1. Decentralization in Albania Pamela Wyville-Staples PHN SOTA 9 October 2002

3. Background on Albania Former Communist Country (extreme isolationist form) with traditionally highly centralized government structures Changed government in early 1990s Approximately 3.5 million people 10,579 miles², $1,000 GNP/capita, and $63 GNP/capita spent on health expenditures

4. Pre-1990s PHC Model Presidency Finance National Health Commune Local Health

5. Current Control and Financing of PHC

6. Advantages of Decentralization Albania has moved beyond an exclusively vertical structure Decentralization has encouraged better governance throughout Albania, especially within the Ministries of Finance and Local Government Greater interest by health care providers in participating in decision-making

7. Current Issues Competing donor interests Timing Decentralization in all social sectors Flow of Funding Specific health points  Fee payer system  Health information system  Pharmaceuticals

8. Roles of USAID & others in PHC reform Ministry of Health Ministry of Local Government Ministry of Finance World Bank/IMF USAID PHR+ AIHA Lezha/Pittsburgh Partnership

9. Current Issues Competing donor interests Decentralization in all social sectors Timing Flow of Funding Specific health related issues  Fee payer system  Health information system  Pharmaceuticals

10. Next Steps Engage MOF, MOH, MOLG, World Bank/IMF, USAID, & others donors regarding proper decentralized structure Engage MOH in designing and implementing useful PHR+ PHC pilot sites including HIS, costing tools, etc. Ensure coordination by all PHC players

11. Thank you