1. Progress and Challenges of Family Medicine in Albania.
Valbona Iljazi, M.D.
Inis Jane Bardella, M.D., FAAFP 

2. Objectives
Discuss the development and current status of family medicine in Albania
Discuss the influence, effectiveness and outcome of specific initiatives aimed at developing family medicine
Explore actions to address remaining challenges and support progress in family medicine development in Albania. [Small group activity]

3. Current status of Family Medicine in Albania, achievement and progress
As for every “pioneer”, the trail of family medicine hasn’t been easy.
Today, family medicine is much better understood in the community.
There is increased frequency of patients choosing this specialty as “the right point to start.”
Due to new government regulations consults have seen a big “jump” forward in the number of patients seeing a primary care physician first.

4. Current status of Family Medicine in Albania, achievement and progress
Communication between healthcare providers and patient follow up have significantly improved.
New standard referral forms
Better understanding of family physician role
Family Medicine is now the pursued specialty by some of the best medical students.
Influenced by the ABC Health Care Center Model

5. Current status of Family Medicine in Albania, achievement and progress
Family Medicine Association in Albania, founded a few years ago.

6. Current status of Family Medicine in Albania, achievement and progress
Primary Care physicians are highly motivated to get updated medical knowledge and to improve their clinical skills.
High attendance at medical conferences and training in primary care is occurring.

7. Current status of Family Medicine in Albania, achievement and progress
The Reform in Primary Health Care so far
Basic Package of Services in Primary Health Care approved.
Clinical guidelines
Basic equipment provision for most of Primary Health Centers
Continuing Professional Development education for primary care physicians (GPs and family physicians)
Recertification
The manual of Family Medicine sponsored from USAID

8. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
Continuous support of the Albanian Ministry of Health through 3 times increasing the number of positions available in the family medicine residency.

9. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
USAID developed, and preformed a two step project between 2003 and 2009.
Training approximately 650 GPs all over Albania.
Manual of Family Medicine sponsored from USAID

10. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
Department of Family Medicine is working for a 3 year Residency Curriculum.
Focus to extend the training of clinical practice to primary care health centers
The Department of Family medicine has included family physicians in the academic staff.
Facilitating curriculum reform for the medical school

11. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
 The project of World Bank from
Focus on improving both the access to and quality of primary health care services
Emphasis on those in poor and under-serviced areas
Supporting the education program for trainers in family practice that will support the new 3rd year of residency program

12. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
Albanian Health Fund & ABC Health Care Center
Organize yearly accredited conferences of family medicine since 2003 as a tremendous rewarding program in CME/CPD for family physicians
Introduction of family medicine to the senior medical students during the 6th year (final year) medical student clinical training.
Model family medicine, opportunity given to family medicine residents to attend the practice in specific days, under direct supervision.
Consultation and mentoring for medical education development

13. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
Prime (PartneRship In Medical Education) in coordination with the Department of Family Medicine has offered continuous medical training according to physician needs.
One of their representatives on a regular bases attends several practices to help primary care physicians develop clinical skills.
Emphasis on palliative care

14. Effectiveness and outcomes of specific initiatives on the development of Family Medicine and Primary Health Care in Albania
World vision has emphasized the role of the family physician through education brochures for the community.
Government programs are trying to introduce family medicine in the community.

15. Actual challenges
The big decision of Ministry of Health: when it will stop allowing junior physicians to work as GPs without residency training
Government use of the junior physicians, without postgraduate training, as the source to fill the need for physicians in rural and village areas
The majority of them will enter a residency after 1 or more years of practice, but a high percentage will continue to practice without further training.

16. Actual challenges
How to fully implement the Basic Package of Services in Primary Health Care
Well baby, prenatal care and immunizations are considered specialist services according to government regulations, even though these are included in the Basic Package of Services in Primary Health Care.
This is not a problem in rural areas and villages, these communities have a better idea of a family physician and it’s role.
In rural areas family physician function as a family physician without any restriction, but some centers may lack the necessary equipments.

17. Actual challenges
Government is supporting only governmental clinics not private primary care clinics.
Health insurance only pays for services in government clinics.
In private clinics patients have to pay without any reimbursement even they have health insurance.
This is why private clinics manage mainly acute problems.

18. Small group discussions: Actions to address remaining challenges and support progress in family medicine development
What strategies can be applied to overcome the actual barriers?
Empowerment of Albanian physicians and the Family Medicine Association
Influence of the government [Ministry of Health, Health Insurance Institute, Public Health] and University of Tirana

19. Thank you!
Faleminderit!

20. Resources
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