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World Bank Report: Albania's 10-Year Health Project Failed in Financial Access
2026-08-19 13:09:00 / EKONOMI&SOCIALE
The World Bank project to improve the health system in Albania failed to achieve a significant part of the objectives with which it started in 2015. On the other hand, the implementation was extended by 55 months beyond the initial deadline and one of the main pillars, such as increasing financial access to health services, was assessed as almost unattained. At least that is how it is assessed in the final document of the Independent Evaluation Group, the independent evaluation unit of the World Bank.
The report on the project “Improving the Health System in Albania” assesses the final result as “Moderately Satisfactory”, as the objectives were reduced and changed during implementation. The assessment for the initial objectives was weaker: improving the efficiency of care in selected hospitals and managing health information were assessed as “Modest”, while increasing financial access to health services was assessed as “Negligible”.
“The project did not contribute to increasing financial access to health services,” the report says. According to the Independent Evaluation Group, there was no reduction in the average prices of the 10 most common prescription drugs and the 10 most expensive hospital drugs, while the target of increasing the percentage of poor people covered by the health insurance system from 50% to 65% was not achieved.
The component dedicated to improving health financing was removed from the project in December 2018 due to lack of progress. The report says there was no progress in drafting and implementing an action plan for organizing health insurance, in using performance-based payments in primary care, or in hospital payment reforms.
Initial design and capacities of FSDKSH
The Independent Evaluation Group attributes some of the problems to the initial design of the project. “The ambition and complexity of the initial design of the project were not commensurate with the country’s capacities,” the report said, after an initial period of two to three years of poor progress. The project was first restructured in December 2018, significantly reducing its objectives and shifting its focus to modernizing some hospital services.
Në vlerësimin e cilësisë së projektit në momentin e nisjes, raporti jep notën “Mesatarisht i Pakënaqshëm”. Sipas dokumentit, Banka Botërore kishte identifikuar kufizime në kapacitetet e Ministrisë së Shëndetësisë, përfshirë përvojën e kufizuar me operacione të mëdha të financuara nga Banka, mangësitë në teknologjinë e informacionit dhe në prokurime, por disa rreziqe u nënvlerësuan.
Veçanërisht problematik ishte komponenti i reformës së financimit. Raporti thotë se ai ishte projektuar pa kushtet e nevojshme institucionale, në një mjedis të karakterizuar nga kapacitete të dobëta të Fondit të Sigurimit të Detyrueshëm të Kujdesit Shëndetësor, ndryshime në drejtim dhe rezistencë ndaj reformave të pagesave. Përfshirja e këtij komponenti pa një vlerësim paraprak të gatishmërisë institucionale cilësohet si një “mangësi themelore në projektim”.
Problemet u reflektuan edhe te prokurimet. Plani Master i Spitaleve, një element kyç i projektit, dështoi tri herë në procesin e prokurimit midis viteve 2016 dhe 2018 për shkak të buxhetit të pamjaftueshëm dhe termave të referencës jo mjaftueshëm të detajuar, duke sjellë një vonesë prej më shumë se tre vjetësh. Tenderi për sistemin rajonal të informacionit spitalor u lançua në vitin 2019, por kontrata nuk u nënshkrua deri në mars 2021. Sistemi u bë funksional në të 11 spitalet rajonale vetëm në vitin 2025.
Afati fillestar i mbylljes së projektit ishte 28 shkurt 2021. Pas katër ristrukturimeve dhe financimit shtesë, ai u shty deri më 30 shtator 2025. Zgjatjet arritën në total 55 muaj, duke e çuar periudhën e zbatimit në 127 muaj, ose 10 vjet e shtatë muaj. Grupi i Pavarur i Vlerësimit e vlerësoi efikasitetin e projektit si “Modest”, duke përmendur kohëzgjatjen, dobësitë në projektim dhe gatishmëri, kufizimet institucionale dhe të prokurimeve, si edhe goditjet e jashtme, përfshirë tërmetin e vitit 2019 dhe pandeminë e COVID-19.
Projekti
Projekti u miratua në shkurt 2015. Angazhimi fillestar i Bankës Botërore ishte rreth 69.5 milionë dollarë dhe angazhimi i rishikuar rreth 68.5 milionë dollarë. Shuma faktike e disbursuar ishte rreth 61.8 milionë dollarë. Në vitin 2021 u miratua edhe financim shtesë prej 25 milionë eurosh, kryesisht për rindërtimin dhe rehabilitimin e strukturave shëndetësore të dëmtuara nga tërmeti i nëntorit 2019.
Pas ristrukturimit, rezultatet ishin më të forta. Raporti e vlerësoi si “Të konsiderueshme” arritjen e objektivit për modernizimin e shërbimeve të përzgjedhura spitalore dhe si “Të lartë” objektivin për rindërtimin e strukturave shëndetësore të dëmtuara nga tërmeti. Rreth 91% e fondeve të disbursuara gjatë gjithë projektit lidhen me periudhën pas ndryshimit të objektivave, çka peshoi në vlerësimin përfundimtar “Mesatarisht i Kënaqshëm”.
According to the report, the regional hospital information system was extended to all 11 regional hospitals, 150 protocols and clinical guidelines were developed and implemented, and the accreditation process was expanded beyond the initial objectives. At the end of the project, the report counts 11 regional hospitals, 22 municipal hospitals, and five university hospitals accredited.
Post-earthquake investments included reconstruction or rehabilitation works in the hospitals of Laç, Kukës, Kruja and Lezha, as well as in several structures of the “Mother Teresa” University Hospital Center. The rehabilitated facilities included measures for earthquake resistance and climate adaptation. This objective received the highest rating of the project, “High”.
However, the use of some of the new digital systems remained below target. For the first four hospitals where data was available, 37.8% of inpatients were registered in the regional hospital information system, against the target of 40%, while for the other seven hospitals included later, no data was available. The number of users of digitally enabled services was around 50,000, roughly half of the target of 100,000.
The Independent Evaluation Group rated the World Bank’s overall performance as “Moderately Satisfactory.” Oversight during implementation was rated “Satisfactory,” while the report notes that early signs of problems, procurement delays, near-zero progress on some objectives, and institutional instability, were evident as early as 2016, but the first restructuring was formalized more than two years later.
"Earlier restructuring can shorten periods of poor performance and reduce the cost of delayed course correction," the report's section on lessons learned from the project states./ Monitor
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