the following drugs to treat breast cancer were available at the Mother Teresa Hospital in Tirana:

• ‘Chemotherapy regimens: a treatment plan that specifies the dosage, the schedule, and the duration of treatment; in combination with:

• ‘Taxane: a type of drug that blocks cell growth by stopping mitosis (cell division). Taxanes interfere with microtubules (cellular structures that help move chromosomes during mitosis). They are used to treat cancer. A taxane is a type of mitotic inhibitor and a type of antimicrotubule agent.

• ‘Trastuzumab: a monoclonal antibody used to treat breast cancer and stomach cancer. It is specifically used for cancer that is HER2 receptor positive. It may be used by itself or together with other chemotherapy medication.

‘Chemotherapy drugs:

• Epirubicin: chemotherapy drug, an anthracycline topoisomerase II inhibitor used as an adjuvant to treating axillary node metastases in patients who have undergone surgical resection of primary breast cancer.

• ‘Cyclophosphamide: a chemotherapy drug in a class of medications called alkylating agents. In treating cancer, it works by slowing or stopping the growth of cancer cells in your body.

• ‘5-fluorouracil: a chemotherapy drug. It slows the growth of cancer cells.

• ‘Docetaxel: an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug. This medication is classified as a “plant alkaloid,” a “taxane” and an “antimicrotubule agent”^{[footnote 52]}.

6.2.2 An article published on 1 October 2018 in the medical journal The Breast noted that Neoadjuvant therapy was available at the Mother Teresa Hospital. The following information was found:

‘Neoadjuvant therapy refers to the systemic treatment of breast cancer prior to definitive surgical therapy. The primary objective of neoadjuvant therapy is to improve surgical outcomes in patients for whom a primary surgical approach is technically not feasible and in patients with operable breast cancer who desire breast conservation. Neoadjuvant therapy also allows for an early evaluation of the effectiveness of systemic therapy.

‘Oncology Service in UHC “Mother Teresa” is the greatest service of treating cancer in Albania, but it is not the only one. There are also some private hospitals which treat patients diagnosed with cancer.’^{[footnote 53]}

6.2.3 Information on the MedCOI database indicated that treatment for breast cancer was available at the University Medical Center of Mother Teresa University Hospital, Rruga e Dibres 372, Tirana:

• ‘Inpatient, outpatient, and follow up treatment by an oncologist.

• ‘Oncology: radiation therapy.

• ‘Diagnostic imaging by means if integrated PET/CT scan, partly available: Only CT scan is available, PET- scan is not available.

• ‘Oncology: terminal and palliative care.’^{[footnote 54]}

6.2.4 : MedCOI advised that the drugs listed below were available in Albania, for example at the Mother Teresa Hospital (Pharmacy), Rruga e Dibres 372, Tirana (a public hospital):

• ‘Daratumumab- Immunosuppressants.

• ‘Anastrozole- oncology: anti- hormones; aromatase- inhibitors.

• ‘Exemestane- oncology: anti- hormones; aromatase- inhibitors.

• ‘Letrozole- oncology: anti- hormones; aromatase- inhibitors.

• ‘Pertuzumab- oncology: cytostatics/ chemotherapy.

• ‘Bevacizumab- oncology: cytostatics/ chemotherapy.

• ‘Tamoxifen- oncology: cytostatics/ chemotherapy/ antineoplastics.

• ‘Trastuzumab- oncology: cytostatics/ chemotherapy/ antineoplastics.

• ‘Rituximab- oncology: monoclonal antibodies

• ‘Mirtazapine- psychiatry: antidepressants.’^{[footnote 55]}

6.2.5 RAD-AID, a non-profit public service whose mission is to increase and improve radiology in the low- and middle-income countries (LMICs), as well as underserved areas of high-income countries (HICs), noted in an undated report that ‘Currently, there is no national breast cancer screening program [radiology services]. Diagnostic breast exams are done using mammography and/ or ultrasound. AHT [American Hospital in Tirana, a private facility] also performs breast MRI and is the only facility that offers breast MR imaging.’^{[footnote 56]}

6.3 Colon carcinoma with metastasis (cancer of the colon)

6.3.1 MedCOI indicated that treatment for colon carcinoma with metastasis was found to be available at the following hospital: University Medical Center of Tirana ‘Mother Teresa’ Hospital , Rruga e Dibres 372, Tirana (a public facility):

• ‘Inpatient treatment by an oncologist.

• ‘Oncology: radiation therapy.

• ‘Terminal and palliative care.

• ‘Surgery: specifically, oncological surgery.’^{[footnote 57]}

6.3.2 Information on the MedCOI database indicated that medication used to treat cancer of the colon was available, for example at the following facility:

‘Mother Teresa Hospital- Pharmacy, Rruga e Dibres 372, Tirana (public facility):

• ‘Trifluridine + tipiracil (e.g. Lonsurf- tradename)- oncology: cytostatics/ chemotherapy.’^{[footnote 58]}

6.4 Hodgkin’s Lymphoma

6.4.1 An example of mixed type Hodgkin’s lymphoma at advanced stage (also with secondary diagnoses of small ovarian cysts and thymus tissue) was found in MedCOI. Treatment was found to be available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by an oncologist.

• ‘Inpatient, outpatient and follow up by a haematologist.

• ‘Diagnostic research: bone marrow puncture.

• ‘Laboratory research of liver function (PT, albumin, bilirubin, transaminases: ASAT (=SGOT), ALAT (=SGPT).

• ‘Laboratory research of renal/kidney function (creatinine, ureum, proteinuria, sodium, potassium levels).

• ‘Laboratory research/ monitoring of full blood count, e.g. Hb, WBC and platelets.

• ‘Diagnostic imaging by means of x-ray radiography.

• ‘Oncology: radiation therapy.

‘University Hospital for Obstetrics and Gynaecology, Queen Geraldine, Rruga bulevardi zogu I pare, stacioni i trenit Tirane. Tirana (public facility).

• ‘Inpatient treatment by a gynaecologist.’^{[footnote 59]}

6.4.2 MedCOI indicated that medication used to treat Hodgkin’s Lymphoma was available in Albania, for example at the following facility:

‘Mother Teresa Hospital- Pharmacy, Rruga e Dibres 372, Tirana (public facility):

• ‘Blemycin- oncology: cytostatics/ chemotherapy.

• ‘Cyclophosphamide- oncology: cytostatics/ chemotherapy.

• ‘Doxorubicin (brand name Adriamycin)- oncology: cytostatics/ chemotherapy.

• ‘Etoposide- oncology: cytostatics/ chemotherapy.

• ‘Procarbazine- oncology: cytostatics/ chemotherapy.

• ‘Vincristine- oncology: cytostatics/ chemotherapy.’^{[footnote 60]}

6.5 Leukaemia

6.5.1 MedCOI indicated that treatment for Leukaemia was available at the University Medical Center of Tirana ‘Mother Teresa’ Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by a haematologist.

‘Note: allogeneic stem cell transplantation including pre- and aftercare is not available in Albania, but follow up after this service (outside of Albania) is available at the public hospital Mother Teresa and at private hospitals:

‘Hygeia Hospital Tirana, Fushe Mezez Komuna Kashar, Tirana (private facility).

‘Spitali Amerikan, Prane S.U.T, Rruga Lord Bajron, Tirana (private facility).’^{[footnote 61]}

6.6 Lung cancer

6.6.1 MedCOI advised that treatment for lung cancer was available at the ‘University Medical Center of Tirana ‘Mother Teresa’ Hospital, Rruga e Dibres 372, Tirana (a public hospital):

• ‘Inpatient, outpatient and follow up by an oncologist.

• ‘Diagnostic imaging by means of MRI.

• ‘Diagnostic imaging by scintigraphy (nuclear medicine).

‘Shefqet Ndroqi Lung Hospital/ University Hospital of Lung Diseases, Rruga Dr Shefqet Ndroqi, Tirane, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by a pulmonologist.’^{[footnote 62]}

6.6.2 MedCOI indicated that medication used to treat lung cancer was available at the following facility:

‘Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

• ‘Pembrolizumab- oncology: monoclonal antibodies.’^{[footnote 63]}

6.7 Melanoma

6.7.1 MedCOI indicated that treatment for melanoma (malignant melanoma on the face) was available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by an oncologist.

• ‘Inpatient, outpatient and follow up by a dermatologist.’^{[footnote 64]}

6.7.2 MedCOI indicated that medication used to treat melanoma was available at the following facility:

‘Florifarma Pharmacy, A. Bulevardi “Zogu I”, Tirana (private facility):

• ‘Nivoluman- oncology: monoclonal antibodies.’^{[footnote 65]}

6.8 Radiation therapy

6.8.1 RAD-AID noted that ‘Albania currently has large gaps in diagnostic imaging and screening due to insufficient staff training and equipment. There are about 30 radiologists in the whole country with only one radiology residency program with capacity of four residents per year.

‘Challenges in providing radiology services include lack of staff training, lack of imaging equipment, and patients’ affordability…

‘In Korçë, the 6th largest city in Albania, there is only one hospital serving around 76,000 people. There is a shortage of radiologists and equipment. There are only 3 radiologists with old and often not working equipment.’^{[footnote 66]}

6.8.2 The International Atomic News Agency (IAEA) noted that ‘Radiation therapy machines are an essential part of effective cancer treatment…

‘“Mother Teresa”, which treats 90% of all cancer cases, is the only public hospital that provides radiation therapy treatment…

‘The IAEA and Albania’s government joined forces ten years ago to support the hospital and have paid for the installation of this latest machine as well.

‘But it takes a lot more than the right equipment to provide effective cancer treatment.

‘The IAEA has assisted with drafting a national cancer control programme in Albania and the commissioning of nuclear medicine and radiotherapy machines since the establishment of the first radiotherapy unit at the hospital in 1966. It has also trained medical staff in machine handling and radiation safety”, said Minister of Health Ogerta Manastirliu.

‘Over the last few years, the hospital has expanded treatment techniques from cobalt teletherapy to linear accelerators, allowing doctors to treat complex cases faster and with more precision.

‘Today, the hospital has two linear accelerators (linac) for radiotherapy treatment and one single-photo emission computed tomography (SPECT-CT) machine for the diagnosis of cancer, cardiovascular and other chronic non-communicable diseases. The second linac was delivered to the hospital in May 2018.’^{[footnote 67]}

6.8.3 IAEA also noted oncology treatments at the Mother Teresa Hospital where ‘A linear accelerator is the device most commonly used to treat cancer with external beam radiation.

‘This machine is used to treat all organs of the body. It delivers high-energy X-rays or electrons to the region of the patient’s tumour. These treatments can be designed in such a way that they destroy the cancer cells while sparing the surrounding normal tissue.

‘Radiation therapy, or radiotherapy, is a branch of medicine that focuses on the use of radiation to treat cancer. It is designed to use radiation to target and kill cells. In the case of cancer, when the radiation is applied to a cancerous tumour, or a mass of malignant cells, the targeted cells are damaged and killed, leading to a reduction of the tumour size or, in some cases, the disappearance of the mass.’^{[footnote 68]}

6.9 Thyroid cancer

6.9.1 MedCOI indicated that treatment for thyroid cancer (metastasised papillary thyroid carcinoma) was available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by an oncologist.

• ‘Inpatient, outpatient and follow up by an endocrinologist.

• ‘Surgery- specifically endocrine surgery (e.g. for thyroid carcinoma).

• ‘Surgery- specifically oncological surgery.

• ‘Diagnostic imaging by means of MRI.

• ‘Diagnostic imaging by Doppler ultrasound/ sonography.

• ‘Diagnostic imaging by Transcranial Doppler (TCD) to measure blood flow through brain’s blood vessels.

• ‘Laboratory research of thyroid functions (TSH, T3, T4).

• ‘Diagnostic research- tumormarker thyroglobulin (Tg) (in Thyroid cancer).’^{[footnote 69]}

6.9.2 Information on the MedCOI database showed that medication for thyroid cancer was available in Albania, for example at the following facility:

‘Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (a public facility):

• ‘Levothyroxine- endocrinology: thyroid hormones.

• ‘Liothyronine sodium- endocrinology: thyroid hormones.

• ‘Thyroxin- endocrinology: thyroid hormones.’^{[footnote 70]}

Section 7 updated: 5 May 2023

7. Cardiology

7.1.1 In 2016, an article in the academic publisher Scientific Research stated that:

‘Coronary Heart Disease (CHD) remains the leading cause of morbidity and mortality in Albania. According to Institute of Statistics of Albania (ISA), CHD remains in the 5 first places caused mortality and morbidity in our country. Currently, all the protocol treatments to Mother Teresa University Hospital (MTUH) are focused on low-density lipoprotein cholesterol (LDL-C) as the primary target for risk reduction therapy, followed by triglycerides (TG) and high-density lipoprotein cholesterol (HDL).’^{[footnote 71]}

7.1.2 MedCOI indicated that cardiology (heart) treatment was available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by a cardiologist.

• ‘Cardiology- placement of pacemaker.

• ‘Cardiology- maintenance and follow up of pacemaker.

• ‘Cardiac surgery- heart valve surgery.

• ‘Diagnostic imaging by means of ultrasound of the heart.

• ‘Diagnostic imaging- ECG (electro cardiogram; cardiology).’^{[footnote 72]}

7.1.3 The private hospital Spitali Amerikan stated there was availability to treat the most severe cases of acute myocardial infarctions (heart attacks) and that the cardiology department provided a 24-hour service^{[footnote 73]}.

7.1.4 The Ministry of Health and Social Care, on 13 April 2022, confirmed that drugs for cardiovascular treatment which are generally available at state hospital pharmacies and for which the cost is reimbursable to the patient from the Compulsory Health Care Insurance Fund, included the following:

• Beta blockers: propranolol, metoprolol, atenolol, bisoprolol, nebivolol, carvedilol.

• Calcium blockers – for hypertension (high blood pressure), etc: amlodipine, felodipine, nifedipine, nitrendipine, lercanidipine, verapamil, diltiazem.

• ACE inhibitors – also for hypertension: captopril, enalapril, ramipril, fosinopril, losartan, valsartan, irbesartan, telmisartan, olmesartan, sacubitril, and various combinations of these.

• Other drugs for hypertension: methyldopa, moxonidine.

• Diuretics: hydrochlorothiazide, indapamide, furosemide, spironolactone, triamteren hcl

• Blood lipid inhibitors (statins) for cholesterol control: simvastatin, lovastatin, pravastatin, atorvastatin, fenofibrate, fluvastatin, ciprofibrate.

• Anti-arrhythmics, etc for cardiac therapy: digoxin, propafenone, amiodarone, glyceryl trinitrate, isosorbite dinitrate, isosorbite mononitrate, trimetazidine, ivabradine, ranolazine, meldonium^{[footnote 74]}.

Section 8 updated: 5 May 2023

8. Diabetes

8.1.1 MedCOI indicated that treatment for diabetes (type 2 diabetes melitus) was available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by an endocrinologist.

• ‘Inpatient, outpatient and follow up by an internal specialist (internist).

• ‘Medical devices internal medicine: blood glucose meter for self use by patient.

• ‘Medical devices internal medicine: blood glucose self-test strips for use by patient^{[footnote 75]}.

• ‘Laboratory research of blood glucose (incl. HbA1C/ glyc.Hb).’^{[footnote 76]}

8.1.2 MedCOI indicated that medication for diabetes available at the Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana, included:

• ‘Glimepiride- diabetes: oral/ tablets^{[footnote 77]}.

• ‘Insulin: long acting [24hr]; insulin glargine.

• ‘Metformin- Diabetes: oral/ tablets.’^{[footnote 78]}

8.1.3 On 13 April 2022 the Ministry of Health and Social Care listed the following drugs as being generally available at state hospital pharmacies and for which the cost is reimbursable to the patient from the Compulsory Health Care Insurance Fund: insulin aspart, insulin glargine, insulin detemir, insulin glulisine, biosynthetic human insulins, metformin, glibenclamide, acarbose, sitagliptin, vildagliptin+metformin, and liraglutide^{[footnote 79]}.

Section 9 updated: 3 November 2022

9. Ear, nose, and throat conditions

9.1.1 In 2016, an article entitled ‘Prevalence and Factors associated with Hearing Impairment in Preschool Children in Albania’ by Suela Sallavaci in the Archives of Medicine, noted that treatment for Ear, Nose and Throat conditions were available at the University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility)^{[footnote 80]}.

9.1.2 Examples of private treatment for ENT conditions were also found to be available at:

• Ear Nose and Throat Clinic, Tirana^{[footnote 81]}.

• Spitali Amerikan (American Hospital)^{[footnote 82]}.

Section 10 updated: 3 November 2022

10. Eye treatment (ophthalmology)

10.1.1 MedCOI gave an example for treatment of glaucoma which was available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by an ophthalmologist.

• ‘Ophthalmology: intravitreal injection with medication.

• ‘Surgery, specifically ophthalmological surgery: lens implantation and vitrectomy.’^{[footnote 83]}

10.1.2 Information on MedCOI indicated that ophthalmology medication (specific to glaucoma) was available in Albania, for example at the following facilities:

‘Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

• ‘Neomycin- antibiotics: aminoglycosides.

• ‘Brimonidine- ophthalmology: anti glaucoma.

• ‘Brinzolamide- ophthalmology: anti glaucoma.

• ‘Dexamethasone + neomycin = polymyxin B- ophthalmology: corticosteroids + antibiotics eye drops/ gel.

• ‘Dexamethasone + chloramphenicol + polymyxin B (combination)- ophthalmology: corticosteroids + antibiotics eye drops/ gel.

• ‘Dexamethasone- ophthalmology: corticosteroid.

• ‘Prednisolone eye drops- ophthalmology; corticosteroid.

‘Florifarma Pharmacy, A. Bulevardi “Zogu I”, Tirana (private facility):

• ‘Brinzolamide + brimonidine (combination)- ophthalmology: glaucoma combinations.’^{[footnote 84]}

10.1.3 Examples of private treatment in ophthalmology was also found to be available at:

• Spitali Amerikan (American Hospital)^{[footnote 85]}.

• Tirana Eye Clinic^{[footnote 86]}.

• German Eye Clinic, Spitali Hygeia, Tirana^{[footnote 87]}.

Section 11 updated: 3 November 2022

11. Gastroenterological conditions

11.1.1 MedCOI indicated that medication to treat gastroenterological conditions (note: gastroenterology is the branch of medicine focused on the digestive system and its disorders. Diseases affecting the gastrointestinal tract, which include the organs from mouth into anus, along the alimentary canal, are the focus of this speciality^{[footnote 88]}) was available in Albania, for example at the following facility:

‘Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

• ‘Bisacodyl- gastroenterology: for constipation/ laxatives.

• ‘Psylliumseeds- gastroenterology: for constipation/ laxatives.

• ‘Pantoprazole- gastroenterology: stomach; proton pump inhibitors^{[footnote 89]}.

• ‘Lansoprazole- gastroenterology: stomach; proton pump inhibitors.

• ‘Omeprazole- gastroenterology: stomach; proton pump inhibitors^{[footnote 90]}.

• Granisetron- gastroenterology: against nausea/ motion sickness.

• Macrogol- gastroenterology: for constipation/ laxatives.

• Lactitol- gastroenterology: for constipation/ laxatives.

• Psylliumseeds- gastroenterology: for constipation/ laxatives^{[footnote 91]}.

• Amylase- Gastroenterology: pancreas enzymes.

• Lipase- Gastroenterology: pancreas enzymes.’^{[footnote 92]}

11.1.2 An example of private treatment in gastroenterology was also found to be available at: Spitali Amerikan (American Hospital)^{[footnote 93]}.

Section 12 updated: 3 November 2022

12. Gynaecological conditions and obstetrics

12.1.1 Regarding public hospitals, the Albania Daily News reported on 16 August 2021 that ‘The Minister of Health, Ogerta Manastirliu has inspected the new laboratory installed in the “Queen Geraldine” Maternity Hospital in Tirana.

‘Manastirliu says that now the laboratories with standardized service are functional in 10 hospitals in Albania.

‘She emphasises that the digitized network of 18 laboratories in public hospitals offers higher quality and security.

‘… I am here with the medical staff in inspection in the new maternity laboratory “Queen Geraldine”, which is added to the network of public laboratories with international standards, increasing the quality of service for mothers and children.’^{[footnote 94]}

12.1.2 Examples of treatments and care for gynaecology and obstetrics were found to be available at the following private facilities:

• ‘Gynaecological Obstetric University Hospital “Koço Gliozheni” - University hospital in Elbasan, Albania^{[footnote 95]}.

• ‘Spitali Amerikan (American Hospital)^{[footnote 96]}.

Section 13 updated: 5 May 2023

13. HIV/AIDs

13.1.1 Information found on MedCOI indicated that treatment for HIV/AIDs was available at the following facilities:

University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Outpatient treatment and follow up by a HIV specialist.

• ‘Laboratory research: resistance test for antiretroviral drugs.

‘Public Health Institute (Instituti i Shendetit Publik), Alexander Moisiu Str. 80 Tirana (public facility):

• ‘Laboratory research HIV: CD4 count.

• ‘Laboratory research HIV: viral load.’^{[footnote 97]}

13.1.2 Information on the MedCOI database indicated that medication to treat HIV/AIDs, including the antiretrovirals below, was available in Albania, for example at the ‘Mother Teresa’ Hospital Pharmacy, Bulevardi Zogu I, Tirana (a public facility):

• ‘Emtricitabine- infections: HIV; antiretrovirals.

• ‘Tenofovir alafenamide- infections: HIV; antiretrovirals.

• ‘Descovy (combination of emtricitabine + tenofovir alafenamide)- infections: HIV; antiretrovirals; combinations.’^{[footnote 98]}

• ‘Elvitegravir- infections: HIV; antiretrovirals.

• Cobicistat- infections: HIV; antiretrovirals.

• Darunavir- infections: HIV; antiretrovirals.

‘Florifarma Pharmacy, A. Bulevardi “Zogu I”, Tirana (private facility):

• ‘Dolutegravir: infections: HIV; antiretrovirals. Available but currently experiencing supply problem, time of resupply: 4 weeks.

• ‘Rezolsta (combination of darunavir/ cobicistat)- infections: HIV; antiretrovirals; combinations. Available but currently experiencing supply problem, time of resupply: 4 weeks.’^{[footnote 99]}

Refer to the website of the National Agency for Medicines and Medical Devices (‘Agjencia Kombetare e Barnave dhe Pajisjeve Mjekesore’) to search for other antiretroviral drugs^{[footnote 100]}.

Section 14 updated: 3 November 2022

14. Kidney diseases (nephrology)

14.1.1 MedCOI indicated that nephrology treatment for renal/ kidney disease was available at the following hospital:

University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Nephrology- chronic haemodialysis.

• ‘Outpatient and follow up by a nephrologist.

• ‘Laboratory research of renal/ kidney function (creatinine, ureum, proteinuria, sodium, potassium levels).

• ‘Laboratory research: PTH, calcium, phosphate^{[footnote 101]}.

• ‘Inpatient treatment by a nephrologist.

• ‘Surgery: specifically, renal/ kidney surgery.^{[footnote 102]}

‘American Hospital, Lapraka, Tirana (private facility).

• ‘Transplantation of kidney including all pre- and aftercare.

• ‘Transplantation aftercare: treatment of graft rejection.’^{[footnote 103]}

14.1.2 MedCOI indicated that medication to treat kidney and renal conditions were available at the following facility:

‘Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

• ‘Ferrioxidesaccharate (ferric saccharate) oral use for phosphate binding- nephrology: phosphate binder: not calcium and not aluminium containing.

• ‘Lanthanum carbonate- nephrology: phosphate binder: not calcium and not aluminium containing.

• ‘Calcium acetate + magnesium carbonate- nephrology: phosphate binder: calcium containing.

• ‘Calcium carbonate- nephrology: phosphate binder: calcium containing’^{[footnote 104]}.

Section 15 updated: 3 November 2022

15. Liver conditions (hepatology) and liver transplants

15.1.1 MedCOI indicated that treatment for liver conditions were available at the University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

‘Hepatitis B:

• ‘Inpatient, outpatient and follow up by a hepatologist.

• ‘Laboratory research of Hep B serology.

• ‘Laboratory research of Hepatitis B antibodies; HBsAb, ABeAb, HBcAb.

• ‘Laboratory research of Hepatitis B antigens; HBsAg, HBeAg.

• ‘Laboratory research of liver function (PT, albumin, bilirubin, transaminases: ASAT (= SGOT), ALAT (=SGPT).

• ‘Inpatient, outpatient and follow up by a gastroenterologist in the gastric hepatologic ward.

• ‘Diagnostic imaging by means of computed tomography (CT scan).’^{[footnote 105]}

15.1.2 MedCOI indicated that medication to treat liver conditions were available at the University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

Hepatitis B:

• ‘Lamivudine- antivirals; Hepatitis B.

• ‘Tenofovir alafenamide- infections: antivirals; Hepatitis B.’^{[footnote 106]}

15.1.3 Facilities for liver transplants were found to be available at the following private hospitals

• ‘Athina^{[footnote 107]}.

• ‘Spitali Amerikan^{[footnote 108]}.

Section 16 updated: 3 November 2022

16. Lung diseases (pulmonology)

16.1.1 MedCOI indicated that treatment for lung diseases were available at the following hospital:

‘Chronic obstructive pulmonary disease- COPD:

‘Shefqet Ndroqi Lung Hospital/ University Hospital of Lung Diseases, Rruga Dr Shefqet Ndroqi, Tirane, Tirana (public facility):

• ‘Inpatient, outpatient and follow up treatment by a pulmonologist.

• ‘Diagnostic research, in the form of lung function tests (i.e. spirometry)

• ‘Diagnostic imaging by means of x- ray radiography.

• ‘Diagnostic imaging be means of computered tomography (CT scan) with contrast.

• ‘Diagnostic research: measuring blood oxygen/ arterial blood gas (Astrup).’^{[footnote 109]}

‘Cystic Fibrosis:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by a general practitioner (GP).

• ‘Inpatient, outpatient and follow up by an internal specialist (internist).

• ‘Laboratory research: medication level in the blood.

• ‘Inpatient, outpatient and follow up by a dietitian.

‘University Hospital Shefqet Ndroqi Pharmacy, Rruga Dr Shefqet Ndroqi, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by a pulmonologist (note: this also covers treatment for patients with Asthma^{[footnote 110]}).

• ‘Pulmonology: assisted cough techniques; air stacking therapy and training.

• ‘Inpatient, outpatient and follow up by a physical therapist.

• ‘Diagnostic imaging by means of computed tomography (CT Scan).

• ‘Diagnostic research, in the form of lung function tests (i.e. spirometry)^{[footnote 111]}.

16.1.2 MedCOI advised that medication to treat the lung disease was available in Albania, for example at the following facilities:

University Hospital Shefqet Ndroqi Pharmacy, Rruga Dr Shefqet Ndroqi, Tirana (public facility):

COPD:

• Ipratropium- Pulmonology: anti- asthmatics; parasympatholytics.

• Glycopyrronium bromide: Pulmonology: anti- asthmatics; parasympatholytics.

• Tiotropium- Pulmonology: anti- asthmatics; parasympatholytics.

• Fenoterol- Pulmonology COPD medication.

• Ipratropium + feneterol (combination) - Pulmonology COPD medication.

• Indacaterol + glycopyrrolate (combination)- Pulmonology COPD medication.

• Tiotropium + olodaterol- Pulmonology COPD medication^{[footnote 112]}.

• Formoterol- Pulmonology: COPD medication.

• Salmetorol- Pulmonology: COPD medication.

• Salmetorol + Fluticasone (propionate): Pulmonology: COPD medication.

Cystic Fibrosis and COPD:

• ‘Beclometasone + formoterol (combination)- Pulmonology: COPD medication

• ‘Dornase alfa- Pulmonology: expectorants/ mucolytics.’^{[footnote 113]}

Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

Cystic Fibrosis:

• Mometasone nasal spray E.N.T. – Nose spray, corticosteroid.

• Beclomethasone nasal spray E.N.T. – Nose spray, corticosteroid.

• Tobramycin- infections: antibiotics; aminoglycosides.

• Azithromycin – infections: antibiotics; macrolides.

• Beclomethasone – pulmonology: COPD medication.

• Vitamins A, E, K and D supplements^{[footnote 114]}.

Asthma:

• Salmeterol- Pulmonology: anti- asthmatics.

• Salmeterol + fluticasone (propionate)- Pulmonology: anti- asthmatics.

• Salbutamol + opratropium- Pulmonology: anti- asthmatics.

• Bedesonide + salmeterol (combination)- Pulmonology: anti- asthmatics.

• Fluticasone (propionate) + formoterol- Pulmonology: anti- asthmatics.

• Formoterol- Pulmonology: anti- asthmatics.

• Vilanterol + fluticasone furoate (combination)- Pulmonology: anti- asthmatics.

• Fluticasone- Pulmonology: anti- asthmatics; inhalation corticosteroids.

• Budesonide- Pulmonology: anti- asthmatics; inhalation corticosteroids.^{[footnote 115]}

Section 17 updated: 5 May 2023

17. Mental health, psychiatry

17.1.1 See the Country Policy and Information Note, Albania: Mental healthcare.

Section 18 updated: 3 November 2022

18. Neurological conditions

18.1.1 Information found on MedCOI indicated that treatment for neurological conditions were available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

‘Epilepsy:

• ‘Inpatient, outpatient and follow up by a neurologist.

• ‘Diagnostic imaging by means of a EEG (Electro Encephalo Gram)^{[footnote 116]}’^{[footnote 117]}

• ‘Special clinic for epilepsy patients. Partly available: There is a special ward for epilepsy patients within the neurology clinic; so, this is not a completely separate special clinic for epilepsy.^{[footnote 118]}

‘Multiple Sclerosis (MS):

• ‘Inpatient, outpatient and follow up by a neurologist.

• ‘Diagnostic imaging by means of MRI.

• ‘Diagnostic means by means of ultrasound of the heart (= echocardiography = TTE)

• ‘Inpatient, outpatient and follow up by a urologist.

• ‘Inpatient, outpatient and follow up by a physical therapist.

• ‘Medical devices: wheelchair.’^{[footnote 119]}

18.1.2 Information on the MedCOI database indicated that medication to treat neurological conditions was available, for example at the following facility:

‘Epilepsy:

‘Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

• ‘Carbamazepine- Neurology: antiepileptics.

• ‘Lamotrigine- Neurology: antiepileptics.

• ‘Levetiracetam- Neurology: antiepileptics.

• ‘Valproic acid OR valproate OR depakine- Neurology: antiepileptics.

• ‘Diazepam (reciole/ rectal suppository for epileptic attacks)- Neurology: benzodiazepines to treat acute attacks e.g., status epilepticus.

• ‘Diazepam (i.v. injection for epileptic attacks)- Neurology: benzodiazepines to treat acute attacks e.g., status epilepticus.

• ‘Midazolam (nose spray for epileptic attacks)- Neurology: benzodiazepines to treat acute attacks e.g., status epilepticus.

• ‘Midazolam (oromucasal solution for epileptic attacks)- Neurology: benzodiazepines to treat acute attacks e.g., status epilepticus.’^{[footnote 120]}

• ‘Phenytoin - Neurology: antiepileptics

• ‘Clonazepam (buccal for epileptic attacks)- Neurology: benzodiazepines to treat acute attacks e.g., status epilepticus.

• ‘Multiple Sclerosis (MS):

• ‘Fingolimod- Neurology: immunomodulator (treatment relapse MS).

• ‘Vitamin- vitamin D- supplements.’^{[footnote 121]}

Section 19 updated: 3 November 2022

19. Orthopaedics

19.1.1 MedCOI indicated that treatment in orthopaedics (musculoskeletal system which includes bones, joints, ligaments, and tendons) were available at the following hospital:

‘Military University Hospital, Tirana, Rruga Lord Bajron, Laprake, Tirane, Tirana (public facility):

• ‘Inpatient, outpatient and follow up by an orthopaedist/ orthopaedic surgeon.

• ‘Surgery: specifically, orthopaedic surgery; hip replacement.’^{[footnote 122]}

Section 20 updated: 3 November 2022

20. Paediatrics

20.1 Inpatient and outpatient care

20.1.1 The Young Persons Advisory Group (YPAG), launched on 15 September 2017 and the Teddy Network, an independent multi- disciplinary, multinational network, noted in an undated report that the:

‘University Hospital Centre “Mother Teresa” in Tirana is a tertiary level Hospital and the only academic and Research Hospital Centre in Albania. Paediatric Intensive Care Unit treats postoperative patients (abdominal and cardiac surgery and sometimes neurosurgery patients) as well as medical severely ill patients with neurological, rheumatic, malignant pathology, and poly-traumatised patients.’^{[footnote 123]}

20.1.2 MedCOI indicated that treatment in paediatrics (children) were available at the following hospital:

‘University Medical Center of Tirana Mother Teresa Hospital, Rruga e Dibres 372, Tirana (public facility):

‘Congenital heart defect (patient aged 6 months):

• ‘Inpatient, outpatient and follow up by paediatrician.

• ‘Cardiac surgery; paediatric heart surgery.

• ‘Inpatient, outpatient and follow up by paediatric cardiologist.

• ‘Inpatient, outpatient and follow up by a paediatric cardiac surgeon.

Note: transplantation of heart including all pre- and aftercare is not available in Albania^{[footnote 124]}.

‘Epidermolysis Bullosa Dystrophica, genetically inherited disease from birth (patient aged 4) which starts with blisters on the skin and mucous membranes with tissues forming scars when healing. This leads to adhesion of toes, fingers, and sometimes the oesophagus.

• ‘Inpatient, outpatient and follow up by a paediatrician.

• ‘Outpatient and follow up by a physical therapist, and a paediatric physical therapist.

• ‘Outpatient and follow up by an occupational therapist.

• ‘Surgery, specifically reconstructive surgery by a plastic surgeon.

• ‘Outpatient and follow up by a plastic surgeon.

• ‘Outpatient and follow up by an anaesthesiologist e.g. pain management.

• ‘Special compresses, lightly adhesive (like various forms of mepilex compresses).

• ‘Chlorine baths^{[footnote 125]}.

‘Orthopaedics and rheumatology: Juvenile idiopathic arthritis with multiple joint destructions and consecutive scoliosis and genu valgum (patient aged 9), includes ophthalmology:

• ‘Inpatient, outpatient and follow up by a paediatrician.

• ‘Inpatient, outpatient and follow up by a paediatric rheumatologist.

• ‘Inpatient, outpatient and follow up by a paediatric ophthalmologist and ophthalmologist.

‘Central Military University Hospital, Rruga “Lord Bajron” Laprake, Laprake (public facility):

• ‘Inpatient, outpatient and follow up by an orthopaedist/ orthopaedic surgeon and paediatric orthopaedist/ orthopaedic surgeon^{[footnote 126]}.

20.1.3 MedCOI noted that the medication used for treatment in the particular paediatric cases they investigated included those listed below. These drugs were all available in Albania, including at the following facility:

Mother Teresa Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

‘Congenital heart defect (patient aged 6 months):

• ‘Acetylsalicylic acid (Aspirin)- cardiology: anti blood clotting; antiplatelet aggregation.

• ‘Carbaslate calcium- anti blood clotting; antiplatelet aggregation.

• ‘Metoprolol- cardiology: anti hypertension; betablockers.

• ‘Atenolol- cardiology: anti hypertension; betablockers.

• ‘Furosemide- cardiology: anti hypertension; loop diuretics.

• ‘Spironolactone- cardiology: anti hypertension; potassium saving ‘diuretic.

• ‘Triamterene- cardiology: anti hypertension; potassium- saving diuretic.

• ‘Cholecalciferol vitamins: vitamin D3

• ‘Vitamin D: vitamin D supplements.

‘Note: Carbasalate calcium is now available^{[footnote 127]}.

‘Epidermolysis Bullosa Dystrophica:

• ‘Clonidine- cardiology: anti- hypertension; central acting.

• ‘Zinc oxide- dermatology: agent for itchiness.

• ‘Levomenthol- dermatology: agent for itchiness.

• ‘Vaseline cetomacrogol cream- dermatology: agent for itchiness.

• ‘Lactulose- gastroenterology: constipation/ laxatives.

• ‘Macrogol- gastroenterology: constipation/ laxatives^{[footnote 128]}.

‘Liver and spleen (and lungs) condition (patient- age 8) cystic echinococcosis caused by echinococcosis granuloses infection (~2–7 millimeter long tapeworm found in dogs -definitive host- and sheep, cattle, goats, and pigs -intermediate hosts):

• ‘Inpatient, outpatient and follow up by a paediatrician.

• ‘Inpatient, outpatient and follow up by a paediatric surgeon.

• ‘Gastroenterology: percutaneous treatment of liver hydatid cysts (PEVAC).

• ‘Diagnostic imaging by Doppler ultrasound/ sonography.

• ‘Diagnostic imaging by means of MRI.

• ‘Inpatient, outpatient and follow up by an infectiologist.

• ‘Inpatient, outpatient and follow up by an internal specialist (internist).

• ‘Inpatient, outpatient and follow up by a paediatric pulmonologist.

• ‘Laboratory research of liver function (PT, albumin, bilirubin, transaminases: ASAT (-SGOT), ALAT (=SGPT)^{[footnote 129]}.

‘Orthopaedics and rheumatology: Juvenile idiopathic arthritis with multiple joint destructions and consecutive scoliosis and genu valgum (patient aged 9) includes ophthalmology:

• ‘Ferrous sulphate- Haematology: against anaemia; iron deficiency.

• ‘Ferrous fumarate- Haematology: against anaemia; iron deficiency.

• ‘Ferrous gluconate- Haematology: against anaemia; iron deficiency.

• ‘Methotrexate- Immunosuppressants strong e.g., for rheumatology, dermatology, colitis.

• ‘Isoniazid- Infections: tuberculosis, leprosy.

• ‘Pyrazinamide- infections: tuberculosis, leprosy.

• ‘Rifampicin- infections: tuberculosis, leprosy.

• ‘Ethamutol- infections: tuberculosis, leprosy.

• ‘Rifabutin- infections: tuberculosis, leprosy.

• ‘Cyclopentolate hydrochloride- Ophthalmology: mydriatic agents.

• ‘Phenylephrine- Ophthalmology: mydriatic agents.

• ‘Tropicamide- Ophthalmology: mydriatic agents.

• ‘Prednisolone acetate- Ophthalmology: corticosteroid.

• ‘Dexamethasone eye drops- Ophthalmology: corticosteroid.

• ‘Allopurinol- rheumatology and gout/ hyperuricemia: anti- gout.

• ‘Colchicine- rheumatology and gout/ hyperuricemia: anti- gout^{[footnote 130]}.

‘Liver and spleen (and lungs) condition (patient- age 8) cystic echinococcosis caused by echinococcosis granuloses infection (~2–7 millimetre long tapeworm found in dogs -definitive host- and sheep, cattle, goats, and pigs -intermediate hosts):

• ‘Albendazole- infections: antiparasitics.

• ‘Ivermectin- infections: antiparasitics.

• ‘Mebendazole- infections: antiparasitics.

• ‘Niclosamide- infections: antiparasitics^{[footnote 131]}.

‘Florifarma Pharmacy, A. Bulevardi “Zogu I”, Tirana (private facility):

• ‘Abatacept- Immunosuppressants strong e.g., for rheumatology, dermatology, colitis.

• ‘Infliximab- Immunosuppressants strong e.g., for rheumatology, dermatology, colitis^{[footnote 132]}.

20.2 Special needs

20.2.1 In an article entitled ‘Special Education Needs Provision within Mainstream Education’, the European Commission’s European Education and Culture Executive Agency (EACEA) noted on 28 March 2019 that until a few years ago:

… the only access to education, children with disabilities had, was attending a special primary school (Tirana, Vlora, Durrës and Elbasan) for the children who had intellectual disabilities, or the School for Blind children” and “The institute of deaf children” which are both in Tirana. The latter institutions offer dorm rooms, and all the expenses are paid by the government. However, for many years, a high number of children with disabilities have had unequal access to education, especially attending secondary or higher level education…

During the last decade, efforts have been made to develop a suitable regulatory framework that would guarantee the inclusion of children with disabilities, in all general schools. Law No. 69/2012, approved in July 2012 “On the Pre-university Education” marks an important step regarding the rights of children with disabilities, for their overall inclusion and quality education.

The principle of equality and non-discrimination is determined on the legal basis that regulates it. Article 5 of this law guarantees the right for education for a lot of categories, including the children with disabilities.

Article 20 guarantees the right to psycho-social services in the educational institutions. Article 44 focuses on the curriculum, and emphasizes the fact that the curriculum should be in compliance with the physical, mental, social, and ethical development progress of the students, and their individual learning characteristics…

Based on the regulatory framework that came into force, every child should be educated, but the decision to enrol the child in general or special school, is left in the hands of the parents. Thus, children with disabilities, regardless of the type and severity of disability, have the right to enrol in nurseries, kindergartens and general schools.^{[footnote 133]}

20.2.2 In a report published on 2 December 2017 entitled ‘We All Matter! Situation Analysis of Children with Disabilities in Albania’, the United Nations International Children’s emergency Fund (UNICEF) noted that, ‘Physiotherapy, speech therapy and other habilitation therapies are provided mainly in day centers.’^{[footnote 134]}

20.2.3 UNICEF further noted that ‘The government Child Care and Development Centre in Tirana provides outpatient services for children with disabilities of age 0–6 years. It also has a 30-bed residential service for children living outside Tirana. The multidisciplinary team assesses children and provides therapeutic services including physiotherapy.’^{[footnote 135]}

20.2.4 Regarding rehabilitation and habilitation services UNICEF noted in the same report that:

‘…children are provided through the health services at medical centers and hospitals and through municipal, NGO or privately run community-based centers also called Day Centres, Day Care Centres or Community Day Centres. According to both parents and children interviewed, Day Centres provide physiotherapy, speech therapy and other types of developmental therapy. Medical centers and hospitals provide some medicines and medical treatments, but no therapy.’^{[footnote 136]}

20.2.5 The Albanian news agency Exit News reported on 27 May 2021 that ‘Intellectual disabilities include Down syndrome, attention-deficit hyperactivity disorder ADHD, and autism spectrum disorders (ASD). There are 681 people living with Down syndrome in Albania, about half of which (305) are under 18 years old.

‘According to a World Vision study conducted in 2018, 1 in 10 children aged 2-17 exhibit a high rate of behavior difficulties such as: attention disorders, communication or learning difficulties, memory problems, inappropriate behavior, hearing and vision issues, difficulty in engaging in social relationships, among others.

‘…10% of all children in Albania, about 70,000 in total, display difficulties but have yet to be diagnosed…

‘In all of Albania, this assessment [early assessment of intellectual disabilities] can only be done in two centers, both located in Tirana.’^{[footnote 137]}

20.2.6 Exit News further noted that ‘… specialized therapy presents an extra cost that families must bear all on their own. The average cost of private therapy is about €365 per month, a considerable discrepancy when compared to the €85 per month financial assistance that people with disabilities receive from the state.’^{[footnote 138]}

20.2.7 Two regional centres for autism were noted by the Non-Government Organisation (NGO) Albanian Children Foundation on 2 April 2015 in a report entitled ‘Inauguration of the second regional center for autism for adult children’ and observed that ‘After the inauguration of the Regional Center for Autism in Farka, 3 and a half years later the Albanian Children Foundation inaugurates another Regional Center for Autism, [Regional Center of Autism Nr.2 in Mjull-Bathore, Sauk] but this time for adult children over the age of 7…

‘After a standardized work of the staff of therapist and employees of the Center in Farka on modern methods, many children not only have overcome the “non communication” condition, but around 20 of them have been integrated into public and private schools in the country…

‘The second Regional Center for Autism is a Treatment, Therapeutic and Educational center for the excellence of talents of children over the age of 7 years with autism spectrum disorder. The structured teaching at this center is based on the combined work between behavioral therapist and professionals from different social fields in order to generalize their distinctive gifts and talents enhanced during therapy, as a profession for the future…

‘Courses provided by the Center are: 1-Therapy (individual + group); 2- Speech therapy; 3- Physiotherapy; 4- Painting; 5- Information Technology ; 6-Music; 7-Hairdresser; 8- Cooking; 9-Tailoring; 10-Physical education and 11- Gardening.

‘The social and physical environment set up and organized for these courses, provides not only visual teaching practices and techniques of the field, but also implementing them by children in order to enhance their gifts, talents and promoting the consolidation of a profession for the future.’^{[footnote 139]}

Section 21 updated: 3 November 2022

21. Painkillers

21.1.1 Information found on MedCOI indicated the following painkillers were available in Albania, for example at the ‘Mother Teresa’ Hospital Pharmacy, Bulevardi Zogu I, Tirana (public facility):

• ‘Paracetamol – pain mediation: light.

• ‘Morphine – pain medication: strong medication.

• ‘Tramadol – pain medication: strong medication^{[footnote 140]}.

• ‘Naproxen – pain medication: NSAID.

• ‘Diclofenac – pain medication: NSAID.

• ‘Ibuprofen – pain medication: NSAID^{[footnote 141]}.

Section 22 updated: 3 November 2022

22. Palliative care, nursing home care and geriatrics

22.1.1 The Albanian government’s National Cancer Control Program 2011- 2020, published in April 2011 noted that:

‘Palliative care in Albania is relatively new. The first palliative care service for terminal cancer patients was established in 1993 by Ryder Albania Association. The Albanian Association of Palliative Care was established in 2002 as a consortium to develop palliative care in the country. Currently there are a limited number of associations and only one public service of palliative care that provide services to terminal cancer patients across the country…

‘Generally, palliative care services are sporadic and do receive financial support from the authorities and public health system.’^{[footnote 142]}

22.1.2 Albania’s National Cancer Control Program stated that the main structures involved in palliative care for oncology were:

• ‘Oncology Service in TUHC, which currently includes a psychologist and a social worker. But terminal patients are not frequently hospitalized in public hospitals, as they prefer to day [sic] at home.

• ‘Albanian Oncology Association, is a Not-for-Profit Organization (NPO) active in:

  • Public and professional education (organization of national and international scientific activities), and publication of educative materials intended for the general public (books, leaflets, posters, etc.)

  • Prevention and early detection (nationwide activities against tobacco), and activities for early detection of breast cancers, skin and gynecological cancers.’^{[footnote 143]}

22.1.3 The same source noted the following agencies were involved in palliative care:

• Ryder Albania, a NPO (Not-for-Profit Organization), subsidiary of a British charitable foundation, established in 1993, consisting of a multi-disciplinary team of physicians, nurses, social workers, and psychologists covering the area of Tirana and Durres.

• OSH (Oncologic Service at Home), a public service.

• The Team of Merry Potter, an NPO organisation. This group covers the area of Korca.

• Center of Palliative Care Elbasan, an NPO providing palliative and soothing care for cancer patients.

• Center of Palliative Care Lezha, a NPO providing palliative and soothing care for cancer patients^{[footnote 144]}.

22.1.4 Hospices of Hope, a non-profit organisation which aims to provide palliative care services to adults and children with terminal and life-limiting illnesses in South-eastern Europe, working with Ryder Albania, and in support of the Bristol- Myers Squibb Foundation, noted in a report published on 11 February 2022, that

‘As of 2017 there were 12 providers offering palliative care in Albania. Geographically, coverage is about one third of the country and in terms of actual access this is less than 6%.

‘In 2001 a state palliative care service, the Oncology Home Service, was established and provides home care services to cancer patients who are referred from the National Oncology Centre in Tirana. For many years this was the only state provision.

‘As of 2015 there are palliative care units in eight regional hospitals. These units are based on a model developed by Ryder Albania in Durres.

‘There is no specific provision for paediatric palliative care in the country although the National Oncology Centre provides some in-patient palliative care advice.

‘Palliative care is recognised as a basic human right and the legislative framework is in place, but lack of finance means that implementation of policy is challenging.’^{[footnote 145]}

22.1.5 Hospices of Hope further stated that ‘We have started sending donated medical supplies to Albania. The first shipment arrived in September 2018.

‘We are assessing the possibility of creating a national network of hospice care in Albania. This is similar to the model we have adopted in Moldova.’^{[footnote 146]}

22.1.6 Information found on MedCOI indicated that home assistance/ care at home by a nurse was available via referral from the University Medical Center of Tirana Mother Teresa Hospital (public facility)^{[footnote 147]}.

Terms of Reference

A ‘Terms of Reference’ (ToR) is a broad outline of what the CPIN seeks to cover. They form the basis for the country information section. The Home Office’s Country Policy and Information Team uses some standardised ToR, depending on the subject, and these are then adapted depending on the country concerned.

For this particular CPIN, the following topics were identified prior to drafting as relevant and on which research was undertaken:

• Sources

  • MedCOI

• Basic indicators

  • Healthcare system

  • Structure

  • Doctors and specialists

  • Pharmaceuticals

  • Private and public hospitals

  • Recent developments in healthcare

  • Impact of COVID-19

  • Cost of treatment and medicines to the patient

• Cancer treatment (oncology)

  • Prevalence and available treatment facilities

  • Breast cancer

  • Colon carcinoma with metastasis (cancer of the colon)

  • Hodgkin’s Lymphoma

  • Leukaemia

  • Lung cancer

  • Melanoma

  • Radiation therapy

  • Thyroid cancer

• Cardiology

• Diabetes

• Ear, nose, and throat conditions

• Eye treatment (ophthalmology)

• Gastroenterological conditions

• Gynaecological conditions and obstetrics

• HIV/AIDs

• Kidney diseases (nephrology)

• Liver conditions (hepatology) and liver transplants

• Lung diseases (pulmonology)

• Mental health, psychiatry

• Neurological conditions

• Orthopaedics

• Paediatrics

  • Inpatient and outpatient care

  • Special needs

• Painkillers

• Palliative care, nursing home care and geriatrics

Bibliography

Sources cited

Albanian Children Foundation, ‘Inauguration of the second regional center for autism for adult children’, 2 April 2015. Last accessed: 9 December 2021

Albanian Daily News,

‘Manastirliu Inspects New Laboratory in Queen Geraldine Maternity Hospital’, 16 August 2021. Last accessed: 23 November 2021

‘Albania Lacks Access to Innovative Treatments on Cancer’, 24 September 2022. Last accessed: 19 October 2022

Athina Global Health,

‘Female Breast Cancer Hospital in Albania’, no date. Last accessed: 27 October 2021

‘Liver Transplant Hospital in Albania’, no date. Last accessed: 23 November 2021.

Central Intelligence Agency (CIA), ‘The CIA World Factbook: Albania’, Last updated: 27 September 2022. Last accessed: 18 October 2022

Computer and Enterprise Investigations Conference (CEIC), ‘Albania Physicians: per 1000 People’, no date. Last accessed: 8 December 2021

COVID- 19 Health System Response Monitor, ‘Albania’, no date. Last accessed: 25 October 2021

Council of Europe (CoE) and European Committee of Social Rights (ECSR), ‘European Social Charter (Revised): Albania’, March 2022. Last accessed: 18 October 2022

Ear, Nose and Throat Clinic, ‘ About: Welcome to ENT Clinic’, no date. Last accessed: 23 November 2021

Euractiv, ‘Albanian healthcare workers flee en masse, government unfazed’, 5 May 2022. Last accessed: 18 October 2022

European Educational and Culture Executive Agency (EACEA), ‘Albania, Special Education Needs Provision within Mainstream Education’, 28 March 2019. Last accessed: 9 December 2021

Exit News, ‘Children with Intellectual Disabilities in Albania Receive Little Assistance from Government’, 27 May 2021. Last accessed: 9 December 2021

Expatfinder, ‘Healthcare in Albania’, no date. Last accessed: 27 October 2021

Fufarma, ‘Albanian health system overview’, no date. Last accessed: 20 October 2022

Gabriani J, Schindler C, Wyss K:

‘Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care’ (Sage Journals), 7 October 2020. Last accessed 7 December 2021

‘Out of pocket payments and access to NCD medication in two regions in Albania’, published by PloS Online, 10 August 2022. Last accessed 5 May 2023.

Good Clinical Practice Network, ‘Pharmaceutical Companies in Albania in alphabetical order’, no date. Last accessed: 20 October 2022

Government of Albania, Instituti i Shendetit Publik (ISHP), ‘The adjuvant treatment of breast cancer human epidermal growth factor receptor (HER2) positive in Albania’, 2017. Last accessed: 26 October 2021

Government of Albania: Ministry of Health and Social Care:

‘Decision No. 230’ (Vendim Nr. 230’) of 13 April 2022. (List of Drugs Reimbursable from the Mandatory Care Insurance Fund.) Last accessed 5 May 2023.

National Agency for Medicines and Medical Devices: (‘Agjencia Kombetare e Barnave dhe Pajisjeve Mjekesore’): Medicines Register (‘Regjistri i barnave’), updated to 6 June 2022. Last accessed 5 May 2023

Hospitals World Guide, ‘Public hospitals in Albania’, no date. Last accessed: 19 November 2021

Hospices of Hope, ‘Everyone deserves to live and die with dignity and without pain’, 11 February 2022. Last accessed: 20 October 2022

International Atomic News Agency (IAEA), ‘Ten Years of Bringing Hope to Cancer Patients in Albania with IAEA Support’, 5 October 2018. Last accessed: 26 October 2021

International Trade Administration (ITA),

‘Healthcare- Albania’, 2019. Last accessed: 7 December 2021

‘Healthcare Resource Guide: Albania’ (Export.gov), Last updated October 2019. Last accessed: 9 December 2021

Journal of Educational and Social Research, Memia F.: ‘Health Care Insurance System in the Republic of Albania and Development Perspective’, January 2015. Last accessed 5 May 2023

Med and Tour, ‘DE Med Ophthalmologist Institute German Eye Clinic, Hygeia Hospital Tirana’, no date. Last accessed: 23 November 2021

MedCOI (subscription required). Last accessed: December 2020:

28 December 2018

6 January 2019

18 January 2019

21 January 2019

30 January 2019

5 February 2019

26 February 2019

12 March 2019

13 March 2019

20 March 2019

15 June 2019

22 June 2019

30 July 2019

14 October 2019

14 November 2019

31 December 2019

17 January 2020

4 March 2020

23 March 2020

30 March 2020

10 April 2020

21 April 2020

29 September 2020

3 November 2020

15 December 2020

NHS (UK), ‘Gastroenterology’, no date

Organisation for Economic Co-operation and Development (OECD), ‘Impact of COVID- 19 in Albania’, no date. Last accessed: 25 October 2021

Privacy Shield, ‘Albania- Pharmaceuticals’, no date. Last accessed: 9 December 2021

RAD-AID International, ‘Albania’, no date. Last accessed: 20 October 2022

Republic of Albania, Ministry of Health, ‘The National Cancer Control Program 2011- 2020’, April 2011. Last accessed: 8 December 2021

Scientific Research, ‘Use of Cholesterol-Lowering Medications of Patients with Myocardial Infarction from 2007-2015 in Cardiology Clinic to “Mother Teresa” University Hospital in Albania’, 6 June 2016. Last accessed: 23 November 2021

Suela Sallavaci, ‘Prevalence and Factors associated with Hearing Impairment in Preschool Children in Albania’, 25 June 2016. Last accessed: 23 November 2021

Spitali Amerikan,

‘Cardiology’, no date. Last accessed: 23 November 2021

‘ENT’, no date. Last accessed: 23 November 2021

‘Gastroenterology’, no date. Last accessed: 23 November 2021

‘Liver transplant successfully realized in the American Hospital’, 14 November 2017. Last accessed: 23 November 2021

‘Obstetric Gynecology’, no date. Last accessed: 23 November 2021

‘Ophthalmology’, no date. Last accessed: 23 November 2021

Together for Life (TFL), Westminster Foundation for Democracy (WFD) and the UK Government, ‘Monitoring of Albania’s health budget 2021’, August 2022. Last accessed: 18 October 2022

Top- Rated.online, ‘Gynecological Obstetric University Hospital “Koco Gliosheni”’, 25 December 2020. Last accessed: 23 November 2021

Tirana Eye Clinic, ‘Where vision meets professionals’, no date. Last accessed: 23 November 2021

The Breast, ‘Neoadjuvant chemotherapy treatment of breast cancer in young women in Albania’, 1 October 2018. Last accessed: 27 October 2021

UK Government Guidance, ‘List of medical facilities in Albania’, Updated 5 June 2020. Last accessed: 27 October 2021

United Nations International Children’s Emergency Fund (UNICEF), ‘We All Matter! Situation Analysis of Children with Disabilities in Albania’, 2 December 2017. Last accessed: 9 December 2021

United Nations Office for Project Services (UNOPS), ‘Enhancing medical care in Albania’, 13 September 2022. Last accessed: 19 October 2022

U.S. Department of State’s Overseas Security Advisory Council (OSAC), ‘Albania Country Security Report’, 22 October 2021. Last accessed: 18 October 2022

U.S. International Trade Administration, ‘Healthcare Resource Guide: Albania’, October 2019. Last accessed 5 May 2023

World Health Organisation (WHO),

‘Primary health care in Albania: rapid assessment’, 2018. Last accessed: 11 June 2021

‘COVID-19’, no date. Last accessed: 8 December 2021

Xe Currency converter, ‘currency converter’. Last accessed: 21 October 2022

Sources consulted but not cited

European Society of Cardiology (ESC), ‘The Albanian Society of Cardiology’, no date. Last accessed: 23 November 2021

The Borgen Project, ‘Progress for Maternal and Child Health Outcomes in Albania’, 16 December 2020

Your Pharma Partner in Europe, ‘Albania’, no date. Last accessed: 20 October 2022

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Official – sensitive: Start of section

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Changes from last version of this note

This is the third Country Information Note (CIN) to be produced on this subject. Updated to include information on the Compulsory Health Insurance Fund and references to drugs lists published by the Ministry of Health and Social Care.

1. EUAA, ‘EUAA MedCOI’ webpage, no date ↩

2. CIA, ‘The World Factbook: Albania’, updated 27 September 2022 ↩

3. CIA, ‘The World Factbook: Albania’, updated 27 September 2022 ↩

4. CIA, ‘The World Factbook: Albania’, updated 27 September 2022 ↩

5. CIA, ‘The World Factbook: Albania’, updated 27 September 2022 ↩

6. CIA, ‘The World Factbook: Albania’, updated 27 September 2022 ↩

7. CIA, ‘The World Factbook: Albania’, updated 27 September 2022 ↩

8. WHO, ‘Primary health care in Albania: rapid assessment’ (pages 4-5), 2018 ↩

9. OSAC, ‘Albania Country Security Report’, 22 October 2021 ↩

10. Fufarma, ‘Albanian health system overview’, no date ↩

11. Gabriani J, Schindler C, Wyss K, ‘Perspectives of Public and …’ (Sage Journals), 7 October 2020 ↩

12. ITA, ‘Healthcare- Albania’, 2019 ↩

13. MedCOI: 20 March 2019 ↩

14. Expatfinder, ‘Healthcare in Albania’, no date ↩

15. TFL, WFD, UK Government, ‘Monitoring of Albania’s health budget 2021’ (page 16), August 2022 ↩

16. TFL, WFD, UK Government, ‘Monitoring of Albania’s health budget 2021’ (page 17), August 2022 ↩

17. WHO, ‘Primary health care in Albania: rapid assessment’, 2018 ↩

18. WHO, ‘Primary health care in Albania: rapid assessment’, 2018 ↩

19. CEIC, ‘Albania Physicians: per 1000 People’, no date ↩

20. Euractiv, ‘Albanian healthcare workers flee en masse, government unfazed’, 5 May 2022 ↩

21. Expatfinder, ‘Healthcare in Albania’, no date ↩

22. ICH GCP, ‘Pharmaceutical Companies in Albania in alphabetical order’, no date ↩

23. Privacy Shield, ‘Albania- Pharmaceuticals’, no date ↩

24. Expatfinder, ‘Healthcare in Albania’, no date ↩

25. MedCOI: 20 March 2019 ↩

26. WHO, ‘Primary health care in Albania: rapid assessment’, 2018 ↩

27. CoE and ECSR, ‘European Social Charter (Revised): Albania (page 18)’, March 2022 ↩

28. Xe Currency converter, ‘Currency conversion’, no date ↩

29. UNOPS, ‘Enhancing medical care in Albania’, 13 September 2022 ↩

30. OECD, ‘Impact of COVID- 19 in Albania’, no date ↩

31. WHO, ‘COVID-19’ (COVID-19 live dashboard with vaccination data) , no date. ↩

32. OECD, ‘Impact of COVID- 19 in Albania’, no date ↩

33. COVID- 19 Health System Response Monitor, ‘Albania’, no date ↩

34. CoE and ECSR, ‘European Social Charter (Revised): Albania’ (page 20), March 2022 ↩

35. TFL, WFD, UK Government, ‘Monitoring of Albania’s health budget 2021’ (page 34), August 2022 ↩

36. ITA, ‘Healthcare Resource Guide: Albania’ (Export.gov), Last updated October 2019 ↩

37. Journal of Educational and Social Research, ‘Health Care Insurance…’’, January 2015 ↩

38. Journal of Educational and Social Research, ‘Health Care Insurance…’’ (page 51), January 2015 ↩

39. Journal of Educational and Social Research, ‘Health Care Insurance…’’ (page 51), January 2015 ↩

40. US International Trade Administration, ‘Healthcare Resource Guide: Albania’, October 2019 ↩

41. Ministry of Health, ‘Vendim Nr. 230’, 13 April 2022 ↩

42. National Agency for Medicines and Medical Devices: Medicines Register, updated to 6 June 2022 ↩

43. US International Trade Administration, ‘Healthcare Resource Guide: Albania’, October 2019 ↩

44. Gabrani et al, ‘Out of pocket payments and access to NCD medication in two…’, 10 August 2022 ↩

45. Link is at: National Agency for Medicines and Medical Devices, Home page. No date. ↩

46. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 2.3.1), April 2011 ↩

47. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 2.3.1), April 2011 ↩

48. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 2.3.2), April 2011 ↩

49. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 4.6.2), April 2011 ↩

50. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 4.6.2), April 2011 ↩

51. Albanian Daily News, ‘Albania Lacks Access to Innovative …’, 24 September 2022 ↩

52. ISHP, ‘The adjuvant treatment of breast cancer …’, 2017 ↩

53. The Breast, ‘Neoadjuvant chemotherapy treatment of breast cancer …’, 1 October 2018 ↩

54. MedCOI: 13 March 2019 ↩

55. MedCOI: 13 March 2019 ↩

56. RAD-AID International, ‘Albania’, no date ↩

57. MedCOI: 13 March 2019 ↩

58. MedCOI: 13 March 2019 ↩

59. MedCOI: 12 March 2019 ↩

60. MedCOI: 12 March 2019 ↩

61. MedCOI: 26 February 2019 ↩

62. MedCOI: 5 February 2020 ↩

63. MedCOI: 5 February 2020 ↩

64. MedCOI: 18 January 2019 ↩

65. MedCOI: 18 January 2019 ↩

66. RAD-AID International, ‘Albania’, no date ↩

67. IAEA, ‘Ten Years of Bringing Hope to Cancer Patients in Albania …’, 5 October 2018 ↩

68. IAEA, ‘Ten Years of Bringing Hope to Cancer Patients in Albania …’, 5 October 2018 ↩

69. MedCOI: 30 January 2020 ↩

70. MedCOI: 30 January 2020 ↩

71. Scientific Research, ‘Use of Cholesterol-Lowering Medications …’, 6 June 2016 ↩

72. MedCOI: 21 January 2019 ↩

73. Spitali Amerikan, ‘Cardiology’, no date ↩

74. Ministry of Health and Social Care, ‘Vendim Nr. 230’, 13 April 2022 ↩

75. MedCOI: 21 April 2020 ↩

76. MedCOI: 29 September 2020 ↩

77. MedCOI: 21 April 2020 ↩

78. MedCOI: 29 September 2020 ↩

79. Ministry of Health and Social Care, ‘Vendim Nr. 230’, 13 April 2022 ↩

80. Suela Sallavaci, ‘Prevalence and Factors associated with Hearing …’, 25 June 2016 ↩

81. Ear, Nose and Throat Clinic, ‘ About: Welcome to ENT Clinic’, no date ↩

82. Spitali Amerikan, ‘ENT’, no date ↩

83. MedCOI: 23 March 2020 ↩

84. MedCOI: 23 March 2020 ↩

85. Spitali Amerikan, ‘Ophthalmology’, no date ↩

86. Tirana Eye Clinic, ‘Where vision meets professionals’, no date ↩

87. Med and Tour, ‘DE Med Ophthalmologist Institute German Eye Clinic, Hygeia Hospital …’, no date ↩

88. NHS (UK), ‘Gastroenterology’, no date ↩

89. MedCOI: 14 October 2019 ↩

90. MedCOI: 30 March 2020 ↩

91. MedCOI: 10 April 2020 ↩

92. MedCOI: 4 March 2020 ↩

93. Spital Amerikan, ‘Gastroenterology’, no date ↩

94. Albanian Daily News, ‘Manastirliu Inspects New Laboratory …’, 16 August 2021 ↩

95. Top- Rated.online, ‘Gynecological Obstetric University Hospital …’, 25 December 2020 ↩

96. Spitali Amerikan, ‘Obstetric Gynecology’, no date ↩

97. MedCOI: 10 October 2020 ↩

98. MedCOI: 15 June 2019 ↩

99. MedCOI: 10 January 2020 ↩

100. National Agency for Medicines and Medical Devices, Home page. No date. ↩

101. MedCOI: 17 January 2020 ↩

102. MedCOI: 30 March 2020 ↩

103. MedCOI: 17 January 2020 ↩

104. MedCOI: 17 January 2020 ↩

105. MedCOI: 15 December 2020 ↩

106. MedCOI: 15 December 2020 ↩

107. Athina Global Health, ‘Liver Transplant Hospital in Albania’, no date. ↩

108. Spitali Amerikan, ‘Liver transplant successfully …’, 14 November 2017 ↩

109. MedCOI: 3 November 2020 ↩

110. MedCOI: 29 September 2020 ↩

111. MedCOI: 4 March 2020 ↩

112. MedCOI: 3 November 2020 ↩

113. MedCOI: 4 March 2020 ↩

114. MedCOI: 4 March 2020 ↩

115. MedCOI: 29 September 2020 ↩

116. MedCOI: 30 July 2019 ↩

117. MedCOI: 12 November 2019 ↩

118. MedCOI: 12 November 2019 ↩

119. MedCOI: 10 April 2020 ↩

120. MedCOI: 30 July 2019 ↩

121. MedCOI: 10 April 2020 ↩

122. MedCOI: 14 November 2019 ↩

123. Young Person’s Advisory Group (YPAG), ‘Kids Albania’ (Teddy Network), no date ↩

124. MedCOI: 6 January 2019 ↩

125. MedCOI: 28 December 2018 ↩

126. MedCOI: 22 June 2019 ↩

127. MedCOI: 6 January 2019 ↩

128. MedCOI: 28 December 2018 ↩

129. MedCOI: 31 December 2019 ↩

130. MedCOI: 26 June 2019 ↩

131. MedCOI: 31 December 2019 ↩

132. MedCOI: 26 June 2019 ↩

133. EACEA, ‘Albania, Special Education Needs Provision…’, 28 March 2019 ↩

134. UNICEF, ‘We All Matter! Situation Analysis of Children…’ (page 80), 2 December 2017 ↩

135. UNICEF, ‘We All Matter! Situation Analysis of Children…’ (page 84), 2 December 2017 ↩

136. UNICEF, ‘We All Matter! Situation Analysis of Children…’ (page 96), 2 December 2017 ↩

137. Exit News, ‘Children with Intellectual Disabilities in Albania…’, 27 May 2021 ↩

138. Exit News, ‘Children with Intellectual Disabilities in Albania…’, 27 May 2021 ↩

139. Albanian Children Foundation, ‘Inauguration of the second regional center …’, 2 April 2015 ↩

140. MedCOI: 28 December 2018 ↩

141. MedCOI: 22 June 2019 ↩

142. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 4.7.2), April 2011 ↩

143. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 4.7.4), April 2011 ↩

144. Republic of Albania, Ministry of Health, ‘The National Cancer Control…’ (section 4.7.4), April 2011 ↩

145. Hospices of Hope, ‘Everyone deserves to live and …’, 11 February 2022 ↩

146. Hospices of Hope, ‘Everyone deserves to live and …’, 11 February 2022 ↩

147. MedCOI: 7 May 2020 ↩