REPUBLIKA E SHQIPERISE

MINISTRIA E SHENDETESISE

VLERESIMI I ZBATIMIT TE PLANIT TE VEPRIMIT PER

ZHVILLIMIN
E SHERBIMEVE TE SHENDETIT MENDOR
NE SHQIPERI (2005-2007)

NENTOR 2007

VLERESIMI I ZBATIMIT
TE PLANIT TE VEPRIMIT PER
ZHVILLIMIN
E SHERBIMEVE
TE SHENDETIT MENDOR NE
SHQIPERI
(2005-2007)

Nntor 2007

Ky dokument, i titulluar Vlersimi i zbatimit t planit t veprimit pr zhvillimin e shrbimeve t shndetit mendor n Shqipri
(2005-2007) po botohet s bashku me versionin anglisht. Procesi i vlersimit u udhhoq nga Zyra Rajonale pr Europn
e OBSH. Dokumenti u shkrua nga Dr. Stojan Bajraktarov, konsulent i OBSH. Zyra pr Shqiprine e OBSH asistoi si procesin
e vlersimit ashtu edhe at t hartimit t dokumentit. Kabineti i Ministrit t Shndetsis mundsoi nj sr takimesh dhe
vizitash n terren, pa t cilat hartimi i ktij dokumenti do t kish qen i pamundur.

Pr m shum kopje t ktij botimi, lutemi kontaktoni:

OBSH Zyra pr Shqiprin
Adresa: Rr. Themistokli Germenji Pallati 10, Tiran
Tel/Fax:: +355 4 266162/3
E-mail: office@who-albania.org

c) World Health Organization 2007

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Prmbajtja:
1. HYRJA (qllimi)
2. PRSHKRIM
- Profili i vendit
- Sistemi shndetsor kombtar
- Struktura aktuale organizative e sistemit t shndetit mendor
- Drejtimi / Qeverisja dhe menaxhimi n sektorin e Shndetit Mendor
3. METODOLOGJIA DHE VLERSIMI
- Konsultimi me aktort kryesor kombtar n fushn e shndetit mendor;
- Dokumentat Kombtar mbi shndetin mendor;
- Raporte dhe vlersime t bra nga institucione dhe ekspert ndrkombtar;
- Vlersimi i aktorve kombtar dhe konsulenca n 4 zonat prioritare;
- T dhna t siguruara nga Programi i Shndetit Mendor Organizata Botrore e
Shndetsis Zyra pr Shqiprin
4. SITUATA AKTUALE DHE ANALIZA E PRIORITETEVE DHE INDIKATORVE TE
PRCAKTUAR N PLANIN E VEPRIMIT PR SHNDETIN MENDOR:
1. Aktivitete t emergjencs / t menjhershme (6 muaj)
A. Krijimi i nj sektori teknik pr shndetin mendor n Ministrin e Shndetsis (MSH)
B. Nxjerrja e pacientve afatgjat nga spitalet n kujdesin komunitar
(deinstitucionalizimi)
C. Ngritje kapacitetesh dhe trainim rifreskues pr profesionistt e shndetit mendor
D. Rishikimi i Ligjit t Shndetit Mendor
2. Aktivitetet afat-shkurtra (2 vjet)
A. Zhvillimi i shrbimeve komunitare t shndetit mendor si me shtretr ashtu dhe ato
ambulatore.
B. Trainimi i punonjsve t kujdesit shndetsor parsor.
C. Sistem monitorues pr t gjitha shrbimet dhe kujdesin individual
D. Hartimi i nj plani aktivitetesh pr t promovuar shndetin mendor.
5. EFEKTI I AKTIVITETEVE T NDRMARRA (2005-2007) N SISTEMIN SHQIPTAR T
SHNDETIT MENDOR
1.
2.
3.
4.

Drejtimi / Qeverisja
Financat
Burimet njerzore
Ofrimi i shrbimeve

6. KONKLUZIONE DHE REKOMANDIME

Dy Fjal n Hyrje
Ministria e Shendetsis n bashkpunim dhe me mbshtetjen e Zyrs s OBSH-s pr Europn
dhe me Zyrn e OBSH-s pr Shqiprin nisn s bashku nj program t gjer emergjence dhe
asistence humanitare n fushn e shendetit mendor, duke prezantuar orientimin e shndetit mendor
komunitar prkundrejt sistemit t vjetr t bazuar n institucionet e mdha spitalore.
Un kam kenaqsin t konstatoj se Shqipria, gj q e dshmon edhe ky dokument, ka vazhduar
progresin n drejtim t reformimit t sistemit t shendetit mendor, duke zvogluar gradualisht
spitalet psikiatrike dhe njkohsisht duke synuar zvendsimin e tyre me modelin e kujdesit
komunitar.
Ngritja e departamentit t Shndetit Mendor pran MSH sht nj tregues mse i qart i angazhimit
konkret t autoriteteve kombtare n kt fush .
Shqipria ka zbatuar n mnyr t suksesshme shum aktivitete me qllim q t ngrej nj sistem
gjithprfshirs t shndetit mendor, i cili u hap rrugn proceseve t ri-integrimit dhe risocializimit
n komunitet t personave t cilt vuajn nga smundjet mendore.
Sistemi i shndetit mendor nuk sht m nj sistem i bazuar vetm n institucionet e vjetra kujdesse
psikiatrike. Prkundrazi, ngritja e sistemit t kujdesit komunitar n fushn e shndetit mendor ka
filluar dhe po zbatohet n mnyr t suksesshme.
Kt fakt e vrteton m s miri dokumenti pr vlersimin e shkalls s zbatimit t Strategjis s
Shndetit Mendor, miratuar nga Ministria e Shndetsis. Por gjithashtu sht imediat strukturimi
organizativ dhe prshpejtimi i reformave n fushn e shndetit mendor.
Procesi i reformave n 2 vitet e fundit ka konfirmuar gjersisht nevojn dhe rezultatet pozitive
t modelit komunitar me deinsititucionalizimin, risocializimin dhe ri-integrimin n komunitet si
karakteristika kryesore.
Roli drejtues i Ministris s Shndetsis sht ky n kto procese, me mbshtetjen e madhe
dhn nga OBSH, si edhe nga agjensi dhe iniciativa t tjera ndrkombtare si Projekti i Shndetit
Mendor dhe i Paktit t Stabilitetit. Ne jemi t vendosur t vazhojm n rrugn e reformave dhe t
konkretizojm Planin e Veprimit pr Zhvillimin e Shrbimeve t Shndetit Mendor n Shqipri.
Megjithse Ministria e Shndetsis ka luajtur nj rol ky n aktivitetet e prshkruara, mungesa e
prfshirjes s institucioneve t tjera t rndsishme sht m shum se sa evidente. Roli i Ministris
s puns dhe shtjeve Sociale dhe ISKSH-s duhet t jet vendimmarrs dhe shum i rndsishm.
Sipas burimeve t ISKSH gati 25 prqind e vizitave t mjekve t prgjithshm jan si pasoj e
rregullimeve neuropsikiatrike.
S fundmi, rekomandimet e ktij dokumenti dshmojn vullnetin e Ministris s Shndetsis pr t
vijuar dhe mbshtetur reformn e sistemit dhe t shrbimeve t shndetit mendor, pr piknisjen e
s cils falenderoj bujarin e donatorve, qeverin suedeze dhe at irlandeze, si edhe ekspertizn
e vazhdueshme t Organizats Botrore t Shndetsis.
Nard Ndoka
Ministr i Shndetsis

1. HYRJE
Synimi dhe qllimi i vlersimit:
Shqipria n vitet e fundit ka br prpjekje domethnse me qllim kaprcimin e sistemit
t vjetr t shndetit mendor dhe vendosjen e nj shrbimi me orientim komunitar sipas prvojave
t mirnjohura europiane dhe botrore duke ndjekur standardet dhe rekomandimet e OBSHs. Rezultatet e reforms s shndetit mendor jan paraqitur n shum raste dhe n mnyra t
ndryshme si prpara publikut vendas ashtu edhe atij ndrkombtar, si edhe jan t njohura nga
autoritetet kryesore t shndetit mendor. Megjithat dokumentat kombtar (Dokumenti Politik
dhe Plani i Veprimit pr Zhvillim e Shrbimeve t Shndetit Mendor n Shqipri) q kan pr
synim prmirsimin e situats n sektorin e Shndetit Mendor, parashikojn dhe rekomandojn q
t ndrmerret nj vlersim i strukturuar pas nj periudhe zbatimi 2 vjeare (2005 2007), duke
prdorur tregues, standarde dhe rekomandime specifike.
Me qllim q t kryhet nj vlersim sasior dhe cilsor mbi rezultatet e arritura, si dhe pr
t kryer nj vlersim t situats aktuale, ky vlersim i drejtohet kryesisht grupeve t mposhtm:
- Njerzit me rregullime mendore, familjet e tyre dhe organizatat prfaqsuese
t prfshira n aktivitetet e prmendura dhe t interesuara n prmirsimin e
cilsis s kujdesit t shndetit mendor
- Institucionet kombtare kompetente, politik brsit, planifikuesit dhe
organizatat ndrkombtare t cilat synojn t mbshtesin m tej, t organizojn
dhe zbatojn reformat n fushn e shndetit mendor.
- Profesionistt e Shndetit Mendor, prgjegjs pr zbatimin e aktiviteteve t
planifikuara.
Dy pyetje kryesore jan n qendr t vmendjes s ktij vlersimi:
1.
2.

A e ka mbshtetur Shqipria zhvillimin n prputhje me Politikn Kombtare t

Shndetit Mendor?
Duke patur parasysh objektivat kryesor t Planit t Veprimit (2005) a ka patur
zhvillim pr prmbushjen e tyre n dy vitet e fundit?

Rezulatet e ketij vlersimi duhen prdorur n mbshtetje t planifikimit pr t ardhmen.
Me qllim q ti prgjigjemi n mnyr bashkkohore ksaj sfide, n procesin e hartimit t ktij
raporti morn pjes prfaqsues t aktorve kryesor n vend. Megjithat, ja vlen t prmendet
fakti q dshira e mir dhe angazhimi vn n dispozicion nga shum individ t prfshir n
ngritjen e sistemit t shndetit mendor komunitar n Shqipri, i ka dhn vlera t mdha sistemit
t ri t shndetit mendor.

1. PRSHKRIM I PRGJITHSHM
Situata n vend:
Shqipria shtrihet n Europn Jug Lindore, n Gadishullin Ballkanik me nj popullsi rreth
3.1 milion banorsh, si dhe ka nj siprfaqe prej 28,750 km2, kryesisht terren malor. Rreth
97% e popullsis n Shqipri jan Shqiptar etnik, dhe 1.9% Grek, ndrkoh grupet e tjera
prfaqsohen n nj numr m t vogl. Islami vlersohet t jet feja e gati 70% t popullsis,
ndrkoh q 20% jan ortodoks dhe 10% Katolik(6). Kto shifra n fakt pasqyrojn fen
e origjins pasi feja nuk ka qen nj faktor i rndsishm identifikimi n shoqrin Shqiptare.
(HIT)
Shqipria sht e ndar n 12 prefektura dhe cdo prefektur ndahet n disa komuna dhe
bashki. Ka gjithsej 315 komuna dhe 42 bashki n t gjith vendin. Edhe pse teorikisht kto njsi
vendore kan fuqi grumbullimi taksash, n praktik, qeverit vendore prfitojn pothuajse t
gjith t ardhurat e tyre nga qeveria qndrore. (HIT)
Megjithse ekonomia po rritet vrullshm, Shqipria konsiderohet si nj nga vendet europiane
m t pazhvilluara. Pas periudhs komuniste Shqipria ka patur nj rimkmbje mbreslnse,
duke filluar ndertimin e nj ekonomie moderne dhe n ndryshim e sipr. Megjithat, prania e
ekonomis informale, shkakton vshtirsi serioze n prllogaritjen e Prodhimit t Brendshm
Bruto (PBB/GDP) dhe Prodhimit Kombtar Bruto (PKB/GNP). Bujqsia, pyjet dhe turizmi jan
burimet kryesore t punsimit dhe t t ardhurave, por n vitet e fundit, sektori i ndrtimeve,
transportit dhe sektori i shrbimeve gjithashtu kan psuar rritje. Parat e drguara nga
emigrantt konsiderohen si nj pjes e rndsishme e ekonomis, (HIT)
T dhnat kryesore
Popullsia total (milion)
Rritja e popullsis (vjetore %)
Pritshmria e jetgjatsis n lindje, femra (vite)
Pritshmria e jetgjatsisn lindje, meshkuj (vite)
PBB/GDP (aktuale US$) (miliard)
Rritja e PBB/GDP (vjetore %)
PKB/GNP pr kok, metoda Atlas (US$)
Inflacioni, cmimet e konsumatorve (vjetore %)
Investimet e huaja t drejtprdrejta, fluksi neto (% e PBB)
Papunsia, total (% e forcs s puns, total)
Koha e nevojshme pr t nisur nj biznes (dit)
Prdorues Interneti (pr 1,000 banor)

2005*
3.1
0.6
78.5
72.6
8.38
5.5
2570
2.4
3.1
15.2
41
60

Burimi: Indikatort Botror t Zhvillimit (2006)

Shqipria ka luajtur nj rol t rndsishm n periudhn tranzitore post komuniste n Europn Jug
Lindore dhe po vazhdon t punoj drejt integrimit n NATO dhe Bashkimin Europian.
Sistemi i Kujdesit Shndetsor
Gjat 15 viteve t fundit, Shqipria ka ndrmarr ndryshime t mdha politike, ekonomike
dhe sociale t cilat kan ndikuar pothuajse n t gjith aspektet e jets, prfshir ktu treguesit
shndetsor dhe shrbimet e kujdesit shndetsor. Me gjith zhvillimin e arritur n reformimin e
sektorit shndetsor gjat ktyre viteve, treguesit shndetsor n Shqipri krahasohen me ato
t vendeve me t ardhura t ulta dhe t mesme t rajonit t Europs dhe Azis Qndrore por
mbeten prapa treguesve t vendeve t tjera t rajonit t Europs Jug Lindore. Megjithat, vitet
e tranzicionit jan pasuar me ndryshime t rndsishme t mnyrs s jetess dhe me rritje t
ekspozimit t popullats ndaj rreziqeve t reja shndetsore. (Raporti i Banks Botrore 2006)

Reformat prfshin disa zvoglime t kapacitetit t rrjetit tepr t shtrir t ofrimit t
shrbimeve, decentralizimin e menaxhimit t kujdesit parsor n drejtorit e shndetit publik si dhe
integrimin e tyre me funksionet e shndetit publik, privatizimin e sektorit farmaceutik dhe shumics
s kujdesit dentar, si dhe krijimin e Institutit t Sigurimeve t Kujdesit Shndetsor (ISKSH), si nj
mjet pr ndryshimet graduale t sistemit t financimit shndetsor.
Drejtimi dhe qeverisja e sektorit shndetsor
Qeveria sht siguruesi kryesor i shrbimeve shndetsore n vend nprmjet nj rrjeti prej
51 spitalesh t prgjithshme dhe rajonale, 564 qendrash shndetsore dhe 1582 ambulancash.
Numri i shtretrve n dispozicion (10,197) pr nj popullsi prej 3 milionsh, sht nj numr i lart
pr nj vend si Shqipria, me nj prdorim shtrati goxha t ult (54%).
Buxheti

Sasia prej 6% e PBB(GDP) t ciln Shqipria e shpenzon pr kujdesin shndetsor, sht
n t njjtn linj me vendet me t ardhura t ulta dhe t mesme, por sektori publik i Shqipris
kontribuon n kt shum me nj sasi m t vogl sesa mesatarja e ktyre vendeve. sht vlersuar
q shpenzimet out-of-pocket n momentin e marrjes s shrbimit llogariten t jen rreth 60% t
financimit t ktij sektori. Megjithse sigurimi shndetsor sht i detyrueshm, t dhnat mbi
shpenzimet familjare kan treguar q vetm 40-45% e popullsis jan t siguruar dhe si rrjedhoj
prfitojn nga mbulimi i saj.

Sistemi i financimit t Shndetsis sht i ndar ndrmjet Ministris s Shndetsis q
paguan pr kujdesin spitalor, rrogat pr personelin jo mjek si dhe disa shpenzime operative pr
kujdesin parsor, dhe Institutit t Sigurimeve t Kujdesit Shndetsor i cili sht prgjegjs pr
pagesn e rrogave t mjekve t kujdesit parsor, barnave me rimbursim, si dhe pr ekzaminimet
e shtrenjta .

Sfida kryesore pr sektorin shndetsor shqiptar sht q t konsolidoj arritjet e deritanishme,

ndrkoh q krijon kapacitete pr tiu prgjigjur me efektivitet incidencs n rritje t smundjeve
jo-ngjitse si dhe t prballoj mbrojtjen nga varfrimi t grupit me t ardhura t ulta
(Raporti i Banks Botrore 2006)
Drejtimi / Qeverisja dhe menaxhimi n sektorin e SHM
Pas trazirave n Ballkan gjat viteve 90, shndeti mendor i popullsis u kthye n nj cshtje
me prparsi t lart. Sistemi i Shndetit Mendor n Shqiprin post komuniste ishte i bazuar n
institucionet e mdha psikiatrike si dhe n disa njsi psikiatrike npr poliklinika.
Situata e kujdesit psikiatrik n vend ishte n kushte t vshtira pasi aksesi i popullats n kto
shrbime ishte ekstemisht i kufizuar: 1 psikatr/78,000 banor, shrbimet t prqendruara n 4
spitale n qytetet kryesore, akses i kufizuar ose munges totale n zonat rurale, etj. Shrbimet n
at koh nuk prmbushnin as standardet minimale t pranueshme. Shrbimet nuk ishin t knaqshme
si nga pikpamja klinike, psikologjike, humane, ashtu edhe nga ajo e rezultateve, efektshmris
apo nga pikpamja ekonomike. Pr rrjedhoj, kishte munges t shrbimeve jasht-spitalore
n komunitet, mungese t aktiviteteve parandaluese dhe rehabilituese, munges prfshirjeje
t familjeve dhe mbshtetjes sociale, alternativa t pakta ndaj kujdesit psikiatrik spitalor dhe
munges mbshtetjeje apo mundsish pr t smurt mendor pr t jetuar n komunitet. Keto
lloj institucionesh psikiatrike azile jan provuar t jen joeficente dhe me cilsi t ult shrbimi,
me munges t theksuar t aspekteve ri-integruese dhe sociale t trajtimit dhe rehabilitimit t
pacientve me smundje mendore.
Duke filluar q prej ndrhyrjeve psiko-sociale ne fillim t viteve 90, OBSh ka njohur dhe
ka provomuar karakterin emergjent te nevojave pr reformim te sektorit t shndetit mendor n
vendet e Ballkanit, duke u bazuar n shrbimin komunitar t shndetit mendor si e vetmja prqasje
e rekomanduar (fund i viteve 90, fillim 2000).
OBSH-ja pr Europn /Zyra n Shqipri mbshteti Ministrin e Shndetsis pr nj program
t gjer emergjence dhe asistence humanitare n reformn e shendetit mendor (1999). Ky program
u mbshtet bujarisht nga donatort ndrkombtar, fillimisht Komisioni Europian (1999-2000), m
pas Qeveria Suedeze (2000-2007) dhe Qeveria Irlandeze (2004-2008). Programi synoi q n
fillim prezantimin e nj qasjeje komunitare t shndetit mendor kundrejt sistemit t vjetr t bazuar
n institucionet e mdha spitalore, duke pasur objektivat e mposhtme:
- Hartimin e dokumentave kombtar n fushn e shndetit mendor, q do t
prfshijn politikat dhe legjislacionin e shndetit mendor t prqndruar n t
drejtat e njeriut t individve me smundje mendore;
- Riorganizimin e sitemit t financimit t sektorit t shndetit mendor:

Ngritjen e shrbimeve komunitare t shndetit mendor, prfshir qendrat ditore dhe

shtpit e mbshtetura;

- Sigurimin e trainimit t vazhdueshm n fushn e shndetit mendor komunitar pr

profesionistt, por edhe pr prfaqsuesit e aktorve kryesor, prfshir pacientt dhe
familjart e tyre
- Ngritjen e disa alternativave t ndryshme t ri-integrimit n komunitet pr individt
me smundje mendore, prfshir aktivitete q gjenerojn t ardhura dhe aktivitete q
synojn fuqizimin social t tyre.
- Instalimin e nj bashkpunimi t decentralizuar ndrmjet shrbimeve t reja komunitare
t shndetit mendor dhe qendrave bashkpunuese t OBSH dhe shrbimeve t tjera t
mirnjohura t shndetit mendor n vende t ndryshme t Europs;
- Prpilimin e programeve t edukimit t publikut, q do t synonin prmirsimin e
qndrimit t publikut ndaj individve me smundje mendore
Duke marr n konsiderat nevojn urgjente pr reform n fushn e shndetit mendor, MSH
(e mbshtetur nga OBSH) ngriti Komitetin Kombtar pr Shndetin Mendor (KDK) si nj njsi
multisektoriale me mandatin q:
- T aprovoj dhe t koordinoj t gjitha aktivitetet n fushn e shndetit mendor;
- Ti propozoj ndryshime qeveris n mnyr q t bhet e mundur reforma e shndetit
mendor:
- T lehtesoj dhe t mbshtes prpjekjet e bra n kt fush etj.
N vitet q pasuan, si rezultat i prpjekjeve t prbashkta t palve t interesuara dhe nn
drejtimin e MSH, rezultatet e shumpritura u arritn, dhe procesi i reforms kaloi nga faza e
emergjencs n fazn e zhvillimit.
Politika Kombtare pr Zhvillimin e Shrbimeve t Shndetit Mendor n Shqipri u
miratua nga Ministri i Shndetsis n Mars t vitit 2003 dhe Plani i Veprimit pr Zhvillimin
e Srbimeve t Shndetit Mendor n Shqipri u miratua nga Ministri i Shndetsis n Maj
2005.
N nivel shrbimesh, u ngritn disa lloje shrbimesh komunitare t shndetit mendor, prfshir
6 Qendra Komunitare t Shndetit Mendor (Tiran, Elbasan, Gramsh, Peshkopi, Vlor dhe Shkodr),
shtpi t mbshtetura (Shkodr, Elbasan, Tiran), aktivitete q gjenerojn t ardhura (Elbasan, Tiran
- me mbshtetjen teknike dhe financiare t OBSH dhe agjensive t tjera ndrkombtare si UNOPS,
Communita di SantEgidio, Cordaid, Global Initiative on Psychiatry, Hamlet Trust. Rezultatet e arritura u
njohn gjersisht jo vetm nga autoritetet vendore por edhe nga ata ndrkombtar. Prvoja e prfituar
nga kto shrbime thekson rndsin e planifikimit largpams dhe t qendrueshm q ka si tipar nevojn
pr ngritjen e shrbimeve t reja komunitare t shndetit mendor drejprdrejt n kuadr t sistemit t
shndetit publik t drejtuar nga MSH, si dhe nevojn pr reforma thelbsore n sistemin e financimit.

10

3. METODOLOGJIA E VLERSIMIT
Funksioni baz i vlersimit sht q t paraqes nj prmbledhje t rezultateve t arritura
sipas standarteve dhe treguesve t specifikuar n dokumentat kombtar, dhe t mbshtes
procesin e planifikimit me qllim q t identifikohen nevojat dhe t prcaktohen prioritetet pr
periudhn pasardhse. T gjitha palt e prfshira n hartimin e komponentve t vlersimit, jan
t mendimit q sht thelbsore ti jepet prparsi konsolidimit t reformave q jan ndrmarr
m par dhe q vazhdimi i tyre t prforcoj gjersisht sistemin e shndetit mendor komunitar.
Duke patur parasysh synimin e ktij raporti vlersues, si dhe nevojn pr tu bazuar n t dhna
konkrete, materiali i prdorur sht prftuar nga burimet e mposhtme gjat periudhs Qershor
Korrik 2007:
Konsultimi me aktort kryesor n fushn e shndetit mendor
Sistemi i Shndetit Mendor sht nn drejtimin e Ministris s Shndetsis dhe m specifikisht
nn prgjegjsin e Sektorit Spitalor ne MSH. Si pjes e ktij sektori u ngrit Njsia e Shndetit
Mendor e prbr nga nj person i ngarkuar vetm me shtje t shndetit mendor. Ky raport
u b i mundur nga mbshtetja e plot e ktij sektori si dhe sektorve t tjer n MSH si: sektori i
Financave, sektori i Kujdesit Shndetsor Parsor, si dhe ekipi drejtues i Ministris. T dhnat mbi
aktivitetet, rezultatet, procesin e planifikimit, trainimin dhe arsimimin, financat etj, u prftuan nga
personat prgjegjs n Ministri. Gjithashtu u morn n konsiderat edhe aspektet q i prkasin
shndetit mendor n dokumentat kombtar t sektorit t shndetsis (Strategjia Kombtare e
Shndetit dhe Projekti i Politiks Shndetsore 2007).
Gjithashtu u prdorn t dhna q u prftuan nga aktor t tjera kombtar si: ISKSH dhe
Ministria e Puns, shtjeve Sociale dhe Shanseve t Barabarta. etj
Dokumentat kombtar mbi Shndetin Mendor
- Politika pr Zhvillimin e Shrbimeve t Shndetit Mendor n Shqipri
- Plani i Veprimit pr Zhvillimin e Shrbimeve t Shndetit Mendor n Shqipri
- Ligji pr Shndetin Mendor
Raporte dhe prmbledhje t prpiluara nga ekspert dhe institucione kombtare dhe
ndrkombtare
- HIT Albania (2002),
- Database i Health for All,
- Raportet Botrore t Shndetit dhe raporte t OBSH / EURO
- Vlersim i ndrhyrjes s Programit t Shndetit Mendor t OBSH n Elbasan/Shqipri: 2006;

J.M. Caldas de Almeida, M.D., Ph.D.
- Vlersim i Ligjit Shqiptar t Shndetit Mendor; Martin Brown, 2006

11

-
-
-
-
-
-
-
-
-
-

Drafti i Strategjis s Sistemit Shndetsor (2007-2013); Antonio Duran

Sektori i Shndetsis n Shqipri, (Health Policy Note) Shkurt 2006; Banka Botrore
Raportet e Banks Botrore pr Shqiprin
Raportet financiare pr sistemin e shndetit mendor n Shqipri 2005/2006; MSH
Qendra Komunitare e Shndetit Mendor, Tiran Analiza Vjetore 2006
Planet Individuale Qendra Komunitare e Shndetit Mendor, Tirana
raport i vlersimit infermieror
raportim i t dhnave nga 4 zonat prioritare
Planet institucionale (Spitali Psikiatrik Elbasan)
Impakti i smundjes mendore n perceptimin nga ana e prdoruesve t vehtes dhe qndrimit
t shoqris: - nj vlersim i Qndrimit t Prdoruesve mbi shtje t Shndetit Mendor,
dhe Ndrgjegjsimi mbi t Drejtat e Tyre/ i zbatuar n Tiran, Elbasan, Vlor, dhe Shkodr
(Qendra Shqiptare e Zhvillimit pr Shndetin Mendor)
- Vzhgim mbi shtrimet n Tiran 2001 2006 (Qendra Shqiptare e Zhvillimit pr Shndetin
Mendor)
- Rregullorja e sherbimeve t shndetit mendor, MSH maj 2007

Vzhgim dhe konsultim me aktort kryesor kombtar n 4 zonat prioritare

Gjat periudhs s vlersimit, u krye nj vzhgim me qllim q t vlersohej situata aktuale
dhe rezultatet e arritura n lidhje me: karakteristikat e shrbimeve, aktiviteteteve, arritjeve dhe
nevojave pr zhvillim, shtjeve menaxheriale dhe t financimit, proceseve t monitorimit dhe
vlersimit; statusi i t drejtave t njeriut, prfshirja dhe sodisfaksioni i prdoruesve t shrbimeve
dhe familjeve t tyre, prfshirja e sektorve t tjer t rndsishm, etj.
Vlersimi u krye nprmjet:
a. Intervistave me:
- Drejtuesit e sistemit t shndetit mendor, prfshir personin prgjegjs n MSH,
ISKSH dhe MPSSHB
- Personelin n institucionet e shndetit mendor
- Prfaqsues t pacientve dhe familjarve
- Prfaqsues t komuniteteve dhe institucioneve (bashkit, deg t qeverisjes
vendore, individ t prfshir n shtje t shndetit mendor)
- Sektori i OJF
b. Vizita n Institucionet e shndetit mendor
- Vizita n shrbimet e shndetit mendor n 4 zonat prioritare
c. Informacioni dhe t dhnat u morn mbi:
- Aktivitetet e planifikuara dhe t zbatuara
- Rezultatet e aktiviteteve
- Trainimi dhe arsimimi i stafit profesional

12

- Informacion lidhur me gjendjen e t drejtave t njeriut, prfshir aktivitetin e

shoqatave t pacientve dhe familjarve
- Programet institucionale, planet dhe t dhnat
- T dhnat klinike (kartelat klinike)
T dhna t marra nga Programi i Shndetit Mendor OBSH, Zyra pr Shqiprin, Tiran
- Dokumentacione t projektit
- Raportet OBSH AIMS (2002 dhe 2004)
- Krkime shkencore profesionale, raporte aktivitetesh, t dhna mbi bashkpunimin me
MSH
- Raporte nga aktor t tjer t rndsishm dhe t interesuar n fushn e shndetit
mendor t paraqitura pran OBSH- programit t Shndetit Mendor, Shqipri.
4. SITUATA AKTUALE DHE ANALIZA E PRIORITETEVE DHE TREGUESVE T PARASHIKUAR
N PLANIN E VEPRIMIT PR ZHVILLIMIN E SHRBIMEVE T SHNDETIT MENDOR
1. AKTIVITETE T EMERGJENCS/ T MENJHERSHME (6 MUAJ)
A. Ngritja e nj sektori teknik t shndetit mendor n Ministrin e Shndetsis
(MSH)
Megjithse me nj vit vones, sektori i SHM n MSH sht ngritur si pjes e sektorit t
kujdesit spitalor. Nj person sht punsuar posarisht pr shtje t shndetit mendor dhe ky
hap sht mirpritur nga t gjitha palt e prfshira. Ky sektor sht organizuar n prputhje
me standardet e parashikuara n Planin e Veprimit si dhe t mbshtetura nga OBSH
B. Dalja e pacientve kronik nga spitalet psikiatrike pr n kujdesin komunitar
(deinstitucionalizimi)
Ka tregues q procesi i deinstitucionalizimit ka nisur n t 4 zonat prioritare ku ekzistojne
institucione psikiatrike me shtretr. Numri I shtretrve sht ulur n mnyr t ndjeshme n t
4 zonat: Shkodr nga 110 n 75, Elbasani nga 400 n 310, Vlor nga 280 n 240 shtretr,
Tirana nga 120 n 115 , n total nga 910 n 730 shtretr.

13

T dhnat e shtrimeve:
Elbasan ( Viti 2006)
Nr. i shtrimeve
511
Nr. i shtrimeve pr her t par
17
Nr. i rishtrimeve brenda vitit 127
Nr. i rishtrimeve brenda 30 ditsh
--Nr. i daljeve
512
Vlor: (Viti 2006)
Nr. i shtrimeve
Shtrime t pacientve akut
Shtrime t pacientve kronik
Vlor:( Janar- Qershor 2007)
Nr. i shtrimeve
Shtrime t pacientve akut
Shtrime t pacientve kronik
Shkodr (Viti 2005)
Nr. i shtrimeve
Nr. i daljeve

456
126
330
216
53
163
553
545

Nr i pacientve kronik (Viti 2007):

Tirana
17
Elbasan
250 (afrsisht, prfshir 10 n shtpin e mbshtetur Drita)
Vlor
170 (afrsisht)
Shkodr
37 (prfshir 10 n shtpin e mbrojtur Mimoza).

Dalje t pacientve kronik (periudha 2005-2007):
Shkodr: 16
Nuk ka t dhna nga zonat e tjera.
Ditqndrimi mesatar sht shkurtuar progresivisht gjat viteve t fundit:
Elbasan : 187.7 (Viti 2005); 153.3 (Viti 2006); 134 (2007/1).
Shkodr: 48.4 (Viti 2005); 42.1 (Viti 2006).
Znia e shtratit:
Elbasan: 71% (viti 2005); 69% (viti 2006); 67.8% (2007/1)
Shkodr: 82.4% (viti 2005), 90% (viti 2006)

14

Qarkullimi i shtratit:
Elbasan: 1.46 (viti 2005); 1.64 (viti 2006)
Shkodr: 6.1 (viti 2005); 8.3 (viti 2006)

Gjendje psikotike organike

Psikoza Alkoholike
Psikoza t tjera
Skizofrenia
rregullime Afektive
Gjendje Deliriumi
rregullime Neurotike
rregullime t personalitetit
Prapambetje mendore
Psikoz Reaktive
Psikoz paranoide
rregullim Deluzional
Epilepsi

Shtrimet n spital sipas diagnozs

T gjitha kto t dhna konfirmojn proceset reformuese prsa i prket deinstitucionalizimit,
zvoglimit t spitaleve, cilsis m t mir t shrbimit gjat shtrimeve dhe trajtimit spitalor.
Numri i shtrimeve sht rritur, megjithat ka nj tendenc n ulje t ditqndrimit spitalor. Numri
i shtretrve sht ulur ndjeshm n 2 vjet, duke sjell uljen e numrit t pacientve afatgjat
n Spitalit Psikiatrike (SP). Qarkullimi i shtratit sht rritur, gj q tregon ulje t qndrimit n
spital. Kto tendenca t pasuara nga investimet n sektorin spitalor t cilat synojn prmirsimin
e kushteve t jetess, duket se tregojn q ka nj proces prmirsimi n kujdesin spitalor. Prsa
i prket trajtimit sipas diagnozave n spitalet psikiatrike, skizofrenia dhe rregullimet e humorit
kan peshn kryesore ku trajtimi mbetet kryesisht biologjik.
C. Ngritja e kapaciteteve dhe trainimi rifreskues pr profesionistt e shndetit
mendor
Numri i burimeve njerzore n sfern e shrbimeve t psikiatris sht pothuajse i njjt, me
nj ndryshim cilsor: nj tendenc e re pr t punsuar profesionist t tjer si punonjs social
dhe psikolog (pritet q kjo t ndodhe n t gjitha shrbimet n nj t ardhmen t afrt), sht
konfirmuar dhe madje zgjeruar.

15

Struktura e personelit n institucionet psikiatrike me shtretr, korrik 2007:

Rajoni
Tirana
Elbasan
Vlor
Shkodr

Psikiatr
17
6
6
3

Infermjere
46
49
35
25

Psikolog
1
1
2
1

Terapist
okupacional
3
4
3
3

Personel
ndihms
40
132
90
29

Punonjs
Social
1
2
3

Prsa i prket trainimit dhe arsimimit n Psikiatri, prfshirja e shtjeve t shndetit mendor
komunitar, sht rritur n t gjitha nivelet. Si institucion prgjegjs pr zhvillimin e kurrikulave
arsimore pr disa institucione universitare, Klinika Universitare e Psikiatris ka prfshir me
sukses shtje t shndetit mendor komunitar t prmendura m lart. Numri i profesionistve
q jan trainuar sht n rritje t vazhdueshme (psh. Numri i psikiatrve nga 33 n vitin 1999
n 46 n vitin 2003). Duket q pjesa m e madhe e profesionistve q punojn n shrbimet
e shndetit mendor, kan marr trainim pr shtje t shndetit mendor si prshkruhet edhe
ne Planin e Veprimit. Duke patur parasysh q n t gjitha zonat e mbulimit jan organizuar
disa aktivitete pr kt qllim, sht e vshtir q t prllogaritet prqindja e sakt e
profesionistve t trainuar. Megjithat ekzistojn raporte q dshmojn rezultatet cilsore dhe
sasiore t aktiviteteve trainuese:
Shembulli i Elbasanit
(pjes nga nj raport i OBSH):
T gjith mjekt psikiatr jan prfshir n trainim pr shndet mendor komunitar nprmjet aktiviteteve t ndryshm
trainues.
50 infermiere dhe 27 kujdestar nga spitali psikiatrik marrin trainim n pun e sipr i cili prqndrohet n:
Zbatimin e instrumentit vlersues pr pacientt e shtruar. do pjesmarrs ka prftuar gjithsej 10 or
trainimi
Zbatimi i udhzuesve t prgjithshm pr shtrimet. do pjesmarrs ka prftuar gjithsej 5 or trainimi
5 infermieret e shtpis s mbshtetur kan marr 60 dit trainim / 2 or n dit gjat periudhs Janar Mars
2006 mbi:
Punn e infermieres s shndetit mendor n komunitet dhe m specifikisht roli i infermierit n shtpin e
mbshtetur (psh. puna me pacient t veant, prqndrimi jo vetm tek nevojat biologjike por edhe tek
ato psikologjike dhe sociale t t smurit mendor).
12 infermiere t pavionit t pranimit n spitalin psikiatrik kan prftuar 10 or trainim mbi:
Zbatimin e instrumentit vlersues, protokollet e shtrimit, rregulloren e pavionit t pranimit dhe metodat e
ndrhyrjes.
6 persona, prfaqsues t grupit t puns pr gjenerimin e t ardhurave: (2 personel i projektit t OBSH, 2
kujdestar dhe 2 terapist vokacional nga spitali) kan prftuar 80 or trainim mbi:
Identifikimin dhe vlersimin e aftsive t pacientve pr t punuar, mnyra pr t mbshtetur dhe rifreskuar
aftsit e tyre vokacionale si brenda ashtu dhe jasht spitalit, si t mbshtesin rehabilitimin e pacientve
potencial pr ti punsuar n ndrmarrjen sociale, si t zhvillojn dhe t menaxhojn nj aktivitet q
gjeneron t ardhura.
Konsulent nga Shrbimet e Shndetit Mendor (Irland) ishin prgjegjs pr trainimin e stafit t spitalit dhe t
shtpis s mbshtetur, ndrkoh q konsulent nga Trieste, Itali ishin prgjegjs pr aktivitetet e gjenerimit t t
ardhurave.

16

D. Rishikimi i Ligjit t Shndetit Mendor

Ligji i Shndetit Mendor nuk sht rishikuar ashtu si e parashikon Plani i Veprimit. Si theksohet
n disa raporte t lidhura me kt shtje, duket q sht m e rndsishme t mbshtetet zbatimi
i Ligjit ekzistues t Shndetit Mendor (1996), sesa t rifillohet procesi nga fillimi. N kt kontekst,
duhen prpiluar rregullore dhe akte nnligjore shtes. Duke ndjekur kto rekomandime, MSH ka
ndrmarr disa nisma.

M konkretisht, n prputhje me ligjin Nr. 8092 Pr Shndetin Mendor, u ngrit nj grup
pune pran MSH i cili punoi pr t hartuar 2 formular ligjor q do t shrbenin pr ligjrimin
e statusit t shtrimeve t pavullnetshme n spitalet psikiatrike. Formulart u miratuan dhe hyn
n fuqi n Qershor 2006. Pati disa vshtirsi n procesin e zbatimit si pasoj e mungess s
infrastrukturs n gjykatat e rretheve. Megjithat, monitorimi i vazhdueshm pr kt shtje rriti
presionin pr zbatimin e saj n institucionet e interesuara.

Duke ndjekur domosdoshmrin q rrjedh nga po i njjti ligj (Nr. 8092), u hartua, nga nj
grup pune pran MSH, Rregullorja e Shrbimeve t Shndetit Mendor. Dokumenti prfundoi n
Shkurt 2007 dhe u miratua nga Ministri i Shndetsis n Maj 2007.
Megjithat, nevoja pr t prmirsuar gjendjen e t drejtave t njeriut vazhdon t jet nj nga
prparsit kryesore, veanrisht n shrbimet me shtretr.

2. AKTIVITETET AFAT-SHKURTRA (2 VJECARE)

A. Zhvillimi i shrbimeve komunitare t shndetit mendor me shtretr dhe pa
shtretr.
Strukturat prbrse t sistemit komunitar t shndetit mendor dhe lidhjet midis tyre
Aktivitetet e planifikuara u prqndruan n 4 zona prioritare me kto struktura ekzistuese t
shrbimeve t SHM:
Rajoni i Tirans
- Klinika Universitare Psikiatrike / Qendra Spitalore Nn Tereza
- 3 Qendra Komunitare t Shndetit Mendor
- Shtpia e Mbshtetur e Komunitetit t SantEgidios pr 5 persona
- Qendra Ditore t organizuara nga OJQ Alternativa dhe Fountain House
Rajoni i Elbasanit
- Spitali Psikiatrik (duke prfshir edhe qendr ditore pr pacientt e spitalit)
- Shtpi e Mbshtetur pr 10 persona n Elbasan

17

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-
-
-

Shtpi e Mbshtetur pr 12 persona n Crrik

Aktiviteti q gjeneron t ardhura, Ndrmarrja Sociale S bashku
QKSHM n Kor
Ekipi komunitar i SHM n Poliklinikn e Elbasanit

Rajoni i Vlors
- Spitali Psikiatrik
- QKSHM
Rajoni i Shkodrs
- Pavion psikiatrik n Spitalin e Prgjithshm t Shkodrs
- Shtpia e Mbshtetur Mimoza pr 10 persona
- Shrbimi ambulator psikiatrik n Poliklinikn e Shkodrs

A.1. Shrbimet me Shtretr

Organizimi i shrbimeve psikiatrike me shtretr

Situata sht thuajse e njjt me 2 vjet m par, me struktura psikiatrike me shtretr n 4
zonat prioritare (spitale psikiatrike ne Vlor dhe Elbasan si edhe pavione psikiatrike n Tiran dhe
Shkodr). N saj t proceseve t zvoglimit t spitaleve, numri i shtretrve n kto institucione sh
ulur (Shkodr nga 110 n 75, Elbasan nga 400 n 310, Vlor nga 280 n 240 dhe Tiran nga 120
n 115 totali nga 910 n 730). N periudhn 2005-2007 MSH ka br investime t rndsishme
n prmirsimin e kushteve t spitaleve psikiatrike. Respektivisht, Klinika Psikiatrike Universitare ka
prfunduar rikonstruksionin (MSh ka investuar me nj shum prej 87 000 000 leksh) dhe n Spitalin
Psikiatrik t Elbasanit rikonstruksioni sht n prfundim e sipr (MSH ka investuar me nj shum
prej 54 000 000 leksh). Pavioni psikiatrik n SHkodr ka prfunduar s rikonstruktuari nga nj
OJQ hollandeze Door, por duhet theksuar se ndrkoh MSH po konsideron planet pr riorganizim
rrnjsor t shrbimeve psikiatrike t Shkodrs dhe t Vlors.
Tiran
Institucioni i vetm psikiatrik terciar Klinika Psikiatrike Universitare funksionon si pjes e Qendrs
Spitalore Universitare Nn Tereza me nj zon mbulimi prej 800 000 banorsh nga Shqipria
Qendrore. Pavioni ka 115 shtretr q prbhen nga 17 shtretr rezidencial, 15 shtretr pr
shrbimin akut pr fmij dhe adoleshent si edhe 83 shtretr pr kujdesin akut pr t rriturit. Ky
departament ka gjithashtu edhe prgjegjsi trainuese pr studentt e mjeksis, specializantt e
psikiatris, studentt e infermieris, psikologjis dhe t puns sociale.
Elbasani
Elbasani sht qyteti i cili ka spitalin psikiatrik m t madh n vend ku reforma e shndetit

18

mendor sht mbshtetur vazhdimisht n vitet e fundit nga projektet e OBSH s. Numri aktual i
shtretrve sht 310 pr nj zon mbulimi prej 900 000 banorsh nga Shqipria e mesme dhe
ajo juglindore.
Vlor
Spitali psikiatrik i Vlors ka n zonn e vet t mbulimit Shqiprin jugore me nj popullsi prej
700 000 mij banorsh. Ky spital ka patur mbshtetjen e UNOPS dhe m pas t Projektit t Shndetit
Mendor t Paktit t Stabilitetit, i cili sht kryesisht i prqndruar n kt zon. Numri aktual i shtretrve
t ktij spitali sht 240.
Shkodr
Pavioni psikiatrik n Shkodr funksionon si pjes e spitalit t prgjithshm dhe ka n zon mbulimi prej
720 000 banorsh nga veriu dhe verilindja e Shqipris. Numri aktual i shtretrve sht 75.

Pavionet e pranimit
Pavionet e pranimit jan ngritur n t 4 zonat prioritare dhe kan funksionuar n mnyr t
suksesshme. Q t gjitha kan kritere t strukturuara funksionimi t inkorporuara brenda institucioneve
psikiatrike me shtretr. Ato funksionojn si filtr duke parandaluar shtrimet e paprshtatshme dhe
afatgjata. Psh. nga rezultatet e pavionit t pranimit n VLor, 65% e pacientve t shtruar doln
pas trajtimit n kt pavion kurse 35% e tyre u transferuan pas trajtimit n pavionet e tjera t spitalit.
Kto pavione gjithashtu jan prdorur edhe si struktura trainuese pr studentt e infermieris, puns
sociale dhe psikologjis. Duhet theksuar se hapja e ketyre pavioneve ka br t mundur prmirsimin
e qndrimeve t publikut kundrejt smundjeve mendore n saj t praktikave t trajtimit m t
prshtatshme dhe respektimit m t madh t t drejtave t njeriut. far sht m e rndsishme,
vet pacientt e trajtuar aty kan shprehur se dinjiteti i lidhur me smundjen e tyre mendore sht
prmirsuar dhe i shtyn t krkojn shrbimin n kohn e duhur n ndryshim nga prvojat n pavionet
e tjera psikiatrike.
Plane institucionale dhe individuale n strukturat spitalore
Kto plane ekzistojn n pothuajse t gjitha shrbimet psikiatrike, por pjesa m e madhe e
tyre jan nj reflektim i sistemit t vjetr, ku mungon vizioni pr shndetin mendor komunitar. Esht
evidente se personeli n strukturat spitalore, prfshir edhe vet strukturat drejtuese t tyre, nuk jan
familjarizuar me kto dokumenta. Nga ana tjetr ka iniciativa pr kujdesin individual dhe menaxhimin
e rastit pr pacientt e spitalit. Forma e vlersimit infermieror sht n prdorim n Elbasan dhe n
Shkodr, ndrkoh q menaxhimi i rastit sht n faz zhvillimi n Tiran dhe Vlor duke mos harruar
bashkpunimin e tyre t ngusht me QKSHM.

19

A.2. Shrbimet e reja komunitare t shndetit mendor

Shrbime t reja komunitare jan t pranishme tashm n t 4 zonat prioritare, duke konfirmuar keshtu perqasjen e
shrbimit te ri komunitar t shndetit mendor. Parimi i respektimit t zonave t mbulimit sht zbatuar n t 4 zonat
prioritare, me prjashtim t pak rasteve pr shtrim nga zonat e tjera.
Shrbime t ndryshme komunitare t shndetit mendor jan ngritur dhe funksionojn n 4 zonat prioritare,
por niveli i zhvillimit t tyr sht i ndryshm. Pjesa m e madhe e SHKSHM jan inkorporuar brenda sistemit
publik t shndetit mendor (institucioneve ose klinikave psikiatrike ekzistuese), dhe vetm pak jan organizuar
nga sektori i OJF ve.
Ndrkoh q trajtimi n komunitet dhe shrbimet mbshtetse jan forcuar, mundsit e trajtimit
n komunitet ende shikohen si t pamjaftueshme. Grupet e interesit krkojn me ngulm zhvillime t reja t
shrbimeve komunitare t shndetit mendor.
Prpjekje t mtejshme jan br pr ngritje t tjera ose forcime t shrbimeve komunitare t shndetit
mendor:
Qendra komunitare t shndetit mendor:
Tiran
2 Qendra t reja komunitare t shndetit mendor t ngritur n 2 vitet e fundit, ndrkoh q dhe qendra e
ngritur q n 2003 m par funksionon me rezultate akoma m t mira. QKSHM 1 e Tirans ka prqafuar nj
prqasje t dukshme komunitare dhe rezultatet e saj pasqyrohen n raportin vjetor. Aktivitetet e zbatuara prej
saj jan ndr praktikat m t mira dhe mund t shrbejn si nj model pr gjith pjesn tjetr t vendit (plane
institucionale dhe individuale, raportime dhe dokumentime.
Drejtuesit e QKSHM nuk kan kompetenca mbi buxhetin. Shrbimet komunitare t shndetit mendor jan
t inkorporuara brenda strukturs organizative t Autoritetit Shndetsor rajonal (ASHR) dhe m ngushtsisht, t
t 3 Poliklinikave t Tirans, ndrkoh q aktivitetet e tyre koordinohen me Klinikn Psikiatrike t Universitare.
Popullsia q mbulon secila poliklinik sht
- Poliklinika Nr 1 - 281.940 banor ose 35.7% t popullsis s Tirans
- Poliklinika No 2 - 232.359 banor ose 29.5% t popullsis s Tirans
- Poliklinika No 3 - 274.520 banor ose 34.8% t popullsis s Tirans
Duhet theksuar se megjithse organizimi i QKSHM n Tiran nuk sht ne perputhje me planin fillestar t
Dokumentit Politik - Sistemi Demosnstrues i Shndetit Mendor t Tirans (SDSHMT1), bashkpunimi midis 2
institucioneve (QKSHM dhe Klinika Psikiatrike Universitare), sht vlersuar si i knaqshm dhe sht nj shembull
i mir i vazhdimsis s kujdesit
Gjithashtu n Tiran funksionon edhe nj Qendr Ditore e ngritur nga OJQ Alternativa me mbshtetjen e
Cordaid, dhe nj tjetr Fountain House nga donator privat.

20

T dhna nga QKSHM 1, Tiran

Struktura e personelit:
Psikiatr
3

Infermiere
6

Psikologe
2

Punonjs social
2

T dhna nga aktiviteti i Qendrs Komunitare t Shndetit Mendor N Tiran (viti 2006):
-
-
-
-
-
-
-

Numri total i vizitave n QKSHM Tiran

8206
Numri i rasteve t reja
320
Numri i vizitave n shtpi
248
Numri i vizitave n Spitalin Psikiatrik, KShP etj
41
Numri i kontakteve t tjera (psh. Instituti i Sigurimeve Shoqrore)
58
Numri i referimeve pr shtrim n SP
87
(48 nga kto shtrime jan referuar pr shkak t prkeqsimit t situats klinike, 5
prej t cilave ishin shtrime urgjente dhe 30 shtrime pr vlersimin e aftsive pr pun)
- Numri i referimeve n Klinikn Psikiatrike (janar-korrik 2007)
12
- Nr. i pacientve afatgjat t shtruar n Klinikn Psikiatrike nga zona e mbulimit t
QKSHM 1 t Tirans
2
Rezultatet e Psikologut:
Numri total i kontakteve me psikologun
Sesione psikoterapeutike
Vlersime
Kshillime
Psiko-edukim individual

217
147
17
29
13

Rezultatet e punonjsit social:

Numri total i kontakteve me punojsin social
Numri i pacientve t cilt kan prfituar ndrhyrje sociale
Rastet e asistencs sociale
Vizita n spitalin Psikiatrik
Vizita tek Shtpia e Motrave t Nn Terezs.

679
84
239
18
12

21

Elbasan
QKSHM ekzistoi deri n vitin 2004 n ambientet e Polikliniks s Elbasanit, dhe u mbyll pr
shkak t mungesave n personel, e cila ngriti shtjen e aspekteve t vazhdimsis t aktiviteteve
t Reforms. Nisma t reja jan n rrug e sipr me krkes t Spitalit Psikiatrik t Elbasanit
pr punsimin e nj psikologu dhe punonjsi social pr nevojat e QKSHM infermiert mund
t identifikohen ndr punonjsit ekzistues t SHP, ndrkoh q nga ana tjeter mjeku psikiater
dhe infermieri i tij n Poliklinik jan m se t interesuar pr tu prfshir. N poliklinik ka
hapsir t mjaftueshme (4 dhoma) pr organizimin e aktiviteteve t planifikuara. Kshtu do t
sigurohet n mnyr t qndrueshme bashkpunimi i ngusht midis SHP dhe QKSHM. sht me
vend t prmendim q kto prpjekje kan mbshtetje t gjer nga Shoqatat e prdoruesve dhe
familjarve t tyre, t cil theksuan prvojn e mir me QKSHM gjat kohs s funksionimit t saj
(2000 2004).
N kt rajon sht planifikuar q me mbshtetjen e OBSH brenda vitit 2007 t ngrihet nj qendr
komunitare e shndetit mendor n Kor .

Disa rezultate t aktiviteteve t shrbimit ambulator t psikiatris t Polikliniks s

Elbasanit: Viti 2005
Numri total i vizitave
Numri total i pacientve

Numri total i pacientve t rinj

4650
800
80

Q nga shtatori 2005 rifilloi puna n terren: 72 pacient u vizituan dhe u mbshtetn n
komunitetin e tyre (22 persona q vuajn nga smundje t shndetit mendor u vizituan n
shtpit e tyre kurse t tjert n qendrat shndetsore prkatse)

Vlor
QKSHM ekzistuese u ngrit n kuadrin e Projektit t Shndetit Mendor t Paktit t Stabilitetit, me
mbshtetjen e OBSH Shqipri. QKSHM sht pjes integruese e strukturs oganizative t Spitalit
Psikiatrik, dhe aktivitetet e saj jan t koordinuar ngusht me Pavionin e Pranimit t Spitalit. Atje
prdoren modalitete t dukshme komunitare dhe bashkpunimi i mir q kan me sektorin e KSHP
ka ndikuar n rezultatet e tyre, t cilat vijn gjithashtu si rrjedhoj e nj programi t gjer trainimi
t personelit t SHP.
Shkodr
Aktualisht po diskutohet pr ngritjen e nj QKSHM

22

Planet institucionale dhe individuale n strukturat e QKSHM

Planet Institucionale
Planet pr kto struktura t reja jan ende t pazhvilluara mir. Megjithat prqasjet individuale
dhe sistemi i menaxhimit t rasteve jan t prfshira n metodat e puns, dhe plani indivual pr
QKSHM e Tirans mund t prdoret si nj model pozitiv n t gjith pjesn tjetr t vendit.
Jetesa e mbshtetur / ngritja e shtpive t mbshtetura
N kt fush sht vn re nj zhvillim i rndsishm n terma t rritjes s shrbimit dhe burimeve
njerzore dhe zhvendosjes s burimeve nga spitali n komunitet.
Tirana
Shtpia e mbshtetur e Komunitetit t SantEgidios sht ende n funksionim ashtu sikundr
spjegohet edhe n dokumentin politik. Gjat vizits vlersuese q u b n shtpi, i gjith grupi
pacient dhe personel ishte me pushime.
Elbasan
Shtpia e mbshtetur pr 10 persona sht ngritur me mbshtetjen e OBSH, brenda strukturs
organizative t spitalit dhe kostoja operative, personeli, ushqimi etj mbulohen nga spitali. Pr
momentin shrbimi sht i organizuar si shtpi e prhershme dhe deri tani asnj nga pacientt
nuk sht ri-bashkuar me komunitetin. Personeli prbhet nga 8 profesionist punonjs t spitalit
psikiatrik (5 infermiere, nj psikolog dhe nj punonjs social me koh t pjesshme si edhe nj
mjek psikiatr q kryen konsultat). Rndsi i jepet aktiviteteve rehabilituese, si psh prfshirja
dhe edukimi i banoreve t shtpis n prgatitjen e ushqimit, kryerjen e funksioneve te jets s
prditshme, si blerje, higjenizim, etj.
Sipas planeve t afrta, nj shtpi e mbshtetur e re pr 12 persona do t hapet n kt zon
n qytetin e Crrikut me mbshtetjen e OBSH- s.
Vlor
Ende nuk ka nj shtpi t mbshtetur, por stafi i ri drejtues i spitalit po shqyrton mundsit e ngritjes
s ksaj shtpie dhe fondeve t nevojshme pr ngritjen e saj.

23

Shkodr
Shtpia e mbshtetur pr 10 persona Mimoza sht ngritur me mbshtetjen e UNOPS dhe
funksionon n strukturn organizative t Pavionit Psikiatrik, i cili mbulon shpenzimet e personelit,
ushqimit etj.. Personeli prbhet nga 7 profesionist (1 punonjs social, 5 personel ndihms dhe
nj psikiatr q kryen konsultat e nevojshme), dhe q jan punonjs t spitalit. 4 banor t ksaj
shtpi jan rikthyer n familje, 2 prej tyre n 2 vitet e fundit.
Ministria e Shndetsis ka caktuar fonde dhe ka nisur aktivitetet pregatitore pr ngritjen e
shtpive t reja t mbshtetura pr 20 persona (10 secila shtpi). Rrjedhimisht sht planifikuar
q pacientt kronik t shkojn n shtpit e mbshtetura kurse shrbimi pr pacientt akut t
transferohet pran Spitalit t Prgjithshm.
Aktivitete q gjenerojn t ardhura
Aktivitetet q gjenerojn t ardhura funksionojn n 2 prej zonave prioritare dhe pacientt e
punsuar aty nuk jan punonjs me koh t plot. Si t tilla aktivitetet funksionojn m tepr si
mbshtetje shtes pr programet e ri-shoqrizimit, por gjithashtu edhe si aktivitete trainimi n
pun pr prgatitjen e punonjsve t ardhshm me koh t plot
Tiran
Ekziston nj aktivitet i izoluar i cili gjeneron disa t ardhura pr disa pacient, organizuar nga
OJF Alternativa. N munges t nj ndrmarrjeje sociale, aktiviteti i prodhimit t qirinjve dhe
rregullimit t biikletave prfshin 3-5 pacient.
Vlor
Nuk jan ngritur ende aktivitete q gjenerojn t ardhura pr persona q vuajn nga probleme
t shndetit mendor.
Elbasan
Me mbshtetjen e OBSH sht ngritur nje projekt pr prodhimin e kulturave bujqsore n
ambientet e Spitalit Psikiatrik n bashkpunim me sektorin privat. 5-6 pacient marrin t ardhura
t prhershme nga ky aktivitet.

Shkodr
Nuk ka aktivitete q gjenerojn t ardhura. Prdorues dhe organizata t familjarve ngritn nj
aktivitet pr riparimin e biikletave para disa vitesh por q u mbyll 2 vjet m par.

24

B. Trainim i punonjsve t shndetit parsor

Jan ndrmarr prpjekje t rndsishme pr trainimin e personelit t SHP dhe si rrjedhim bashkpunimi
m kt shrbim sht i ndjeshm. Module trainimesh jan aplikuar veanrisht n Elbasan dhe Vlor.
Elbasan
20 Mjek Familjeje dhe 20 infermiere nga SHP i Elbasanit si edhe 10 personel te shrbimit parsor
nga Crriku jan prfshir n modulin e trainimit t shndetit mendor.
Vlor
Esht ndrmarr nj program i gjer pr t gjith Mjekt e Familjes n kuadr t Projektit t
Shndetit Mendor t Paktit t Stabilititetit.
Sipas personelit t institucioneve t shndetit mendor, kto trainime kan sjell nj prmirsim
t ndjeshm t bashkpunimit me sektorin e SHP, veanrisht prsa i prket referimeve dhe
vazhdimsis s kujdesit. Megjithat, vetm nj koh e kufuzuar e mjekve psikiatr i kushtohet
marrjes s nj roli konsultues t mjekve t prgjithshm.
C. Sistemi i monitorimit t t gjith shrbimive dhe kujdesit individual.

N kt drejtim rezultatet nuk prputhen me pritshmrit. Sistemi i mbledhjes s t dhnave
nuk sht zhvilluar si duhet, rrjedhimisht sht e vshtir t mblidhen t dhna t knaqshme,
si pr treguesit sasior ashtu edhe pr ata cilsor, si pr inputet ashtu edhe pr rezultatet.
Pr kt arsye, nuk sht e mundur t verifikohen t gjith treguesit e prshkruar n Planin e
Veprimit. Sistemi Monitorues nuk funksionon dhe duhet t jet nj nga prparsit pr periudhn
n vazhdim.
D. Hartimi i nj plani aktivitetesh pr t promovuar shndetin mendor.
Nuk ekziston nj plan kombtar aktivitetesh promovuese pr shndetin mendor, ndrkoh q OJF
t ndryshme dhe institucione t ndryshme publike t shndetit mendor vijojn t zhvillojn aktivitete
te posame n dit t shnuara si p.sh. Dita Botrore e Shndetit Mendor.

5. EFEKTI I AKTIVITETEVE TE NDERMARRA NE SISTEMIN SHQIPTAR TE SHENDETIT

MENDOR

25

DREJTIMI / QEVERISJA
Dokumenti Politik Kombtar dhe Plani i Veprimit pr zhvillimet e Shrbimeve t Shndetit
Mendor n Shqipri sht njohur gjersisht si mjeti m i rndsishm i reforms n fushn e
shndetit mendor. Ministria e Shndetsis ka marr prsipr rolin drejtues n planifikimin,
organizimin dhe zbatimin e aktiviteteve reformuese, me mbshtetjen kye t Zyrave
Europiane dhe vendore t OBSH-s. Ngritja e Departamentit t Shndetit Mendor n Ministrin
e Shndetsis, sht nj hap prpara dhe nj tregues shum i rndsishm i angazhimit t
institucioneve kombtare n vazhdimsin e reforms n kt fush.
Dokumenti Politik Kombtar i Shndetit Mendor (2003) ka nxitur prqasjen e re t shndetit
mendor t bazuar n komunitet, duke ndjekur kshtu zhvendosjen e prqasjes s vjetr t azileve
ose institucioneve t vjetra. Dokumenti Politik prmblodhi synimet e reforms ndrkoh q Plani i
Veprimit (2005) prcaktoi prparsit e s ardhmes dhe planifikoi aktivitetet e nevojshme.
N strukturat e sistemit t shndetit mendor kan ndodhur ndryshime thelbsore, si
prmirsimi i shkalls dhe cilsis s shrbimeve komunitare t shndetit mendor. T gjitha palt
e prfshira n kto procese kan ndar gjersisht t njjtin opinion se Dokumenti Politik dhe Plani
i Veprimit jan instrumentat ky t strukturimit, organizimit dhe prshpejtimit t reformave n
fushn e shndetit mendor. Procesi i reformave n 2 vitet e fundit ka konfirmuar gjersisht nevojn
si edhe ka njohur rezultatet pozitive t modelit komunitar me deinsititutionalizimin, rishoqrizimin
dhe riintegrimin n komunitet si karakteristikat kryesore t ktij modeli.
Megjithse Ministria e Shndetsis ka luajtur nj rol ky n aktivitetet e prshkruara,
sht evidente mungesa e prfshirjes s institucioneve t tjera t rndsishme. Duke patur parasysh
aspektet sociale t smundjeve mendore, roli i Ministris s Puns, shtjeve Sociale dhe Shanseve
t Barabarta duhet t jet m aktiv dhe m i strukturuar. N kt drejtim, ka shum hapsira pr
aktivitete t prbashkta, sidomos pr aktivitetet rehabilituese. Po ashtu, reformat rrnjsore
q po ndrmerr ISKSH, ky vendimmarrs shum i rndsishm, e theksojnw akoma m shum
rndsin e prfshirjes s sektorit t SHP dhe politikave t barnave. Sipas burimeve t ISKSH
gati 25% e vizitave t mjekve t prgithshm jan si pasoj e rregullimeve neuropsikiatrike.
Lista e mjekimeve nn prgjegjsin e ISKSH prmban disa tipe t neuroleptikve t rinj (si psh
Clozapine, Risperidone and Olanzapine), por nuk siguron gjeneratn e re t antidepresivve.
Progres i kufizuar sht br n drejtim t mbrojtes s t drejtave t pacientve
dhe prmirsimit t qndrimeve t publikut si edhe prfshirjes s pacientve, por ende
vlen t shqetsohemi prsa i prket nevojs pr ngritje dhe konsolidim t mekanizmave t
sigurimit t t drejtave t njeriut. Kjo bhet edhe m e rndsishme kur kujtojm se ende nuk
sht prpunuar ndonj Ligj i ri pr Shndetin Mendor, ndrkoh q mungojn mekanizmat
pr zbatimin e Ligjit Aktual t Shndetit Mendor (1996) (shiko raportet e Martin Brown,
2005, 2006). N prfundim, mbetet ende shum pr t br pr t prshtatur nj kuadr
legjislativ n prputhje me zhvillimet e fundit n Shqipri dhe standardet ndrkombtare.
FINANCAT:

26

Administrimi i buxhetit t shndetit mendor sht nn autoritetin e Ministris s Shndetsisi,

dhe buxheti i barnave mbulohet nga Insitituti i Sigurimeve t Kujdesit Shndetsor.

Financimi dhe administrimi i shrbimeve psikiatrike vijon t jet shum i ngjashm me

2 vjet m par, me vendimarrje gjithmon n nivel qendror dhe me munges t prgjegjsive
menaxheriale t rndsishme n nivel lokal. Tabelat m posht tregojn kostot e spitaleve
psikiatrike pr 2005 dhe 2006:

Shpenzimet pr Programin e SHM 2005

Prmbledhje e shpenzimeve n SHM n Shqipri (lek)

Treguesit
1.Numri i
personelit
- me diplom
universitare
- me diplom t
shkolls s mesme
- arsimi i ult
2.Paga mesatare
mujore
- me diplom
universitare
- me diplom t
shkolls s mesme
- arsimi i ult
3.Investime
4. Shpenzime
Operative
(Tot. pr shndetin
mendor)
nga t cilat
Barna dhe pajisje
mjeksore
Ushqim
t tjera
TOTALI:

Financuar nga buxheti

i shtetit

Financuar
nga
burime
dytsore

269

25

52

15

160
57

0
0

10
0

0
0

22.273

29.400

20.064

17.356

146.021.261

221.493

385.636

59.708.057
49.274.758
37.038.446
236.613.144

0
0
0

221.493
0
0
221.493

344.236
0
41.400
385.636

Financuar
Financuar
nga Sigurimet nga
Shndetsore donator

Burimi: Ministria e Shndetsis

27

Shpenzimet pr Programin e SHM 2006

N lek
Treguesit
1.Numri i
personelit
-me diplom
universitare
-me diplom t
shkolls s mesme
-arsimi i ult
2.Paga mesatare
mujore
-me diplom
universitare
-me diplom t
shkolls s mesme
- arsimi i ult
3.Investime
4.Shpenzime
Operative
(Tot. pr shndetin
mendor)
nga t cilat
Barna dhe pajisje
mjeksore
Ushqim
t tjera
TOTALI:

Financuar nga
buxheti I shtetit

Financuar
nga
Sigurimet
Shndetsore

Financuar
nga
donator

537

21

84

13

406
47

0
0

0
0

22800

30000

24033

35000

16140
5292
73586682

0
0
0

18000

0
0
13385807

93781067

203550

151187

50240507
41779214
1761346

0
0
0

203550

151187
0
0

352.490.981

9.729.150

Burimi: Ministria e Shndetsis

28

Financuar
nga burime
dytsore

Buxheti i ISKSH- s pr shndetin mendor 2006

Treguesit

Financuar
nga Sigurimet
Shndetsore

1.Numri i personelit
21
-me diplom universitare
13
- me diplom t shkolls s
mesme
8
-arsimi i ult

2.Paga mesatare mujore

30000
- me diplom universitare
35000
- me diplom t shkolls s
mesme
18000
arsimi i ult

3.Investime

4. Shpenzime Operative
203550
(Tot. pr shndetin mendor)

nga t cilat

Barna dhe pajisje mjeksore

203550
Ushqim

t tjera

TOTALI:
9.729.150
Institucionet e Shndetit Mendor n 4 zonat prioritare jan financuar nga buxheti i shtetit / nn
administrimin e Ministris s Shndetsis Viti 2006
Pavioni
Pavioni
Spitali
Spitali
Treguesit
Psikiatrik
Psikiatrik
Psikiatrik
Psikiatrik
Tiran
Shkodr
Elbasan
Vlor
1.Numri i personelit
91
81
171
125
-me diplom universitare
17
8
10
25
-me diplom t shkolls s
mesme
54
46
161
100
-arsimi i ult
20
27

2.Paga mesatare mujore

28000
22500
25895
25895
-me diplom universitare
33959
29400
26898
26898
-me diplom t shkolls s
mesme
20320
20064
18954
18330
arsimi i ult
19685
17356

3.Investime
52999000

11562000
2912000
4. SHpenzime Operacionale
39255706
10592905
33436543
1313271
(Tot. pr shndetin mendor)

nga t cilat

Barna dhe pajisje mjeksore

35048478
3361521
5339621
438111
Ushqim
4207228
6342734
28096922
740160
t tjera

888650

135000
TOTALI:
130.780.466 38.149.105 111.950.583.4 53.166.821
Burimi: Ministria e Shndetsis

29

1% e buxhetit total t shndetit prdoret pr qllime t shndetit mendor (t dhna nga

MSH), shifr e cila sht shum m posht standardeve ndrkombtare. prcaktimi i buxhetit
realizohet n kritere historike duke mos pasqyruar ndryshimet n nevojat pr personel dhe kosto
t tjera dhe duke mbetur, rrjedhimisht, nj pik shum kritike dhe penges potenciale pr aktivitete
n t ardhmen.
Nj penges e rndsishme pr zhvillimet n t ardhmen mbetet mungesa e nj buxheti
t prcaktuar pr shndetin mendor. Si sht planifikuar, menaxhimi i buxhetit duhet t
decentralizohet n mnyr q t rritet eficenca dhe t ndrmerren veprimet e duhura. Nj moment
i rndsishm pr buxhetin e shndetit mendor 2006 sht se shuma t konsiderueshme jan
caktuar pr investime n spitalet psikiatrike. Pa kto investime, buxheti i SHM do t kish vijuar t
mbetej n mnyr t konsiderueshme i ult.
Trainimi pr prmirsimin e aftsive menaxheriale t drejtuesve n sektorin e Shndetsis,
duke prfshir edhe shndetin mendor, duket se sht prioritar pr periudhn q vijon.
Nj shtje e rndsishme sht mungesa e mekanizmave monitorues pr zhvendosjen
e fondeve/buxhetit nga shrbimet psikiatrike me shtretr n shrbimet komunitare t shndetit
mendor. Megjithse jan br disa prpjekje n kt drejtim (QKSHM n Vlor, shtpit e
mbrojtura n Elbasan dhe Shkodr jan n kuadr t buxhetit t insititucioneve psikiatrike), kto
veprime duhet t strukturohen m mir ose t integrohen brenda planeve institucionale. Prpjekjet
e MSh-s pr prmirsimin e kushteve n spitalet psikiatrike jan m se t mirpritura (investime
t konsiderueshme pr rikonstruksione n Elbasan dhe Tiran), por keto investime duhet t jen t
qndrueshme n koh dhe t zbatohen n vazhdimsi n drejtim t sistemit komunitar t shndetit
mendor (aktualisht MSH po planifikon ndrtimin e 2 shtpive t mbrojtura n Shkodr).
Roli i ISKSH n fushn e shndetit mendor sht n rritje, duke marr n konsiderat
prgjegjsin e ISKSH pr buxhetin e sektorit t kujdesit t shndetit parsor dhe furnizimin me
barna. Sipas ISKSH mesatarisht 25% e vizitave pran mjekve t familjes lidhen me rregullimet
neuropsikiatrike; si rrjedhim rregullimet mendore jan n krye t programeve t tyre. Neuroleptikt
mbulohen n mnyr t konsiderueshme edhe pr barnat e gjenerats s re, por ende mungon
mbulimi i gjenerats s re t antidepresivve. Shtrirja e mbulimit me barna t tjera psikotrope
sht mse e mirpritur. Rimbursimi vijon t sigurohet nprmjet mekanizmave t komplikuar, ka
ndikon fuqishm n mundsin e prdorimit t barnave. Duke patur parasysh buxhetin e ISKSH
caktuar SHM, nj tregues interesant sht kostoja ditore e spitalit pr barna - 84 lek (2005),
150 lek (2006) pavion Psikiatrik Shkodr

Duhet prmendur megjithat se prqindja e lart e pagesave n form ryshfeti n
t gjith sektort e shndetsis krijon pabarazi serioze n akses dhe kufizon efektivitetin e rolit
drejtues t MSH. Ky faktor ndikon ndjeshm analizimin e sakt t shtjeve q lidhen me buxhetn
si edhe l pasoja n motivimin e personelit dhe zbatimin e ndrhyrjeve komunitare (personeli
mjeksor zakonisht paguhet nn dor pr vizitat n shtpi dhe konsultat, duke shmangur dhnien
e ndihms komunitare n kuadr t sistemit t kujdesit shndetsor publik).

30

BURIMET NJERZORE

Njihet gjersisht fakti se njohurit, qndrimet dhe praktikat e punonjsve t shndetit mendor jan
prmirsuar ndjeshm n dekadn e fundit veanrisht prsa i prket zbatimit t qasjeve komunitare
t shrbimeve.

N kt drejtim jan realizuar nj sr aktivitetesh trainimi dhe ngritje kapacitetesh me
prfshirjen e shum ekspertve vendas dhe t huaj. Rndsia e rritjes s vazhdueshme profesionale
sht konfirmuar gjithashtu si nj prparsi e rndsishme n dokumentin politik kombtar, dhe
nj numr i madh profesionistsh t shndetit mendor kan marr pjes n trainime t rregullta.
Prfitimet e ktyre proceseve jan konfirmuar edhe prmes rezultateve t mira t shrbimeve t
reja t orientuara n komunitet. Nj nga treguesit m t rndsishm sht nxitja e qasjeve multiprofesionale, prfshirja dhe punsimi gjitmon n rritje i profesioneve t tjera n ekipet e shndetit
mendor si jan psikologt dhe punonjsit social.

T gjitha palt megjithat, bien dakord se ka ende shum pr tu arritur n zhvillimin e
punonjsve t shrbimeve t reja komunitare t shndetit mendor. Prmirsimet n cilsi dhe
efektivitet jan thelbsore n reform. Ashtu si edhe rekomandon OBSH, vmendja e trainimeve
dhe zhvillimeve duhet t jet n arritjen e ndryshimit t qndrimeve, orientimit, aftsive dhe praktikave
t personelit t shndetit mendor pr t siguruar se jo vetm do ti jap fund stigms, por edhe do t
punojn n partneritet me prdoruesit dhe kujdestart e tyre pr t nxitur shrimin dhe mirqnien
sociale dhe emocionale

Nj pikpamje e shprehur gjersisht sht se punonjsit e shndetit mendor duhet t luftojn
kundr stigms ndaj smundjeve mendore. Aktivitetet parandaluese dhe promovuese duhet t
zhvillohen edhe m tepr si nj metod pune rutin e profesionistve dhe institucioneve t shndetit
mendor. Sipas opinioneve t pacientve dhe famijarve t tyre, qndrimet e personelit t spitalit
vijojn t prbjn nj burim t vazhdueshm shqetsimi.

Nj fakt tjetr i rndsishm sht se n saj t lvizjeve demografike nga zonat rurale n
ato urbane, ka nj prqndrim t madh t profesionistve t shndetit mendor n qytetet e mdha
kryesisht n Tiran. Vetm nj numr i kufizuar psikiatrish punojn jasht qyteteve t mdha,
ndrkoh q popullsia n zonat rurale dhe ato malore varen nga mjekt e familjes pr nevojat e
tyre mendore.

Prfshirja e Kujdesit t Shndetit Parsor sht identifikuar si nj parakusht shum i rndsishm
pr suksesin e reforms. Si u theksua m lart jan realizuar aktivitete t ndryshme trainuese
dhe kjo dha rezultate n zonat prioritare. Si sht raportuar s fundmi, shum pak koh e
profesionistve t shndetit mendor i kushtohet bashkpunimit dhe trainimit t mjekve t familjes.
N kt kuadr, planet pr prfshirjen, n t ardhmen, t mjekve t familjes n kujdesin pr
shndetin mendor duhet t konsistojn n trainimin pr qasjet komunitare n shndet mendor dhe
prmirsimin e lidhjeve me shrbimet e shndetit mendor.

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Dobsit kryesore t punonjsve t shndetsis n Shqipri, si referon raporti i Banks Botrore,
jan: motivimi i ult, mungesa e monitorimit dhe vlersimit t performancs n pun, mangsit n
aftsit e menaxhimit spitalor, informaliteti i parave q hyjn n sistemin shndetsor, etj. Kto
shtje jan raportuar gjithashtu n anketimet dhe raportet e sektorit t shndetit mendor (disa
aspekte t Raportit Vjetor t QKSHM n Tiran). P.sh. arsyet pr motivimin e ult variojn nga
pagat shum t ulta, sindroma e burn out, etj. Kto shtje jan konfirmuar dhe komentuar n
dokumentat e MSH (strategjia afat-gjat pr zhvillimin e Sistemit Shndetsor n Shqipri 2004,
drafti i Strategjis 2007), por edhe n disa dokumenta t tjer, si jan HIT Shqipria 2002 dhe
Raporti i Banks Botrore 2006, n t cilat sht parashikuar se kaprcimi i ktyre dobsive ka
nevoj pr prpjekje serioze.
OFRIMI I SHRBIMEVE

Reformat e vazhdueshme n fushn e shndetit mendor kan nj ndikim shum t madh n aspekte
t ndryshme t ofrimit t shrbimeve, me prmirsime t kushteve t 4 institucioneve psikiatrike me
shtretr, si edhe ngritjen e vargu shrbimesh komunitare t shndetit mendor. Esht pranuar si praktik
e prbashkt nj qasje pune e bazuar n prgjegjsin e zonave t mbulimit

Efekte t konsiderueshme vihen re n drejtim t zvoglimit t numrit t shtretrve spitalor;
aktivitete specifike pr kt qllim jan zbatuar n zonat prioritare me qllim uljen e numrit t
pacientve t spitalit. Politika t reja pr pranimet jan prqafuar nga t gjith institucionet me
shtretr s bashku me funksionimin e pavioneve t reja t pranimit. Ka disa tregues si u prmend
(nga 930 n 730 shtretr n total; shtimi i buxhetit t shtetit pr investime) t clt tregojn pr
zvoglimin e institucioneve psikiatrike dhe prmirsimin e kushteve t jetess pr pacientt e
spitalit.

Ka prpjekje t dukshme pr praktikat e reja t shmangies s shtrimeve afat-gjata; tregues t
2 viteve t fundit konfirmojn kto tendenca. Ngritja e pavioneve t pranimit dhe politikat e shtrimeve
n t 4 zonat prioritare kan ln gjurm n kt proces, dhe duhet t theksohet gjithashtu se kjo
sht nj nga arritjet m t rndsishme n kto 2 vitet e fundit. E megjithat ka ende rralle disa
praktika pr shtrime t paprshtatshme, ka munges t planeve t daljes, t vazhdimsis s kujdesit
pas daljes nga spitali ka on n nj numr t madh rishtrimesh. Duhet prmendur se kto arritje nuk
jan shoqruar nga zhvendosje t konsiderueshme t burimeve njerzore dhe financiare nga
institucionet psikiatrike te lartprmendura n drejtim t shrbimeve komunitare t shndetit mendor.

shtjet e t drejtave t njeriut brenda spitalit mbeten ende nj fush q krkon shum
prmirsime. Pacientt dhe prfaqsuesit e familjeve shpesh raportojn probleme q lidhen
me aksesin ndaj shrbimeve, qndrimet e publikut dhe stigmn ekzistuese, si edhe mungesn e
prfshirjes s partnerve t tjer t komunitetit.

N kt aspekt prmirsimi i planeve t zhvillimit institucional si edhe prezantimi i planeve
individuale dhe sistemit t menaxhimit t rastit jan ngritur si shtje t nj prioriteti t lart n sektorin

32

spitalor. Duke marr n konsiderat shtjet menaxheriale ka nj nevoj pr prmirsime t ktyre

aftsive tek profesionistt e shndetit mendor.

Ngritja e shrbimeve t reja komunitare t shndetit mendor (QKSHM, shtpi t mbshtetura
dhe aktivitete q gjenerojn t ardhura) sht nj faktor vendimtar n reformat n kt fush.
Jo vetm treguesit por edhe stili i t punuarit, angazhimi, objektivat e personelit dhe mundsit
e tyre pr rritje profesionale, prfshirja dhe sodisfaksioni i prdoruesve dhe familjarve t
tyre, t drejtat e njeriut dhe aspektet sociale t trajtimit dhe rehabilitimit jan karakteristikat e
shumpritura t shrbimeve t reja. Qndrimet e personelit n strukturat komunitare t shndetit
mendor jan identifikuar si nj forc kryesore dhe e vazhdueshme pr proceset e ksaj reforme.
Planifikimi institucional dhe prezantimi i planeve individuale dhe modalitetet e menaxhimit t rastit
jan konfirmuar si praktik e prditshme e shrbimeve komunitare t shndetit mendor.

Duhet theksuar se ekzistojn mundsi t hapura dhe t dukshme pr zhvillime t mtejshme
t qndrueshme n koh t shrbimeve t shndetit mendor, si sht thn n Planin e Veprimit.
(p.sh mundsi t dukshme pr ringritjen e QKSHM n Elbasan, ekip i SHM n Crrik dhe QKSHM
n Kor).

Prve shum zhvillimeve pozitive, sht raportuar gjithashtu se ka ende disa aspekte pr
tu prmirsuar n shrbimet e shndetit mendor. Theksohet se disponueshmria e shrbimeve duhet
t prmirsohet prmes ngritjes s m shum shrbimeve komunitare n mnyr q t prputhen
krkesat n rritje. Efektiviteti dhe kompetenca e shrbimeve ekzistuese komunitare t shndetit
mendor jan provuar prmes rezultateve pozitive t dukshme t aktiviteteve t tyre, dhe far
sht m e rndsishme ato njihen nga njerzit q vuajn nga rregullime mendore dhe familjet e
tyre si shrbime t orientuara tek klienti.

Aksesi n kujdesin e shndetit mendor sht prmirsuar pjesrisht prmes prfshirjes n rritje
t sektorit t shndetit parsor, ku mjekt e familjes kan treguar interes n rritje pr shtjet e
shndetit mendor . Megjithat sht prsri rasti t theksohet se personat q vuajn nga smundje
mendore e kan t vshtir t ken akses n shrbimet e shndetit mendor veanrisht kur bhet
fjal pr trajtimin n kriz.

Bashkpunimi ndr-sektorial nuk sht i zhvilluar n mnyr sistematike ose t koordinuar
ndonse ka disa ka disa prvoja pozitive n disa zona prioritare. Prfshirja e shrbimeve sociale
/ Ministris s Puns dhe shtjeve Sociale duhet t rritet. Ka ende nevoja t paplotsuara pr
prfshirjen e partnerve t komunitetit n proceset e rishoqrizimit/riintegrimit n komunitet, duke
marr n konsiderat aspektet sociale t smundjeve mendore.

Bashkpunimi midis shrbimeve t shndetit mendor mungon ende dhe kjo e bn aspektin
e vazhdimsis s kujdesit nj sfid t madhe, prgjegjse pr nj sr rishtrimesh dhe relapsesh.
Prvojat dhe praktikat pozitive t bashkpunimit midis pavioneve/spitalit psikiatrik dhe qendrave
komunitare n Vlor dhe Tiran duhet t njihen dhe konfirmohen si model pr strukturimin dhe
funksionimin e ardhshm t sistemit t SHM.

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Megjith prmirsimet e rndsishme n fushn e mbledhjes s t dhnave, duhet t ritheksohet

nevoja pr nj sistem t prhershm monitorimi dhe vlersimi t shrbimeve t SHM.
Prmbledhtas mund t themi se sht e qart se Shqipria ka ndrmarr reforma t dukshme dhe t
rndsishme n sektorin e ofrimit t shrbimeve, duke e orientuar reformn n fushn e SHM drejt
shrbimeve komunitare t shndetit mendor.
6. KONKLUZIONE DHE REKOMANDIME
Duke marr n konsiderat 2 pyetjet kryesore t cilat jan n qendr t ketj
vlersimi:
1.
2.

A i sht prmbajtur Shqipria zhvillimit n prputhje me prioritetet e Planit t Veprimit

dhe Dokumentit Politik t Shndetit Mendor?
A ka prparuar Shqipria n keto 2 vitet e fundit n drejtim t zbatimit t Planit t
Veprimit (2005) duke patur parasysh objektivat kryesore t ktij plani?

n prgjithsi mund t thuhet se reforma e shndetit mendor ka prparuar, me synim zvoglimin

gradual t spitaleve psikiatrike dhe zvndsimin e tyre me nj model t kujdesit komunitar.
Shqipria ka zbatuar n mnyr t suksesshme shum aktivitete me qllim q t ngrej nj
sistem gjithprfshirs t shndetit mendor, i cili u hap rrugn proeseve t ritintegrimit dhe
rishoqrizimit n komunitet t personave me smundje mendore, duke br q sistemi i shndetit
mendor t mos jet m nj sistem i bazuar vetm n institucionet e vjetra psikiatrike.
ROLI DREJTUES
N prfundim, n rolin drejtues t Ministris s Shndetsis, mbshtetur gjersisht nga OBSH
dhe nga agjensi dhe iniciativa t tjera ndrkombtare (si Projekti i Shndetit Mendor i Paktit t
Stabilitetit), ngritja e departamentit t Shndetit Mendor pran MSH sht nj tregues mse i
qart i angazhimit konkret t autoriteteve ne kt fushe edhe pse kjo u b me nj vones prej mbi
nj viti dhe me m pak personel nga ishte planifikuar n fillim.
Dokumentat kombtar pr shndetin mendor (Dokumenti Politik dhe Plani i Veprimit)
u hartuan si nj kusht paraprak pr zbatimin e sukseshm t reforms. Pjesa m e madhe e
prparsive t prmendura n kto dokumenta tregojn progres prmes inputesh t gjithanshm
dhe tregues rezultatesh. Nga ana tjetr, ende vzhgohen hendeqe midis rezultateve t pritshme
dhe atyre t arritura. Dshtimi n realizimin e disa objektivave pioritare nuk rezulton aq nga
mungesa e parimeve t duhur por m shum nga standartet e larta t vendosura n nj koh
relativisht t shkurtr, si edhe nga aktivitete ambicioze t propozuara n dokumentat kombtar.
Megjith informacionin dhe t dhnat e shumta t disponueshme, duhet t theksohet se disa prej
parimeve dhe treguesve t prshkruar n Planin e Veprmit kan paraqitur vshtirsi pr tu ndjekur
pr shkak t mungess s nj sistemi t prshtatshm monitorimi dhe vlersimi.

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N mnyr q t vazhdohet reforma rekomandohet q t zhvillohet nj Plani i Ri Veprimi
pr Shndetin Mendor pr 5 vjett e ardhshme, ashtu si sht planifikuar n Dokumentin Politik
dhe Panin e Veprimit. Ashtu sikundr sht konfirmuar edhe nga t gjitha palt e prfshira, n
vmendje t ktij plani duhet t jet fuqizimi i rezultateve t arritura dhe prshpejtimi i kalimit t
burimeve nga spitali n shrbimet komunitare. Gjithashtu duhet t hartohet nj format i prshtatshm
monitorimi dhe vlersimi.

Pr sa i prket Legjislacionit t Shndetit Mendor, mund t thuhet se Ligji i Ri pr Shndetin
Mendor nuk u zhvillua ashtu si ishte parashikuar dhe sht m e rndsishme t theksohet se as
ligji n fuqi nuk zbatohet. Takimet n 4 zonat prioritare zbuluan n nj nivel t konsiderueshm
paknaqsie t pacientve dhe familjeve t tyre veanrisht prsa i prket prfshirjes n
planifikimin e aktiviteteve dhe mbrojtes s t drejtave t njeriut. T drejtat e njeriut t personave q
vuajn nga smundje mendore dhe familjarve t tyre vazhdojn t mbeten shqetsim i ndjeshm
veanrisht n shrbimet me shtretr.

Si rrjedhim, rekomandohet q nj nga prioritetet e tjera t s ardhmes s afrt t jet ngritja
dhe zbatimi i mekanizmave t prshtatshm pr promovimin dhe mbrojtjen e t drejtave t njeriut
t personave q vuajn nga smundje mendore, aktualisht mekanizma q drejtohen nga Ligji
pr Shndetin Mendor i vitit 1996. Nga ana tjetr Ligji i Ri i Shndetit Mendor duhet t filloj t
zhvillohet n prputhje me standartet ndrkombtare dhe dokumentat mbshtets.
(OBSH ka nj sr botimesh udhzuese t ksaj fushe)

Prsa i prket prfshirjes s vendimmarrsve t tjer n proceset e planifikimit dhe
zbatimit mund t nxjerrim prfundimin se prfshirja e tyre nuk sht e knaqshme. Megjithse
jan identifikuar disa partner t bashkpunimit ndrsektorial n disa zona prioritare, ata nuk
kan bashkvpruar n mnyr t organizuar dhe t koordinuar. sht e nevojshme t nxirren
disa parime dhe prqasje sistematike n mnyr q t mbshtetet bashkpunimi ndrsektorial
n mnyr t till q koordinimi i kujdesit t ofruar ti shrbej sa m mir trajtimit, shrimit dhe
riaftsimit t personave q vuajn nga probleme t shndetit mendor. N kt kuptim Ministria e
Shndetsis duhet t shfrytzoj rolin e saj drejtues si pr t siguruar prfshirjen e partnerve t
till (ISKSH dhe MPS si m t rndsishmit), ashtu edhe pr t nxitur bashkpunimin me autoritetet
/ prfaqsuesit e komuniteteve vendore.

Prsa i prket aktiviteteve t promovimit dhe parandalimit mund t thuhet se aktivitete t
tilla mungojn si n nivel kombtar ashtu edhe n nivel lokal. Mund ti rekomandohet MSH dhe
sektorit t OJF ve se duhet t organizohen m shum aktivitete promovuese dhe parandaluese
n mnyr q t rritet njohja publike dhe rrjedhimisht lufta kundr stigms si nj nga kushtet
m t domosdoshme t reforms. Ashtu sikundr theksohet n Draftin e Strategjis Kombtare
t Shndetit, sistemi i kujdesit n Shqipri duhet t zhvendos fokusin e vet nga ekskluzivisht
n kujdesin shrues n at t prfshirjes m t madhe t promovimit t shndetit dhe kujdesit
parandalues.

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BUXHETI

Prsa u prket shtjeve q lidhen me buxhetin mund t nxirret prfundimi se buxheti i
shndetit mendor sht i ult si n shum totale ashtu edhe n prqindje. Sektori i buxhetit sht
trsisht i centralizuar duke deleguar prgjegjsi t vogla n nivel vendor. N kt drejtim, ka
nj munges t aftsive t prshtatshme t drejtim-administrimit, t cilat nga ana e tyre ndikojn
negativisht n zbatimin e aktiviteteve t planifikuara. Gjithashtu, mund t theksohet se ndikimet
e politiks sidomos n ndryshimin e drejtuesve t institucioneve t shndetit mendor prodhojn
vazhdimisht vonesa n zbatim. Gjithsesi mund t thuhet se fondet qe MSH ka caktuar pr investime
n fushn e SHM, jan t konsiderueshme dhe ndikojn n prmirsimin e kushteve t jetess n
strukturat spitalore. Tendenca e investimeve mund dhe duhet t shtrihet edhe drejt shrbimeve
komunitare t shndetit mendor. Ka nj nevoj urgjente pr nj buxhet t prcaktuar qart pr
shndetin mendor, me mekanizma t sakt t kalimit t buxhetit, ka do t siguroj qndrueshmrin
e sistemit t ri t sapongritur. Trainimi pr prmirsimin e aftsive t drejtim administrimit duhet t
jet i strukturuar dhe t kthehet n piknisje pr decentralizimin e prgjegjsive.
BURIMET NJEREZORE

N kt aspekt prfundimi i nxjerr, pohuar edhe nga shum persona t tjer t prfshir,
do t ishte se punonjsit e shndetit mendor kan luajtur nj rol vendimtar n suksesin e ktyre
proceseve. Angazhimi dhe devotshmria pr prmirsim t situats n kt fush sht mse i
dukshm n t gjith nivelet, duke e vendosur shndetin mendor n listn e prparsive m t
mdha t nevojave kombtare t shndetit. Nj varg aktivitetesh edukuese jan organizuar dhe
nj ndr rezultatet m pozitive sht prfshirja e sektorit t KSHP. Si u tregua dhe m lart, jan
planifikuar aktivitete n vazhdimsi pr zbatimin e programeve edukuese pr SHM (Fakulteti i
Mjeksis Klinika Universitare e Psikiatris, Fakulteti i Shkencave Sociale Dega e Psikologjis,
Puns Sociale). Po n kt kuadr prvojat pozitive t shrbimeve komunitare, ekzistenca e nj
numri kritik profesionistsh me qndrime reformuese, vendosja e reformave n nj vij integruese
me iniciativa t tjera europiane, t gjitha kto prbjn mundsi t shumta pr zhvillime n kt
fush. Por ende ka pengesa t cilat mbeten pr tu kaprcyer. shtja e rezistencs s nj pjese t
stafit t spitalit, mungesa e qasjeve multi-disiplinare n strukturat spitalore, mungesa e programeve
t vazhdueshme edukuese, si edhe mungesa e instrumentave pr kujdesin individual vazhdojn
t mbeten shqetsim. Midis personelit t SHKSHM jan raportuar ulje t motivimit pr shkak t
pagesave t shumta informale, pagave shtetrore t ulta, etj t cilat mund t krijojn pengesa
pr zhvillimet e ardhshme.

Me qllim q kaprcehen kto vshtirsi rekomandohet q t inkurajohet prfshirja e m shum shoqatave
t afirmuara profesionistsh (psikiatrish, shoqata infermiersh, psikologsh, punonjsish social). Ngritja
e programeve edukuese t vazhdueshme pr punonjsit e institucioneve t shndetit mendor duhet t
vihet n zbatim dhe duhet monitoruar nga institucionet kombtare prkatse (psh. Klinika Universitare
Psikiatrke n bashkpunim me QKSHM-t e Tirans, t koordinuar nga departamenti i SHM n MSH).

36


Trainimi i personelit t KSHP duhet t ngrihet si nj praktik e prhershme dhe t zbatohet
edhe n zonat e tjera t Shqipris. Si nj element i rndsishm mbetet gjithashtu edhe edukimi
i vet personave q vuajn nga probleme t shndetit mendor si edhe familjarve t tyre si nj
praktik e prditshme e shrbimeve t SHM.
OFRIMI I SHRBIMEVE

Srish edhe ktu mund t nxjerrim si prfundim se ngritja e shrbimeve komunitare t
shndetit mendor mban peshn m t madhe t reforms s kujdesit t shndetit mendor. N
4 zonat prioritare kujdesi pr shndetin mendor sht zhvendosur nga spitalet psikiatrike drejt
SHKSHM. Aktivitetet e planifikuara pr ngritjen e m shum shrbimeve t SHMK (QKSHM Kor,
shtpit e mbshtetura n Shkodr dhe n Crrik) do ti japin shtytje m t fot reforms s nisur
dhe do t rrisin efikasitetin e proceseve n 4 zonat prioritare. Pasojat e prvojave t kaluara
(mbyllja e QKSHM n Elbasan) na msojn se sht e nevojshme t prqndrojm prpjekjet tona
n integrimin e plot t QKSHM n sistemin e shndetit publik, n mnyr q t sigurohet q n
fillim qndrueshmria e reforms. Megjithat situata n sektorin spitalor ndryshon shum ngadal.
Ngritja e pavioneve t pranimit si edhe prmirsimet e kushteve n ambientet e tjera jan tregues
shpresdhns pr prparimin e reforms. Qndrimet n praktikat e prditshme n pavionet
kronike konfirmojn nevojn pr ndrmarrjen e veprimeve urgjente pr prmirsimin e situats
sidomos n fushn e t drejtave t njeriut dhe ngritjen e proceseve t rishoqrizimit. Megjithat,
prpjekje thelbsore jan ndrmarr pr vendosjen e standardeve cilsor n spitale dhe po
ashtu jan marr edhe masa pr ngritjen e nj sistemi t akreditimit spitalor. Me mbshtetjen
e OBSH MSH ka prpunuar nj total prej 252 standartesh t cilt mbulojn fushat kryesore t
aktiviteteve spitalore. Mund t thuhet gjithashtu se reforma n shndet mendor sht n t njjtn
linj reformimi t t gjith sistemit shndetsor ku interesi i KSHP pr tu prfshir sht konfirmuar
tashm (ngritja e shtpis s mbshtetur n Crrik n bashkpunim me KSHP), ndjekur nga prvojat
e bashkpunimit t KSHP n Vlor dhe Elbasan.

Rekomandimi kryesor pr kt pjes t sistemit t shndetit mendor, sht forcimi i shrbimeve
komunitare t SHM duke prmirsuar bashkpunimin me shrbime t tjera mbshtetse. Jan
prpiluar disa instrumenta si plani individual i cili prdoret n QKSHM n Tiran ose Forma e
Vlersimit Infermieror n spitalin e Elbasanit t cilat mund t propozohen n t gjitha shrbimet e
SHM. Gjithashtu, t gjith shrbimet e SHM duhet t takohen rregullisht e t shkmbejn prvojat e
tyre. Shrbimet e reja t SHM duhet t planifikohen dhe ngrihen gradualisht dhe te gjitha detajet
duhen vendosur n Planin e Veprimit. Duhet t ndrmerren edhe veprime t tjera pr stablizimin e
standardeve t mirprcaktuar pr t gjtha SHKSHM.

N sektorin spitalor theksi duhet vendosur si n parandalimin e shtrimeve, ashtu edhe n
daljen sa m t shpejt nga spitali. Kjo mund t arrihet duke hartuar politika pranimi dhe ekipe
t menaxhimit t krizs, ka duhet t sjell uljen e shtrimeve ashtu si ka ndodhur edhe ne disa
zona t Tirans. Vazhdimsia e kujdesit do t lehtsoj daljen e hershme nga spitali si edhe uljen
e relapseve dhe rishtrimeve. Kjo mund bhet nga strukturat jo me shtretr, shrbimet mbshtetse

37

duke prfshir ekipet komunitare dhe duke prmirsuar partneritetin me sektort e tjer. Esht
e nevojshme prfshirja e profileve t tjera profesionale (psikologt dhe punonjsit social) pr
ti dhn mbshtetje m t madhe reforms. Trainimi i organizuar dhe i prhershm i t gjith
personelit pr SHMK dhe t drejtat e njeriut sht nj shtje urgjente.

Prvojat pozitive me shrbimet ekzistuese komunitare dhe mbshtetja e dhn nga sektori
i OJQ-ve (n Tiran: QSHZHSHM, Alternativa, Fountain House, n Elbasan: Fokus) duhet t
vazhdojn pse jo edhe t inkorporohen ose t jen t lidhura ngusht me sistemin publik t shndetit
mendor.

N prfundim, mbshtetja e vendimmarrsve sht kye pr sigurimin e suksesit t reforme
s shrbimeve t shndetit mendor.
Nj thirrje pr t gjitha palt e prfshira sht se ky model i sukseshm bashkpunimi midis
partnerve kombtare dhe ndrkombtar sht nj model pozitiv reforme q duhet t mbshtetet
dhe promovohet m tej.

AKRONIMET
QSHZHSHM
SHMK
QKSHM
SHKSHM
ISKSH

AGJA

SHM
MSH
MPS
KDK
SP

KSHP
PV

SDSHMT1
BB

38

-
-
-
-
-
-
-
-

Qendra Shqiptare pr Zhvillimin e Shndetit Mendor

Shndeti Mendor Komunitar
Qendr Komunitare e Shndetit Mendor
Shrbimet Komunitare t Shndetit Mendor
Instituti i Sigurimeve Shndetsore
Aktivitete q gjenerojn t ardhura
Shndeti Mendor
Ministria e Shndetsis
Ministria e Puns, shtjeve Sociale dhe Shanseve t Barabarta
Komiteti Drejtues Kombtar pr Shndetin Mendor
Spitali Psikiatrik
Kujdesi Shndetsor Parsor
Plani i Veprimit
Sistemi Demonstrativ i Shndetit Mendor Tiran1
Banka Botrore

EVALUATION OF THE
OPERATIONAL PLAN FOR
DEVELOPMENT OF MENTAL
HEALTH SERVICES IN
ALBANIA

(2005-2007)

November 2007

The original document, entitled Evaluation of the implementation of the operational plan for
development of mental health services in Albania (20052007) is being published together with the
Albanian version. The process of the evaluation was supervised by the WHO Regional office for
Europe. The document was written by Dr. Stojan Bajraktarov, a WHO consultant. The WHO Country
Office Albania did assist the process of the evaluation as well as the drafting of the document.
The Cabinet of the Minister of Health did make possible a series of meetings and site visits, without
which the development of this report would not have been possible.

For more copies of this publication please contact:

WHO Country Office, Albania
Address: Rr. Themistokli Germenji Pallati 10, Tirana, Albania
Phone/Fax: +355 4 266162/3
E-mail: office@who-albania.org

(c) World Health Organization 2007

All rights reserved. The Regional Office for Europe of the World Health Organization welcomes
requests for permission to reproduce or translate its publications, in part or in full.
The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of the World Health Organization concerning the
legal status of any country, territory, city or area or of its authorities, or concerning the delimitation
of its frontiers or boundaries. Where the designation country or area appears in the headings of
tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate
border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers products does not imply that they
are endorsed or recommended by the World Health Organization in preference to others of a
similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary
products are distinguished by initial capital letters.
The World Health Organization does not warrant that the information contained in this publication
is complete and correct and shall not be liable for any damages incurred as a result of its use.
The views expressed by authors or editors do not necessarily represent the decisions or the stated
policy of the World Health Organization.

Content:
1. INTRODUCTION (scope and purpose)
2. OVERVIEW
- Country profile
- National health system
- Current organizational structure of the mental health system
- Stewardship and management in the Mental Health sector
3. METHODOLOGY OF THE EVALUATION
- Consultation with main national stakeholders in mental health field
- National documents on mental health :
- Reports and reviews made by international institutions and experts:
- National stakeholder survey and consultation in 4 priority areas:
- Data provided by Mental Health Program - WHO Country Office Tirana
4. CURRENT SITUATION AND ANALYSIS OF THE PRIORITIES AND INDICATORS SET
FORTH IN THE OPERATIONAL PLAN FOR MENTAL HEALTH:
1.
A.
B.
C.
D.

Emergency / immediate activities (6 months)

Establishment of a technical mental health sector within the Ministry of Health (MoH)
Discharge of long-term patients into community care (deinstitutionalization)
Capacity building and refresher training of mental health professionals
Revision of the Mental Health Act

2.
A.
B.
C.
D.

Short-term activities (2 years)

Development of community mental health services for both inpatients and outpatients
Training of primary care workers
Monitoring system of overall services and individual care
Elaboration of an activity plan to promote mental health

5. EFFECT OF THE UNDERTAKEN ACTIVITIES (2005-2007) ON THE ALBANIAN MENTAL

HEALTH SYSTEM
1.
2.
3.
4.

Stewardship
Finance
Human resources
Service delivery

6. CONCLUSIONS AND RECOMMENDATIONS

Foreword

The Ministry of Health in cooperation and with the support of WHO EURO and WHO Albania
Country Office started a wide emergency program and humanitarian assistance in the mental
health sector, introducing the community mental health approach as an alternative to the old
system based on the big hospital institutions.
I have the pleasure to notice, as confirmed by the present document, that Albania has continued
the progress towards reforming the mental health system, by gradually reducing the psychiatric
hospital beds and in the same time by aiming their replacement with the community care model.
The establishment of the Mental Health Department at the MoH is a clear indicator of the concrete
commitment of the national authorities in this sector.
Albania has implemented in a very successful way many activities that have aimed at the
establishment of an integrated mental health system, which can promote the re-integration and
re-socialization in the community of people with mental health problems.
The mental health system is not anymore a system exclusively based in the old psychiatric care
institutions. In the contrary, the establishment of the community mental health system started and is
being successfully implemented. This is confirmed by the present evaluation document. Furthermore,
this document does present the immediate need for operational structuring and intensification of
the mental health reform.
The reform process has widely confirmed, during the last 2 years, the need and the advantages
of the community model, with its main characteristics as de-institutionalization, re- integration and
re-socialization in the community.
The leading role of the Ministry of Health is a key to these processes, having benefited by the
great support of WHO as well as of agencies and other international initiatives as the SEE Stability
Pact Mental health Initiative. We are determined to continue this way of reforms and to further
implement the Operational Plan for the Development of Mental Health Services in Albania.
Even though the Ministry of Health has played a key role in the above activities; the lack of the
involvement of the other important institutions is more than evident. The role of Ministry of Labor
and Social Affairs and the role of HII must be increased and must influence the decision making
process. According the HII sources almost 25% of the consultations delivered by the General
Practitioners (GP) is for neuron-psychiatric disorders.
At last, the recommendations of this document show the will of the Ministry of Health to support and
to continue the reform of the mental health system and services, for which support I sincerely thank
the donors generosity, the Swedish and Irish Governments, as well as the continuous expertise of
the World Health Organization.
Nard Ndoka
Minister of Health

1. INTRODUCTION
Scope and purpose of the evaluation:
Albania has made significant efforts in last few years in order to overcome the old custodial
mental health system, and to establish community based mental health approach, according to the
advanced European and worldwide best known experiences, following the WHO standards and
recommendations. The outcomes of the implemented reforms have been represented in different
forms to the domestic and international audience on many occasions, and recognized by the leading
mental health authorities. However, the national documents (Mental Health Policy and Operational
Plan), aimed to improve the situation in the mental health sector, envisage and recommend that the
structured evaluation, using the specific indicators, standards and recommendations, be conducted
after the two-year implementation period (2005-2007).
In order to make quantitative and qualitative appraisal of the achieved results, and to
make assessment of the current situation, this evaluation is mainly addressed to the following target
audience:
- People with mental disorders, their families and representative organizations
involved in the mentioned activities and interested in the improvement of the quality
of mental health care
- Competent national institutions, policy-makers, planners and accredited
international organizations who attempt to further support, organize and
implement the reforms in mental health field
- Mental health professionals, responsible for the implementation of the planned
activities
Two dominant questions created the central interest of the evaluation:
1.
2.

Has Albania sustained the progress in accordance with the priorities of the National
Mental Health Policy?
Having in mind the main objectives in the Operational plan (2005), has Albania
made satisfactory progress toward its implementation in last 2 years?

The outcomes of this evaluation should be also used as a supportive tool for future
planning processes. In order to adequately respond to the needs of this mayor challenge,
representatives of the main stakeholders took part in the processes of structuring and creation
of this report. However, it is worth mentioning that willingness, sentiment and commitment
which many people involved have put in the foundation of the community mental health
system in Albania, is something which gave a great value to the new mental health structure.

2. OVERVIEW
Country profile
Albania is situated in south-eastern Europe on the Balkan Peninsula with 3.1 million inhabitants,
and covers an area of 28 750 km2 , primarily mountainous, apart from its flat coastline.
About 97% of the Albanian population is ethnic Albanian and 1.9% Greek, while other
groups are represented in small numbers. Islam is the religion of 70% of the population, while
20% are Orthodox Christian and 10% Roman Catholic (6). These figures reflect the religion of
origin, since religion has not been an important identifying element in Albanian society. (HIT)
Albania is divided in 12 counties, and each county us subdivided in several communes. There
are 315 communes and 42 municipalities in the country. Although in theory they all have taxraising powers, in practice local governments receive almost all their annual revenue from the
central government. (HIT)
Although the economy is growing rapidly, Albania is considered as underdeveloped European
country. After the communist period, Albania has made an impressive recovery, starting to build
a modern and diversified economy. However, the presence of an informal economy causes serious
difficulties in the calculation of the Gross Domestic Product (GDP) and Gross National Product
(GNP). Agriculture, forestry and tourism are the main sources of employment and income in
Albania, but in recent years, the construction, transport and service sectors have also been growing.
Money sent home by emigrants are considered an important part of the economy (HIT).
Main figures
Population, total (millions)
Population growth (annual %)
Life expectancy at birth, female (years)
Life expectancy at birth, male (years)
GDP (current US$) (billions)
GDP growth (annual %)
GNI per capita, Atlas method (current US$)
Inflation, consumer prices (annual %)
Foreign direct investment, net inflows (% of GDP)
Unemployment, total (% of total labor force)
Time required to start a business (days)
Internet users (per 1,000 people)

2005*
3.1
0.6
78.5
72.6
8.38
5.5
2570
2.4
3.1
15.2
41
60

Source: World Development Indicators (2006)

Albania played a relevant role in transitional post-communist period in the southeastern
Europe and is continuing to work towards joining NATO and the European Union.

National Health System

Over the past decade and a half, Albania has undergone major political, economic, and
social changes that have affected almost all aspects of the populations life, including health
outcomes and health care services. Despite progress achieved in the health sector reforms in
this period, Albanias health outcomes compare favorably with those of lower middle income
countries outside the regions of Europe and Central Asia, but lag behind those of other countries
in the Southeast European region. Moreover, the transition years have resulted in marked lifestyle
changes and population exposure to new health risks. (World Bank Report 2006)

The reforms included some reduction in the overextended provider network capacity, the
decentralization of primary care management to district public health directorates and integration
of the former with public health functions, the privatization of the pharmaceutical sector and most
of the dental care, and the establishment of the Health Insurance Institute (HII), in view of a gradual
aspired change of the health financing system.
Current organizational structure of the health system
The Government is the major provider of health care services in the country through a network
of 51 general and districts hospitals, 564 health centers and 1582 MCH clinics called Health Posts.
The number of beds available (10,197) for a population of 3 million is high for a country like
Albania, with fairly low utilization of hospital beds (54%).
Budgeting

The 6 percent of GDP which Albania spends on health care is in line with the average for
lower middle income countries, but Albanias public sector contributes a below average share to
these expenditures. It is estimated that out-of-pocket expenditures at the point of service account
for almost 60 percent of sectoral funding. Although health insurance is mandatory, household
survey data suggest that only between 40-45 percent of the population actually have a health
insurance license and thus benefit from coverage.

The health finance system is divided among the Ministry of Health - paying for hospital
care, non-physician salaries, and at times other operating costs for primary care, and Health
Insurance Institute - responsible for payment of salaries for primary care physicians, prescription
drugs, and high-end diagnostics.
The main challenge for Albanias health sector is to consolidate the achievements in health
outcomes to date, while establishing capacity to effectively address the growing incidence of
non-communicable diseases and affording low-income groups better protection from impoverishing
health expenditures (World Bank Report 2006)

Stewardship and management in the MNH sector

After the turmoil in the Balkan region in the 90s, mental health of the population has been
raised as high priority issue. The mental health system in Albania in post communist period was
mainly organized in asylum institutions, with certain number of psychiatrist units in the policlinics
around the country.
The situation of the psychiatric care system in the country was in desperate condition as the
populations access to services was extremely limited: 1 psychiatrist/78,000 inhabitants, services
mainly concentrated in 4 hospitals in the main cities, limited or non existent services in the rural areas,
etc. The mental health services in that period havent met general basic acceptable standards. The
services were not satisfactory from clinical, psychological, human, outcome, efficiency or economic
points of view, with consequent lack of outpatient services in the community, lack of prevention and
rehabilitation activities, absence of family involvement and of social support, scarce alternatives
to mental hospital treatment and lack of support or possibilities to live and cope in the community
for people with mental illnesses. That kind of asylum psychiatric institutions proved to be inefficient
and with low quality of care, with evident lack of re-socialization and reintegration aspects of the
treatment and rehabilitation of people with mental illnesses.


Starting from the psycho-social intervention in the initial period (90), WHO has recognized
and promoted the emergency character of the need for reforms in the mental health sector in
Balkan countries, with evidence-based community mental health as merely recommended approach
(late 90 - 2000) .
WHO EURO / Country Office Albania has supported the Ministry of Health and jointly
started the extensive emergency and humanitarian assistance programme on mental health
reforms (1999). This programme did receive generous support by the international donors,
initially the European Commission (1999-2000), the Swedish Government (2000-2007) and the
Irish Government (2004-2008). The programme aimed, from the beginning, the introduction of
the community mental health approach versus old custodial psychiatric system, with the following
objectives:
- Establishment of national documents in the mental health area, featuring mental health
policies and legislation focused on human rights of people with mental illnesses;
- Reorganization of the finance system of the mental health sector
- Setting up community mental health services, including day-centers and protected
homes;
- Provision of continuous education for the professionals, but also for the representatives
of all main stakeholders, including patients and their families in the area of community
mental health

- Setting up different alternative solutions for reintegration of the people with the
mental illnesses in the community, including income generating activities and
social empowerment activities
- Setting up decentralized cooperation of the newly established community mental
health services with WHO collaborating centers and other mental health services
of excellence in European countries;
- Setting up public educational programs, aimed to improve public attitudes toward
people with mental illnesses
Considering the urgent need for reforms in the mental health field, MoH (supported by
WHO) has established National Steering Committee for Mental Health (NSC) as multi-sectoral
governmental body, with mandate to:
- approve and co-ordinate all activities in the mental health field;
- propose changes to the government that will enable mental health reform;
- facilitate and support the efforts made in the field etc.
In the following years, as result of the joint effort of all interested parties and under leadership
of Ministry of Health, the noteworthy results were achieved, and the reform processes were
shifted from emergency to development phase.
The National Policy for Mental Health Services Development in Albania was approved
by the Minister of Health in March 2003 and Operational Plan for Mental Health Services
Development in Albania approved by the Minister of Health in May 2005.
At the field level, different types of community mental health services were established,
including six mental health centers (Tirana, Elbasan, Gramsh, Peshkopi, Vlora and Shkodra),
protected homes (Shkodra, Elbasan, Tirana), Income Generation Activities (Elbasan, Tirana) with technical and financial support by WHO, and other international agencies such as UNOPS,
Communita di Sant Egidio, Cordaid, Geneva Initiative, Hamlet Trust. The results achieved have
been widely recognized by the national, as well as international authorities. Some experience
gained by these services has stress the importance of the sustainability and prospective planning,
featuring need for directly establishment of the new community mental health services in the
frames of the public health system as governed by the Ministry of Health, as well as need for
fundamental reforms in the budgeting system.

10

3. METHODOLOGY OF THE EVALUATION

The core function of the evaluation is to present review of the achieved results according to the
standards and indicators specified in the national documents, and to support planning processes
in order to identify needs and define priorities for the upcoming period. All parties involved in
development of evaluation components agreed that it was essential to prioritize consolidation of
the reforms that were achieved in prior period and that further reforms should largely confirm
community based system. Taking in consideration the expected effect of the evaluation report, and
need of evidence based approach, the inputs were obtained from the following sources, during
the period of June July 2007:

Consultation with main national stakeholders in mental health field

The mental health system is clearly under the governance by the Ministry of Health (MoH),
and more specifically under responsibilities of Hospital Sector in the MoH. In the frame of this
sector, the Mental Health Unit was established with one person deployed only for the mental health
issues. This report was undertaken by the full support of this department, and with support from
other department in the MoH, such as: Finance sector, Primary Health Care sector, and also the
managerial team of the Ministry. The data related to the activities, outcomes, planning processes,
training and education, finances etc, were provided by the responsible persons in the Ministry. The
mental health aspects in the national documents related to health sector (National Health Policy,
and the Draft Health Policy- 2007) were also considered.
Also data and information were provided by other national stakeholders such as: Health
Insurance Fund, Ministry of Social Welfare etc.
National documents on mental health
- Mental Health Act
- National Mental Health Policy
- Operational Plan
Reports and reviews made by international and national institutions and experts
-
-
-
-

HIT Albania (2002),

Health for All databases,
World Health Reports and reports of WHO EURO
Assessment of the WHO Mental Health intervention in Elbasan / Albania: 2006; J. M.
Caldas de Almeida, M.D., Ph.D.
- Assessment of Albanian Mental Health Law; Martin Brown, 2006

11

-
-
-
-
-
-
-
-
-
-

Draft Health System Strategy (2007-2013); Antonio Duran

Albania Health Sector Note February 2006; World Bank
World Bank Reports for Albania
Financial reports for Albanian mental health system 2005/2006; MoH
Community mental health center Tirana Annual report 2006
Individual plan Community mental health center Tirana
Nursing assessment report
Data reports from 4 priority areas
Institutional plans (PH Elbasan)
The impact of mental illnesses on the users perception of self and society attitude:
- an assessment of Users Attitude About Mental Health Issues, and Awareness
About Their Rights / implemented in Tirana, Elbasan, Vlora, and Shkodra (Albanian
Development Center for Mental Health)
- Tirana admission survey 2001 2006 (Albanian Development Center for Mental
Health)
- Regulation of the mental health services, May 2007 MoH

National stakeholder survey and consultation in 4 priority areas

During the evaluation period, the survey was conducted in order to assess the present situation
and results achieved in terms of: services characteristics, activities, achievements and development
needs, managerial and budgeting issues, monitoring and evaluation processes, state of human
rights, users and their families involvement and satisfaction, involvement of other important sectors,
etc.
Survey was conducted by means of:
a. Interviews with:
-Leaders/Managers of the mental health system, including responsible persons in the
MoH, HII and MoSW
-Personnel in the mental health institutions
-Patients and family representatives
-Community representatives and institutions (from local municipalities, local
governmental branches, individuals involved in the mental health issues)
-NGO sector
b. Site visits to the mental health institutions
- Visits to the mental health services in 4 priority area

12

c. Information and data gathered for:

-
-
-
-

Organized, implemented and planned activities

Outcomes of the undertaken activities
Training and education of the professional staff
Information related to the state of human rights, including activities of patients and
their relatives associations
- Institutional programs, plans and records
- Clinical records
Data provided by Mental Health Program - WHO Country Office Tirana
- Projects documentation
- WHO AIMS reports (2002 and 2004)
- Professional / scientific researches, assessments, activity reports, data for collaboration
with MoH
- Report from different stakeholders and interested parties in mental health field
submitted to WHO MNH Albania
4. CURRENT SITUATION AND ANALYSIS OF THE PRIORITIES AND INDICATORS SET FORTH
IN THE OPERATIONAL PLAN FOR MENTAL HEALTH
1. EMERGENCY / IMMEDIATE ACTIVITIES (6 MONTHS)
A. Establishment of a Technical Mental Health Sector within the Ministry of Health
(MoH)
Although with over a years delay, the mental health sector has been established within the
Hospital Sector of the Ministry of Health. One person is employed specifically for the mental
health issues, and this step was welcomed by all involved parties. The sector is organized in
accordance with the standards set forth in the Operational Plan, and supported by WHO.
B. Discharge of long-term patient into community care
C. ( de-institutionalisation)
There are indicators showing that the deinstitutionalization processes have taken place in all
4 priority areas, where inpatient psychiatric facilities are functioning. There number of beds is
significantly reduced in all 4 areas: Shkodra from 110 to 75, Elbasan from 400 to 310, Vlora from
280 to 240 beds, Tirana from 120 to 115 i.e. from 910 to 730 beds in total.

13

Admission data:
Elbasan ( Year 2006)
Nr. of admissions
Nr. of first time admissions
Nr. of readmissions within 1 year
Nr. of readmissions within 30 days
Nr of discharges

511
17
127
--512

Vlora:(Year 2006)
Nr. of admissions
Admission of acute patients
Admission of chronic patients
Vlora:(Jan- Jun 2007 )
Nr. of admissions
Admission of acute patients
Admission of chronic patients
Shkodra (Year 2005)
Nr. of admissions
Nr. of discharges

456
126
330

216
53
163
553
545

No of chronic patients (Year 2007):

Tirana
17
Elbasan
250 (app including 10 at the supported accommodation Drita )
Vlora
170 (app)
Shkodra
37, including 10 placed in protected home CASA MIMOSA.

Discharged chronic patients (period 2005-2007):
Shkodra
16
No data from other areas.
The mean length of stay was progressively shortened in the last few years:
Elbasan
Shkodra

187.7 (Year 2005); 153.3 (Year 2006); 134 (2007/1).

48.4 (Year 2005); 42.1 (Year 2006).

Occupancy rates:
Elbasan: 71% (Year 2005); 69% (Year 2006); 67.8% (2007/1 ):
Shkodra: 82.4% (Year 2005), 90% (Year 2006)

14

Bed circulation:
Elbasan: 1.46 (Year 2005); 1.64 (Year 2006)
Shkodra: 6.1 (Year 2005); 8,3 (Year 2006)

HP Elbasan, Year 2006

HP Vlora, Year 2006

Psychotic organic condition

Alcoholic psychosis
Other psychosis
Schizophrenia
Affective disorders
Delirium conditions
Neurotic disorders
Personality disorders
Mental retardation
Ps. Reactive
Paranoid ps.
Delusional disorders
Epilepsy

Hospitalizations per diagnosis

All these data are clearly confirming the reformative processes with regards to deinstitutionalization, hospital downsizing, higher quality of admission and hospital treatment
policies Number of admissions has increased; however, there is a permanent downward trend
in the length of hospitalization period. The number of beds has significantly decreased in 2 years,
with reduction in the number of long- term patients in the PH. Bed circulation is increasing, which
indicated shortening of hospitalization. These trends, followed by the investment in the hospital
sector aimed towards improvement of living conditions should indicate that there are some
processes of improvement in the sphere of inpatient services. In terms of treatments per diagnosis, in
mental hospitals schizophrenic and mood disorders were the majority, with predominant biological
approach.

C. Capacity building and refresher training of mental health professionals

The number of human resources in the psychiatric services sphere is almost the same, with
one qualitative difference: a new tendency for employment of other professions like social workers
and psychologists, (expected to be the case in all services in the near future), has been confirmed
and further widened.

15

Personnel structure in the inpatient psychiatric institutions, July 2007:

Region

Psychiatrists

Tirana
Elbasan
Vlora
Shkodra

17
6
6
3

Occupational
Nurses Psychologist Therapist
46
1
3
49
1
4
35
2
3
25
1
3

Auxiliary Social
personnel worker
40
132
1
90
2
29
3

With regards to training and education in psychiatry, the inclusion of community mental healh issues has
increased at all educational levels. As responsible for development of educational curricula for several
university institutions, the University Psychiatric Clinic has successfully incorporated the community mental
health issues in above mentioned. The number of the trained professionals is permanently increasing ( ex.
the number of psychiatrists has increased from 33 in 1999 to 46 in 2003). It seems that majority of the
personnel in the mental health services has completed some training or education in the mental health
issues, as indicated in the OP. Since a range of activities in all 4 priority areas have been organized in this
respect, it is not possible to strictly calculate the percentage of the trained personnel. Nonetheless, there
are reports showing the qualitative and quantitative outcomes of training activities:
Elbasan example
(part of WHO report)
All psychiatrists were involved in community mental health training through various training and educational activities.
50 nurses and 27 caretakers from the psychiatric hospital received on-the-job trainings, focusing on:

Implementation of the assessment tool for the inpatients. Overall, each participant received 10 hours of training
Implementation of the general admission guidelines. Each participant received 5 hours of training

5 nurses in the supported accommodation facility have received 60 days of training / 2 hours daily during January March
2006 about:
The work of the mental health nurse in the community and more specifically her role in the protected apartment (e.g working
with
individual patients, paying attention not only to the biological aspects but also to the psychological and social aspects

of mentally ill persons etc
12 nurses from the admission unit of the psychiatric hospital received 10 hours of training in:

Implementation of the assessment instrument, admission protocol, admission unit rules and the methods of operation.

6 persons, representing the income generating working group: (2 WHO project staff, 2 caretakers and 2 vocational
therapists from the hospital) received 80 hours of training in:

Identification of patients ability to work, ways to support and refresh their vocational skills within and outside the
hospital, how to support rehabilitation of potential patients for job positioning within the social enterprise, the
development and management of an income generating activity.

Consultants from Mental Health Services (Ireland) were responsible for the training of the hospital staff and the staff from
supported accommodation facility, while a consultant from Trieste Mental Health Services (Italy) was responsible for activities
related to the income generating activity.

16

D. Revision of the Mental Health Act

The Mental Health Act was not revised in accordance with the guidelines from the OP. As
stressed in few relevant reports, it seems that in this moment is more important to support the
implementation of the existing Mental Health Act (1996), than to reinitiate the process from the
start. In this regard, additional regulations and sub-laws should be developed. In line with these
recommendations, the Ministry of Health has undertaken several activities.
Namely, pursuant to the Law Nr. 8092 Mental Health Act, a working group, worked on the
elaboration of two legal forms that would serve for regulation of the legal status of the patients
admitted involuntarily in the psychiatric hospitals. The forms were approved and endorsed in
June 2006. There were difficulties in the implementation process, due to lack of infrastructure
at the district courts. However, continuous monitoring increased the pressure on the relevant
institutions.

Following an explicit request set forth in the same Law Nr. 8092, the Regulation of the Mental
Health Services was prepared by a Workgroup accountable to the Minister of Health. The paper
was finalised on February 2007 and was approved by the Minister of Health in May 2007.
However, the need for improvement in the field of human rights still remains one of the
highest priorities, especially in the inpatient psychiatric services.

2. SHORT-TERM ACTIVITIES (2 YEARS)

A. Development of community mental health services for both inpatients and
outpatients
The composing structures of the community mental health system and relationship among
them
The planned activities were focused in 4 priority areas, with the following current structure of the
mental health services:
Tirana area
- University Psychiatric Clinic/ University Hospital Center Mother Teresa
- 3 Community Mental Health Centers
- Supported accommodation Communita Sant Egidio for 5 persons
- Day Center organized by NGO Alternativa and "Fountain House"

17

Elbasan area
- Psychiatric Hospital (including day center for inpatients)
- Supported accommodation for 10 persons in Elbasan
- Supported accommodation for 12 persons in Cerrik
- Income generating activity Green House
- Community Mental Health Center in Korca
- Community Mental Health team in the Elbasan Policlinic
Vlora area
- Psychiatric Hospital
- Community Mental Health Center
Shkodra area
- Psychiatric Ward of the General Hospital of Shkodra
- Supported accommodation Mimosa for 10 persons
- Psychiatric ambulatory service in the Shkodra Policlinic
A.1. Inpatient Services
The organization of the inpatient psychiatric services

The situation is almost the same as it was 2 years ago, with inpatient psychiatric facilities in 4
regions (psychiatric hospitals in Elbasan and Vlora, and psychiatric wards in Tirana and Shkodra).
Due to the processes of hospital downsizing, the number of beds in these institutions has been reduced
(Shkodra from 110 to 75, Elbasan from 400 to 310, Vlora from 280 to 240 beds, Tirana from 120
to 115 total from 910 to 730). In the period 2005-07 the MoH has made significant investments for
the improvement of the condition in the psychiatric hospital sector. Namely, the University Psychiatric
Clinic has been completely renovated (MoH has reported investment of 87 000 000 Lek), and in
Psychiatric Hospital in Elbasan the renovation is still in progress (MoH has reported investment of
54 000 000 Lek). The Psychiatric Ward in Shkodra has been almost completely renovated by the
Holland NGO Door, but it should be mentioned that the MoH is under consideration of ambitious
plans for a radical reorganisation of the psychiatric services in both Shkodra and Vlora.
Tirana
The only tertiary psychiatry institution University Psychiatric Clinic is functioning in the frame of
the University Hospital Center Mother Teresa, covering the catchments area of app. 800 000
inhabitants from central Albania. The ward has 115 beds composed by 17 residential beds, 15
beds for acute care for children and adolescents and 83 beds for acute care. This department
has also training responsibilities towards all medical students, psychiatry residents, and students of
Faculties of nursing, psychology and social work.
Elbasan
Elbasan is the city that has the largest psychiatric hospital in the country, and the reforms there are

18

permanently supported by the WHO Project Unit in last few years. The actual number of beds in
the PH is 310, covering the catchments area of app. 900 000 inhabitants from middle and south
east Albania.
Vlora
The large psychiatric hospital in Vlora is covering the catchments area of southern Albania of
app.700 000 inhabitants. Additional support to this priority area has been provided by UNOPS
and presently by the SEE Stability Pact Mental Health Project. The actual number of beds is 240.
Shkodra
The Psychiatric Ward in Shkodra is functioning in the frame of the general hospital, covering the
catchments area of 720 000 inhabitants from the north and northeast Albania. The actual number
of beds is 75.
Admission wards

The admission wards were set up and are successfully functioning in all 4 priority areas. They
all have structured functioning criteria, incorporated in the organizational structure of the inpatient
psychiatric institutions. They are functioning as a filter, preventing the inappropriate admissions
and long-term hospitalizations. For ex., according to the outcomes of the admission ward in Vlora,
65% of the admitted patients are dismissed after the treatment in the admission ward, and just
35% are transferred after the treatment in admission ward to other hospital wards. These wards
are also used as training facilities: ex. for students from Nursing School in Vlora, Faculties for
Psychology and Social Work in Tirana. It should be stated that there is a common view that
the establishment of these wards has also improved the public attitudes toward mental illnesses,
establishing practices for more appropriate and more human kind of treatment. Most importantly,
the people treated there have expressed improved feeling of their dignity and self-respect in
regards of their illnesses in opposite of the available hospital treatment, which is encouraging them
to easily approach services when needed.
Institutional and individual plans in the hospital settings

These plans exist in almost all inpatient psychiatric services, but most of them are just reflection
of the old system, without any vision toward community mental health. It is evident that the personnel
in the hospital settings, including the management are not familiar with those documents. On the
other hand, there are initiatives for individual approach and case management for inpatients.
Nursing assessment form is in use in Elbasan and Shkodra, and case management approach is
also in development phase in Tirana and Vlora, having in mind their close collaboration with the
community mental health centers.
A.2 The new community mental health services
New CMH services have been introduced in all 4 priority areas, confirming the new community mental health approach. The

19

principle of catchments areas is taking place in all 4 priority areas, with very few examples for admission of patients from
other regions.

Different community mental health services are established and functioning in all 4 priority areas, but their
development is on a different level. Most of the newly established community mental health services are incorporated
within the public mental health system (existing psychiatric institutions or Polyclinics), and few are organized by the NGO
sector.
While community treatment and support services have been strengthened, community treatment options are
still seen as insufficiently available. Groups of interest are insisting in their demands for further development of the
community mental health services.
Advanced efforts are made toward establishment, or further strengthening of the following community mental
health services:
Community mental health centers
Tirana
2 new community mental health centers have been opened in the last 2 years, and the previously established center
is operating with improved outcomes. The CMHC Tirana 1 has established a visible community approach, and its
outcomes are reported in its annual report. The implemented activities are among the best practices, and can serve as
a model for the rest of the country (institutional, individual plans, reporting and documentation.

The managers of the CMHCs do not have any authority over the budget. The community mental health services
are incorporated within the organizational structure of the Tirana Health Authority and more in details within the 3
Tirana Polyclinics, but they have joint coordination of activities with the University Psychiatric Clinic.
The population that each policlinic covers is:
- Policlinic No 1 - 281.940 inhabitants or 35.7% of the population of Tirana
- Policlinic No 2 - 232.359 inhabitants or 29.5% of the population of Tirana
- Policlinic No 3 - 274.520 inhabitants or 34.8% of the population of Tirana
It should be stressed that even the organization of the community mental health center in Tirana does not conform to the
initial plan in the Policy document - Tirana Demonstration Mental Health System Nr.1 (TDMHS1), the collaboration
of the 2 institutions (CMHC and University Psychiatric Clinic) is assessed as very satisfactory, and it is a good example
for the continuity of care approach.
In Tirana there is also a the Day-care Center established by the NGO Alternativa is operating, with the support of the
Dutch NGO Cordaid, and another one "Fountain House" financed by private donors

20

Data from CMHC 1, Tirana

Structure of the personnel :
Psychiatrists
3

Nurses
6

Psychologists
2

Social workers
2

Activity data from Tirana Community Mental Health Center 1 (Year 2006):
-
-
-
-
-
-
-

total number of visits at the CMHC Tirana

8206
number of new cases

320
number of home visits
248
number of visits at the Psychiatric Hospital, PHC, etc
41
number of other contacts (e.g. Social Insurances Institute)
58
number of referrals and admissions to the PHC
87
(48 of these admissions are referred because of the aggravation of the clinical
situation, 5 of which were emergency admissions and 30 admissions for
evaluation of work ability).
- The number of referrals to the Psychiatric Clinic (Year 2007, Jan-Jul
12
- No. of persons hospitalized long-term in the Psychiatric Clinic, from the region of
the CMHC Tirana 1

2

Psychologist outcomes:
The total number of contacts of psychologists
Psychotherapy sessions
Assessments
Counseling
Individual psycho-education

217
147
17
29
13

Social worker outcomes:

The total number of contact of social workers
The number of patients who have had social intervention
Social assistance cases
Visits to Psychiatric Hospital
Visits to Mother Teresas Sisters House

679
84
239
18
12

21

Elbasan
The CMHC existed until 2004 in the organizational structure of the Polyclinic Elbasan, and was closed
due to lack of personnel, which raised the issue of sustainability aspects of reform activities. The
new initiative is under way, with the request from the Psychiatric Hospital Elbasan for employment
of a psychologist and social worker for the needs of the CMHC the nurses can be identified
among the existing employees of the PH, and the psychiatrist and the nurse in the Polyclinic are
more than interested to get involved There is enough space at the Polyclinic (4 rooms) for the
organization of the planned activities. In that way, the close collaboration between PH and the
CMHC will be secured in sustainable way. It is worth mentioning that this effort has a wide support
from the associations of users and their families, who are stressing the very good experience with
the CMHC while it was functioning (2000-2004).
In this region it is planned that a Community Mental Health Center shall be established in Korca, with
WHO support.
Some outcomes of the activities of the outpatient psychiatric department in the Polyclinic
Elbasan: (Year 2005)
total number of visits
total number of patients

total number of new patients

4650
800
80

Since September 2005 this unit has restarted the outreach work: 72 mentally ill individuals
were visited and supported in their communities (22 were visited in their homes, while others
in the health centres of the communes).

Vlora
The existing CMHC was established in the scope of the Stability Pact Mental Health Project, with
support of WHO CO Albania. The CMHC is integrated into the organizational structure of the
Psychiatric Hospital, and its activities are closely coordinated with the Hospital Admission Ward.
A visible community approach is adopted, and the good collaboration with the PHC sector is
obviously influencing the good outcomes, which also results from the extensive PHC personnel
training program .
Shkodra
There are initial discussions for establishment of a CMHC.

22

Institutional and individual plans in the CMHC settings

The plans for these new structures are still underdeveloped. However, the individual approaches
and case management system are incorporated in the working method, and the individual plan
for the CMHC Tirana can be used as a positive model for the rest of the country.
Supported living / establishment of the protected homes
In this field there is a significant development in terms of growth of service and human resources, and
re-shift of resources from hospital to community.
Tirana
The protected home Communita Sant Egidio is still functioning as explained in the policy
documents, and during the time of the evaluation visit the entire group patients and personnel
- was on a summer holiday.
Elbasan
The protected home for 10 persons is established with support of WHO, within the organizational
structures of the hospital, which is covering all costs, providing personnel, food etc. At this moment,
this service is organized as a permanent protected home, and so far none of the patients has
rejoined the community. The personnel consist of 8 professionals - employees of the Psychiatric
Hospital (5 nurses, 1 psychologist and part time social worker, a visiting psychiatrist). More
emphasis shall be given to rehabilitation activities, i.e. involvement in preparation of food, of
daily functioning skills, etc.
According to plans, a new supported home for 12 persons will be opened in this region in the
near future in the city of Cerrik, with WHO support.
Vlora
There is no protected home here, the new hospital management team is investigating the possibilities
for the location, and the funds needed for establishment of the protected home.

23

Shkodra
The protected home for 10 persons Mimoza was established with support of UNOPS, and is
functioning in the organizational structure of the Psychiatric Ward, which covers the costs, personnel,
food. Personnel consists of 7 professionals (1 social worker, 5 members of assisting personnel and
visiting psychiatrist), which are employees of the Psychiatric Ward. 4 inhabitants in total have
been re-socialized, 2 of them in the last 2 years. The MoH has allocated funds and initiated
preparatory activities for establishment of 2 new protected homes for 20 inhabitants (10
each). Accordingly, it is planned to second the chronic patient from the Psychiatric Ward in these
protected homes, and to have only department for acute patients in the organizational structure
of General Hospital.
Income generating activities
The income generating activities are functioning in 2 priority areas, and the patients involved are
not permanently employed. Thus the activities are more focussed as additional support for the
re-socialization programs, but also as work-training activities for preparation of future possible
permanent employments.
Tirana
There is a sole activity which is generating some income for few patients, organized by NGO
Alternativa. Lacking a social firm structure, the production of candles and repair of bicycles are
taking place, with 3-5 patients involved
Vlora
There are no organized income generating activities for people with mental illnesses
Elbasan
With the support of WHO an agriculture project is established in the area of the Psychiatric
Hospital, in cooperation with private sector. 5-6 patients are receiving permanent income from this
activity.
Shkodra
There are no income generating activities. The users and family organization set up a repair of
bicycles as IGA few years ago , but it stopped 2 years ago.

B. Training of primary care workers

Significant efforts for training of the PHC personnel have been undertaken, and therefore the
improvement of the collaboration with the latter is quite visible. The training modules were undertaken
more specifically in the regions of Elbasan and Vlora.

24

Elbasan
20 GPs and 20 nurses from the PHS Elbasan, and for 10 PHC personnel from Cerrik , have been
included in the mental health training module .
Vlora
Extensive program for all GPs in the area was implemented, in the scope of the Stability Pact
Mental Health Project. According to the personnel in the mental health institutions, these trainings
have led to a much improved collaboration with PHC sector, especially in the aspects of referrals
and continuity of care. However, only a small proportion of psychiatrists time is allocated to
providing a consultant role to general practitioners.

C. Monitoring system of overall services and individual care

This is the area where outcomes have not met the expectations. The data collection system
is not developed in proper way, and it is quite demanding to obtain satisfactory data, both for
qualitative and quantitative indicators, for inputs and outputs. Therefore, it is not possible to track
all the indicators specified in the Operational Plan as described there. Monitoring system is not in
function, and should be one of the priorities in the forthcoming period.

D. Elaboration of an activity plan to promote mental health

There is no any national plan for promotional activities in mental health. However, it should be
noted that different NGOs and other public mental health services do implement activities on
special occasions, like the World Mental Health Day.

5.

EFFECT OF THE UNDERTAKEN ACTIVITIES ON THE ALBANIAN MENTAL HEALTH

SYSTEM

STEWARDSHIP
The National Policy and the Operational Plan for mental health service development in
Albania has been widely recognized as the most important tool for reforms in the mental

25

health field. The Ministry of Health has assumed the leadership role in the planning,
organization and implementation of the reforms activities, with crucial support from WHO
EURO/Country Office Albania. The establishment of the Mental Health Department in the
MoH is an important step forward and significant indicator for the commitment of the
national institutions to the further reforms in this field.

The National Mental Health Policy(2003) has promoted the new community based mental health
approach, followed by shift from old institutional/asylum approach. With the Policy document the
achieved results of the reform processes were summarized, and the future priorities and planning
activities were introduced in the Operational Plan (2005).
Substantial change has occurred in the structure of the mental health system, given the
improvement of the range and quality of community mental health services. All parties involved
in these processes have widely shared an opinion that the National Mental Health Policy and
Operational Plans are the crucial instrument for structuring, organizing and accelerating the reforms
in the mental health field. The reforms process in the last two years has widely confirmed the
necessity and good outcomes of the community based approach, with de-institutionalization, resocialization and community reintegration as main characteristics.
Although the Ministry of health played a crucial role in all activities described in this document,
the lack of involvement of other important institutions is more than evident. Having in mind the
importance of the social aspects of the mental health illnesses, the role of the Ministry of Social
Welfare should be more visible and better structured. As discussed with the responsible persons,
there are many opportunities for future joint actions, with needed support for the rehabilitation
processes, and more precisely for support of the continuity of care. HII as also very important
stakeholder is undergoing fundamental reforms and its role in this sector at this point is mostly visible
via their involvement in PHC sector and drug policies. According to the HII sources almost 25% of
the visits to the general practitioners are due to the neuropsychiatric disorders. The list of medicines
which is under responsibility of HII is covering few types of new neuroleptics (including Clozapine,
Risperidone and Olanzepine), but is lacking to provide the newer generation of antidepressants.

Some progress has been made towards advocacy for patients rights and improved public
attitudes and consumer and patient involvement, but concern in terms of establishment of
structured human rights mechanisms still remains, having in mind that the new Mental Health Act
has not been developed yet, or what is even more important - there is a lack of implementation
mechanism for the existing Mental Health Act (1996). (see Martin Brown reports 2005, 2006)

It can be concluded that much work remains to be implemented, in order to have appropriate
mental health legislation in place, in conformity with the recent Albanian developments and the
international standards.

26

FINANCE
Governance of the mental health budget is clearly under authority of Ministry of Health,
with budget for drugs covered by the Health Insurance Institute.
Economics and management of psychiatric services has been very similar to what it was 2
years ago, with the decisive role on central level, and lack of significant managerial responsibilities
on local level. The following tables are showing the costs in psychiatric services in 2005 and
2006:
Expenditures for the MNH Programme 2005
Summary of MNH expenditures in Albania (in Albanian Lek)

Indicators

Financed by the state

budget

Financed
by
secondary
sources

Financed
by Health
Insurance

Financed
by
donors

269
52

0
0

25
15

0
0

160
57

0
0

10
0

0
0

22.273
29.400

20.064
17.356

146.021.261

221.493

385.636

59.708.057
49.274.758
37.038.446
236.613.144

0
0
0

221.493
0
0
221.493

344.236
0
41.400
385.636

1.Number of
personnel
- university diploma
- high school
diploma
-lower education
2.Average monthly
salary
- university diploma
- high school
diploma
- lower education
3.Investment
4.Operational
expenditures
(Tot. for mental
health)
of which
Drugs and medical
supplies
Food
Other
TOTAL:
Source: Ministry of Health

27

Expenditures for the MNH Programme 2006

In Alb. Lek
Indicators

Financed by the
state budget

1.Number of
personnel
- university
diploma
- high school
diploma
-lower education
2.Average
monthly salary
- university
diploma
- high school
diploma
- lower education
3.Investment
4.Operational
expenditures
(Tot. for mental
health)
of which
Drugs and medical
supplies
Food
Other
TOTAL

Financed
by Health
Insurance

Financed by
donors

537

21

84

13

406
47

0
0

0
0

22800

30000

24033

35000

16140
5292
73586682

0
0
0

18000

0
0
13385807

93781067

203550

151187

50240507
41779214
1761346

0
0
0

203550

151187
0
0

352.490.981

9.729.150

13.536.994

Source: Ministry of Health

28

Financed by
secondary
sources

HII budget for mental health 2006

Financed
Indicators
by Health
Insurance
1.Number of personnel
21
- university diploma
13
- high school diploma
8
-lower education

2.Average monthly
salary
30000
- university diploma
35000
- high school diploma
18000
- lower education

3.Investment

4.Operational
expenditures
203550
(Tot.for mental health)

of which

Drugs and medical

supplies
203550

Food

Other
9.729.150
TOTAL:
Mental health institutions in 4 priority areas are financed by the state budget / under governance
of the Ministry of Health Year 2006:
Psychiatric Psychiatric
Psychiatric
Indicators
Psychiatric
ward
Hospital
hospital
ward Tirana Shkodra
Elbasan
Vlora
1.Number of personnel
91
81
171
125
- university diploma
17
8
10
25
- high school diploma
54
46
161
100
-lower education
20
27

2.Average monthly salary

28000
22500
25895
25895
- university diploma
33959
29400
26898
26898
- high school diploma
20320
20064
18954
18330
- lower education
19685
17356

3.Investment
52999000

11562000
2912000
4.Operational expenditures
(Tot. for mental health)
of which
Drugs and medical supplies
Food
Other
TOTAL
Source: Ministry of Health

39255706

35048478
4207228

130.780.466

10592905
33436543

3361521
5339621
6342734
28096922
888650

38.149.105 111.950.583,4

1313271

438111
740160
135000
53.166.821

29

1% of the total health budget is allocated for mental health purposes (MoH data), which is quite
below international standards. Anyhow, it is evident that the budget is based on historical figures,
without reflecting needs for changes in personnel and other costs, and therefore, remaining a
critical point and potential obstacle for future activities.
An important obstacle for the future development remains the lack of defined mental health
budget. As planned, the management of the budget should be decentralised in order to have
better efficiency and to have more appropriate actions. An important moment for the mental health
budget 2006 is that significant new amounts were allocated for investments in the psychiatric
hospitals, and without those figures, the MNH budget is considerably lower.
Training for improvement of the managerial skills for all leaders in the health sector, including
mental health, seems to be priority in the upcoming period.
An important issue is the lack of monitoring mechanisms for shifting the funds/ budgets
from the inpatient psychiatric services to the community mental health services. Although
some efforts were made in this direction (the CMHC in Vlora, protected homes in Elbasan and
Shkodra are in the frame of the budgets of psychiatric institutions), these directions should be
better structured or confirmed in the institutional plans. MoH efforts for improvement of the
conditions in the psychiatric hospitals and wards are more than welcome (considerable investments
for reconstructions in Tirana and Elbasan), These initiatives need to be sustained and further
implemented towards the implementation of the community mental health system (currently the
MoH is planning construction of 2 houses in Shkodra as protected homes).
The role of the HII in the mental health field is seen as increasing, taking into consideration that
they are responsible for budget for the primary health care sector and drug supply. According to
the HII, approximately 25% of the visits to the general practitioners are due to the neuropsychiatry
disorders, and therefore mental disorders are high on its agenda. There is good coverage of
neuroleptics with few new generation drugs, but with absence of coverage of new generations
of antidepressant drugs. The availability of other drugs is considered satisfactory. Still, there is a
complicated mechanism for reimbursement which is making significant impact to the access to the
medicines. With regards to the HII budget allocated for MNH, an interesting indicator is the cost
per hospital day for drugs- 84 lek (2005), 150 lek (2006) Shkodra Psychiatric Unit.

However, in all health sectors the high share of out-of-pocket payments significantly
influences health finance framework and creates serious inequities in access and limits effectiveness
of the MoH stewardship role. This factor is considerably influencing the adequate analysis of the
budgeting issues, and largely influences the motivation of the personnel, and the implementation
of community interventions (health personnel is commonly paid out-of-pocket for their home visits
and consultations, avoiding to offer community interventions in the frame of the public health care
system).

30

HUMAN RESOURCES
It is widely recognized fact that the knowledge, attitudes and practices of the mental health
workforce have improved considerably in the last decade, especially with the initiation of community
based approach.
Many educational activities were undertaken, with involvement of many international and
national experts. The importance of continuous professional development is also confirmed as high
priority in the national documents, and a number of mental health professionals have attended
regular training with regards to evidence-based care. Indirectly, these processes are confirmed
via good outcomes of the new community-oriented services. One of the important indicators is the
promotion of the multi-professional approaches, the involvement and the increasing employment of
new professions in the mental health teams, such as psychologists and social workers.
However, it is confirmed by all parties that there is still more to be achieved in developing
the mental health workforce for new CMH services. Improvements in quality and effectiveness are
fundamental to mental health care reform. As recommended by WHO, the focus of training and
development must be on changing the attitudes, orientation, skills and historical practices of the mental
health workforce to ensure that it no longer perpetuates stigma, but rather works in partnership
with consumers and caretakers to promote recovery and social and emotional wellbeing.
A commonly expressed view is that the mental health workforce should further advocate the
fight against stigma of mental illness. Promotion and prevention activities should be further promoted
as a manner of work of mental health professionals and institutions. According to the patients and
their family representatives, the attitudes of some hospital personnel are identified as a continuing
concern.
Another important fact is that due to the migration processes from rural to urban areas, there is
a concentration of the MNH professionals in the bigger cities, mostly in Tirana. Only a small number
of psychiatrists work outside the major cities, and the population in rural and remote areas often
depends only upon primary health care practitioners for their mental health needs.
The involvement of Primary Health Care is envisaged as a very important precondition for
successful reforms. As stressed, the noticeable efforts via different educational activities were
undertaken, which resulted with respectable outcomes in the priority areas. As reported presently,
in other regions, small proportion of MNH professionals allocate their time to collaboration with
general practitioners and training. In that sense, future plans and activities for general practitioners
providing mental health care should be directed towards providing education in community mental
health approach and improving linkages with mental health services.
As per World Bank Report, the main weaknesses of the health workforce in Albania are: low
motivation, lack of permanent monitoring and evaluation of job performance, lack of managerial
capacities in hospitals, too much informal money in the system. These issues are reported also

31

in the surveys and reports from the mental health sector (some aspects in the Annual Report from
CMHC Tirana). For instance, reasons for low motivation stem from the unrealistically low salaries,
burn out syndrome, etc. As these issues have also been confirmed and commented in the documents
of the MoH (Long-term strategy for development of the Albanian Health System 2004, and the
new Draft Strategy 2007), but also in some aspects of other documents such as Albanian HIT 2002
and World Bank Report 2006, it is envisaged that serious additional efforts must be undertaken
in order to overcome these weaknesses.
SERVICE DELIVERY
The ongoing reforms in the mental health field have a major impact in the area of service delivery,
with improvement of the conditions in the 4 inpatient psychiatric institutions, and establishment of range
of community mental health services. Responsibility based on catchments areas as working approach
has been widely accepted as common practice.
Considerable effects are demonstrated in the aspect of hospital downsizing; planned activities in
accordance with the OP have been initiated and implemented in the priority areas in order to
reduce the number of hospital patients. New admission policies are adopted in all institutions, with
new admission wards in function. There are certain indicators as mentioned (from 910 to 730 beds
in total, the increase of the state budget in capital investments) showing the downsizing of the large
psychiatric institutions and improvement of the living conditions for the inpatients.
There are visible efforts for implementation of the new practices for avoiding of the new longterm hospitalizations; indicators from last 2 years are confirming these trends. The establishment
of admission wards, and admission policies in all 4 areas has made major impact on this process,
and it should be pointed out that this is one of the most important achievements in last 2 years.
Nevertheless, there are still some rare practices for inappropriate hospitalizations, and there is
lack of exit plans and plans for continuity of care after dismissal, which leads to large number of
readmissions. It should be mentioned that these achievements were not accompanied by considerable
transfer of human and finance resources from the mentioned psychiatric institutions towards the
community mental health services.
Human rights issues inside the hospitals still remain a sphere for much needed improvement.
Patients and family representatives often report problems when it comes to access to services,
public attitudes and existing stigma, lack of involvement of other community partners.
The improvement in the aspect of the institutional development plans and introduction of individual
plans and case management system are set up as high priority in the hospital sector. In regards
of the managerial issues, there is a need for improvement of such skills among mental health
professionals.
Establishment of the new community mental health services (CMH centers, protected homes
and income generating activities) is crucial factor for reforms in this area. Not just the indicators,
but also the working style, commitment, personnel goals and opportunities for personal growths,

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involvement and satisfaction of the users and their families, human rights and social aspects of
the treatment and rehabilitation are the characteristics of the new services which are more than
welcomed. The attitudes of personnel in the community mental health setting have been identified as
a major and continuing enforcement to reform processes. The institutional planning and introduction
of individual plans and case management approaches has been confirmed as everyday practice of
the CMH services.
It should be stressed that there are open and visible opportunities for further sustainable
development of the community mental health services, as indicated in the Operational Plan. (i.e.
visible opportunity for re-establishment of the CMHC Elbasan, mental health team in Elbasan and
CMHC in Korca).
Despite the many positive developments, it was also reported that there is still room for
improvement of some aspects of mental health services. It is stressed that service availability should
be improved through establishment of more community services in order to meet the escalating
demands. Effectiveness and competence of the existing community mental health services is proven
through evident positive outcomes of their activities, and what is most important they are recognized
by the people with mental illnesses and their families as client- oriented services.
Access to mental health care has been improved partly through the growing involvement of
the primary health sector, and general practitioners are increasingly including mental health issues
in their filed of interest. However, it is still the case that people with mental illnesses are unable to
access mental health care, especially when they are in need of crisis treatment.
Inter-sectoral collaboration is not developed in a systematic or coordinated way although
there are some positive experiences in some priority areas. There are remarks addressed to the
involvement of social services / Ministry of Social Welfare, which must be improved. There are
unaddressed needs for involvement of many community partners in the support of re-socialization/
community reintegration processes, having in mind the social aspects of mental illnesses.
The collaboration among mental health services is also seen as lacking, and the aspect of
continuity of care remains a great challenge, responsible for a number of readmissions and relapses.
The positive experiences and practices, such as collaboration between psychiatric hospital/ward
and community centers in Tirana and Vlora should be acknowledged and confirmed as model for
future structuring and functioning of the MNH system.
Despite some significant improvement in the field of data collection, a permanent system for
monitoring and evaluation of the MNH services should is required.
Overall, it is evident that Albania has undertaken quite significant and visible reforms in the sector of
service delivery, directing the reforms in the MNH field towards community mental health services.

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6. CONCLUSIONS AND RECOMMENDATIONS

Considering the two dominant questions which central to this evaluation:
1.
2.

Has Albania sustained the progress following the priorities of the National Mental Health
Policy and Operational Plan?
Considering the main objectives in the Operational plan (2005), has Albania made
satisfactory progress toward its implementation in last 2 years?

a general conclusion can be that the mental health reform has continued to progress forward,
aiming at the gradual reduce of the size of the mental hospitals and their replacement with a
model of community mental health care.
Albania has successfully implemented many activities to establish a comprehensive mental
health system, which enable the processes of re-socialization and reintegration of people with
mental illnesses in the community, by making the mental health system to be no longer based only
on old custodial psychiatric institutions. Instead, a successful process of establishment of much more
appropriate mental care in the community has been initiated and implemented.
STEWARDSHIP
The conclusion is made that the leadership role of the Ministry of Health is a very significant
asset to these processes, with strong support provided by the World Health Organization, as well
as other international agencies and initiatives such as the Stability Pact Mental Health Project.
The establishment of the Mental Health Department in the MoH is an obvious indicator for the
commitment of the national authorities when it comes to further actions in this field, although this
sector was established with 1.5 years delay and fewer personnel than initially planned.
National documents on mental health (National Strategy and Operational Plan) were
developed as an important precondition for successful implementation. Most of the priorities
stated in these documents are showing progressive trends, thorough input, process and outcome
indicators. Still, it can be observed that there are certain gaps between some of the expected
outcomes and achieved results. The failure to achieve certain priorities does not result from the lack
of an appropriate guiding principle, but more probably as result of setting up high standards/
expectations in a quite limited timeframe, as well as the ambitious activities proposed in the
national documents. It should be pointed out that although a lot of information and data are
available, some of the principles and indicators set forth in the Operational Plan have been
difficult for follow up because of the lack of appropriate evaluation and monitoring system.

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 In order to continue the reforms, the recommendation is made for development of a new
Mental Health Operational Plan for the next 5 years, as planned in the National Policy and
Operational Plan. As confirmed by all involved parties, the focus in this plan should be also
placed on strengthening of the achieved results and reinforcement of the priority for secondment
of all resources from hospital sector to the community services. Also, appropriate monitoring and
evaluation format should be set up.
With regards to the Mental Health legislation, the conclusion is that the new Mental Health
Act was not developed as planned, and more importantly, the existing legislation is not in function.
The consultations in 4 priority areas revealed a certain level of dissatisfaction among patients and
their families, especially when it comes to their involvement in activity planning and in the field of
human rights. The human rights of people with mental illnesses and their families continue to be an
issue of noteworthy concern, especially in the inpatient services.
Therefore, it is recommended that one of the most important priorities in the near future should
be establishment and appropriate implementation of the mechanisms for promotion and protection
of human rights of people with mental illnesses, presently governed by the existing Mental Health
Act from 1996. At the same time, the process of development of the new Mental Health Act
should be initiated, in accordance with international standards and relevant documents (WHO
have produced a lot of guiding documents in this area).
As for the involvement of the other key stakeholders in the planning and implementation
processes, the conclusion is that their involvement is not sufficient. Although some patterns of
inter-sectoral collaboration have been reported in certain priority areas, they are not developed
in a systematic or coordinated way. Certain principles and systematic approach of inter-sectoral
collaboration are needed to support the coordinated care, which will offer better treatment,
recovery and rehabilitation opportunities for people with mental disorders. In that sense, the
recommendation is that Ministry of Health should use their leading role and ensure involvement
of such partners, (involvement of HII and Ministry of Social Welfare as most important), as well as
to promote closer collaboration with authorities / representatives from local communities.
Regarding the promotion and prevention activities, the conclusion can be made that such
activities are lacking both at national and local level. Recommendation can be made to MoH
and to the NGO sector that promotion and prevention activities have to be much more visible in
order to improve public knowledge, and consequently strengthening the fight against stigma, as
one of the most needed conditions for successful reforms. As stressed in the Draft National Health
Strategy, Albanian health care system needs to shift its emphasis from almost exclusive focus on
curative care to higher presence of preventive care and health promotion.

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BUDGETING
With regards to the budget-related issues, the conclusion can be made that mental health
budget is low both in terms of amount and percentage. The budgeting sector is completely
centralized, with very low responsibilties at local level. In that sense, there is a lack of appropriate
managerial skills, which in turn significantly influences the implementation of projected activities. In
this regard, a remark can be made that the political influence and quite often changes of directors
in the mental health institutions are generating delays in the implementation processes. However,
the funds that MoH is setting aside for investment in the MNH field are quite significant, especially
when it comes to improvement of conditions inside the hospital setting.
The recommendation is made that this trend of investments should also be extended toward
community mental health services. There is an urgent need for clearly defined mental health budget,
with exact mechanisms for allocation of sufficient budget, which will secure sustainability of the
newly established system. The education for improvement of managerial skills should be organized
in a structured mode, which should lead to decentralization of responsibilities.
HUMAN RESOURCES
As many people involved pointed out, the conclusion is that mental health workforce had
the decisive role in the last period, making these processes successful. Devotion and commitment
to the processes of improvement of the situation in this area are more than obvious at all levels,
thus placing mental health high on the agenda of the highly demanding national health priorities.
A range of educational and training activities were organized, and one of the most positive
outcomes is the involvement of the primary health care sector. As indicated, there are further plans
for establishment of many educational programs for community mental health (Medical Faculty
- University Clinic of Psychiatry, Nursing Schools, Faculties of Psychology, Social Work). In this
regard, positive experiences from the established community services, the existing critical number
of the reformers among professionals, reforms in line with the European integration initiatives can
be seen as great opportunities for further development in this area. Still, there are trends that
should be overcome. The issue of resistance against the reforms especially among a portion of
hospital staff, lack of appropriate multi-disciplinary approach in hospital settings, lack of continued
educational programmes, and of the instruments for individual care approach are still a matter of
concern. There are reports of reduced motivation among personnel in the CMHS, about too many
informal payments, low formal salaries etc, which can create obstacles to future developments.

In order to overcome these possible barriers, more influential involvement of professional
associations (psychiatric, nursing associations, faculties for psychiatry, psychology, social work)
can be recommended. Establishment of continuous education for the employees in mental health
institutions must be implemented and monitored by relevant national institutions (ex. University
Psychiatric Clinic in collaboration with the CMHCs of Tirana, coordinated by the MNH department
in the MoH).

36

 The education for the personnel in the primary health care sector should be established as a
permanent practice and spread to other regions. As an important element, continuous education
for the people with mental illnesses and their families must be set up as part of the everyday
practices in the MNH services.
SERVICE DELIVERY
Yet, the conclusion is made that results in the setup of community mental health services
and increased availability of community-based services bear a strong significance for mental
health care reform. The mental health care has moved from psychiatric hospital treatments toward
community mental health services, mostly established in 4 priority areas. The planned activities for
establishment of more CMH services (CMHC Korca, Supported Homes in Shkodra and Cerrik) will
give additional boost to the started reforms, and increase efficiency of the processes in 4 priority
areas. Some lessons learned (closing of the Elbasan CMHC) are placing focus on the necessity for
full integration of the cmhs in the public health system, in order to ensure sustainability of the reform
processes. Nevertheless, the situation in the hospital sector is changing quite slowly, and there are
urgent demands for implementation of the planned reforms. Establishment of the admission wards
in all 4 areas is positive indicator for fulfilment of reforms processes, and there are improvements
in the condition of majority of departments. The attitudes and everyday practices in the chronic
wards are affirming the need for urgent actions towards improvement of the situation, especially
in the field of human rights and establishment of re-socialization processes. Albania has already
undertaken substantial activities towards establishment of quality standards in hospitals and has
taken measures towards the establishment of a hospital accreditation system. With the support
of WHO, it has developed a total of 252 standards, covering the main domains of hospital
operations. It can also be said that the reforms in the mental health sector are in line with the
overall health sector reforms, and the interest for involvement of primary health sector is already
seen (the establishment of the protected home in Cerrik in collaboration with PHC), followed by the
experiences with the established collaboration with PHC in Vlora and Elbasan.
With regards to this part of the mental health system, further strengthening of the existing
community mental health services, followed by improvement of the different support services is
recommended. There are instruments in place, such as the Individual Plan used in CMHC Tirana1,
or nursing assessment toll in Elbasan, which can be introduced as tools in all MNH services. Also,
meetings and collaboration among MNH services should be organized on regular base. The new
CMHS should be planned and established gradually, and this should be detailed in the new
Operational Plan. Actions should be taken towards establishment of certain standards in the
community based mental health services.
In the hospital sector, a stronger emphasis on both prevention of admission and early discharge
is necessary. This can be achieved by establishing admission policies and close joint working with
crisis teams, resulting in reduction in number of admissions, as has been achieved in parts of
Tirana. Continuity of care will facilitate early discharge and reduce relapse and readmission.

37

This can be provided by easily accessible out patient clinics, support services including community
teams and improved partnerships with other sectors. There is a need for further engagement of
other professional profiles (psychologists, social workers), which will support the deinstitutionalization
processes. Organized and permanent education of the personnel in the field of community mental
health, and education in the human rights field is an urgent matter.
The positive experiences with the established community services and the support given by
NGO sector (in Tirana: Albanian Development Center for Mental Health, Alternativa, Fountain
House in Elbasan: Fokus) , should be supported and either incorporated, or closely connected with
public mental health system.
Finally, there are widely-known experiences of failure in many reforms in countries in transition,
because support by national and international stakeholders was stopped midway. Therefore, a
pledge to all parties concerned is that this positive model of reforms should be further supported,
and be promoted as a model of successful collaboration between national and international
partners.

ABBREVIATIONS
ADMHC
CMH
CMHC
CMHS
HII

IGA

MNH
MoH
MoSW
NSC
PH

PHC

OP

TDMHS1
WB

38

-
-
-
-
-
-
-
-

Albanian Development Mental Health Center

community mental health
community mental health center
community mental health services
Health Insurance Institute
income generating activity
Mental health
Ministry of Health
Ministry of Labour, Social Affairs and Equal Opportunities
National Steering Committee for Meatal Health
psychiatric hospital
primary health care
Operational Plan
Tirana Demonstration Mental Health System no.1
World Bank

REPUBLIC OF ALBANIA

MINISTRY OF HEALTH

EVALUATION OF THE IMPLEMENTATION OF THE

OPERATIONAL PLAN FOR THE DEVELOPMENT
OF MENTAL HEALTH SERVICES
IN ALBANIA (2005-2007)

NOVEMBER 2007