2022 health budget

Prime Minister Edi Rama’s remarks at meeting with doctors and nurses on aspects of the next year’s state budget for the country’s health system:


Good evening everyone and thank you very much for taking the trouble to attend the meeting in this hall.

As far as I can recall, this is not the first time we come together, but you could also remember the commitments we have made in this very room, starting with our pledge to increase the health workers’ salaries, have been actually followed by facts.

And indeed, doctors and nurses have received a pay boost by 63 %, since we took office. Of course, we are not satisfied with this fact as it is our ambition to continue to increase the health workers’ salaries every year and we plan a 40% pay rise within the third term in office, starting with a 6% increase next year.

Taking notice of the panorama of significant changes to the country’s health system, I am always reminded of the saying that “bad things are more likely to be forgotten quickly, whereas goodness is endless.” It is of course in the very human nature, because if a man was to remain hostage to the bad experiences he goes through, it would be impossible for him to hope for much better things as he would be powerless and incapable of aspiring to them.

However, it is important that as we rightly aspire for much more and while definitely a lot has been done in the health system, as it is the case in all other areas, there is no room for self-complacency, because there are still a lot of gaps to fill.

Let’s not forget where we started from and how unimaginable the situation was when we took office, while your daily professional life was a sort of a jungle that has completely changed now, also thanks to the incredible efforts of all health workers and their self-denial spirit they are never credited with anytime one comments on doctors and nurses.

Taking notice of all of these, I would say that what we have accomplished is really encouraging. Of course, as the Health Minister noted, we simply do our job, because this is the phrase we happen to commonly come across any time we deliver and do really great things. Of course, we do our job! That’s why we have been voted and we are not elected to work some magic, but to properly do our job.

All the governments are actually formed to do the jobs they are tasked with and they are not formed to do otherworld miracles. The difference stands in the way we do our job and when thinking that documents show a much bigger volume of supposed investments in the country’s health system in the past 25 years that preceded this transformation era than the bulk of investments we have launched in the past few years, but when you compare the outcome of that investments volume and the outcome of our investment volume, then you can’t help but regret when considering how much time has been wasted and how many damages have been caused and, on the other hand, it won’t be difficult at all to realize that it is much more difficult to built back something that has not been properly built rather than building something from scratch. 

It is unimaginable to think about the medical equipment you used to work with until a few years ago. It is unimaginable that right at the heart of Europe, right at the heart of Albania, precisely at the country’s largest hospital university centre and at maternity hospitals, surgeons had to enter the operating theatres to perform surgical interventions by using wartime-like medical equipment available to them. And this used to happen not 10 years ago, but until a few years ago.

The situation today is completely different. Just a few years ago, the University Hospital Centre resembled a grand train station with people coming from all corners, a noisy and chaotic place, where the medical personnel encountered unimaginable difficulties. Whereas today, the Hospital Centre is still an ongoing construction site, and you know quite well, as we do also know, what is still missing to fully complete the entire mosaic, but not possible comparisons can be drawn. We have created decent working and professional conditions for doctors and nurses and they form a solid basis for us to make proper future decisions.

The medicines reimbursement system excluded around 600,000 uninsured people until a few years ago. Nobody is excluded from the reimbursement scheme today. The financial volume to cover the reimbursement system has more than doubled, even it has almost tripled, and it provides coverage for everyone, no matter whether they are insured or not. And not such a long time ago, the country’s hospitals had to cope with the lack of basic medicines.

It is hard to imagine the infrastructure of the primary health care system and the health centres across the country that failed to provide any basic working conditions for the doctors and the medical personnel.

There are certainly a number of health care centres that need to be transformed like the one I already pointed out, but 300 newly-rebuilt health centres all over the country now meet the highest standards for doctors, nurses and patients. The new health centres have also helped to significantly relieve the immense pressure on the main hospital centres, and the University Hospital Centre in Tirana in particular.

Not to mention what remains one of the most inexplicable things in the history of all these years, namely suspension of the specialist training program for four consecutive years, making Albania the only country on the planet without a training specialist program. Such a decision certainly created a 4-year gap, translated into a dramatic shortage of specialists in the health system.

An unexplainable, incomprehensible, but a meaningful indicator of the fact that the system was not managed, but it was simply misused, to put it mildly.

Today I am convinced that many of those who have had the opportunity to hear the doctor who opened this gathering, have probably thought of everything except what he said, precisely the fact that he is one of the doctors who has made an admirable journey abroad to join now the group of those who have decided to return back home and give their contribution here. They can think of everything except that because the reality of the incredible difficulties that doctors and nurses have to deal with is not understood by anyone if not part of the system.

I find it impossible to hide the fact that I have been unable to really realize the way I realize it today in my capacity as the country’s Prime Minister. How particularly hard is the doctor’s life, as we only get one shot at their life.

Not only that, but some even intentionally refuse to acknowledge the system’s incredible contribution today, also thanks to the fact that doctors and nurses are now enjoying much better though not sufficient working conditions. I have been discussing it with some of your colleagues, but I can’t really imagine what would have happened if the pandemic was to strike us before building this infrastructure.

What would have happened with the system’s critical infrastructure and its support infrastructure?

Earlier today we had a meeting with a team of international partners, who are seeking to contribute, mainly financially, to our digital revolution. The reason they demanded the meeting is that they have been closely monitoring progress of Albania’s digital transformation and Albania’s transition from a country ranking bottom regionally in terms of digital services to a top reformer in the region and among countries in Europe through a more advanced process in terms of delivering public services digitally.

By support infrastructure I precisely meant the digital system of issuing authorizations to people to leave their homes amid the total lockdown and other restriction measures imposed due to the pandemic.

What would we have done?

How would we be able to cope with the chain of infections, if people would have had to report at service windows to obtain a permit to leave their homes?

It is important for everyone to bear in mind these facts, especially us as part of this effort, while others who do not wish to listen or understand and rightly enough ask for more, they can ignore all these facts. But it is absolutely crucial for us to clearly know where we are seeking to go and there could be no better saying than the following quote by Winston Churchill: “The farther back you can look, the farther forward you are likely to see.”

We are now rebuilding and expanding the system by procuring and securing the state-of-the-art medical equipment, critical structures for our system, namely the Infectious Diseases Hospital, the new Internal Medicine Hospital, the Paediatric Hospital, the National Blood Transfusion Centre, the Queen Geraldine University Hospital of Obstetrics and Gynaecology, the Paediatric Hospital in Elbasan, the Regional Hospital in Kukes and the maternity hospital in the north-eastern town.

All these construction sites, already underway or nearing completion, will provide fresh energies and impetus to the system, although they will not fully meet the system’s needs, as there are still many pieces to add to the whole mosaic, yet they will cover the whole critical infrastructure of the system.

Are eight years enough for someone to deliver on all these? It depends on the way we see things. If 25 years were not enough to build a sustainable system, but on the contrary the system totally degraded, in the last eight years we succeeded in building an important basis.

The Memorial Hospital in the city of Fier is a new experience in all aspects, but also an experience extending beyond the new regional hospital, designed to become an absolute point of reference for high quality service, but, in addition to the health care services, the new facility also represents an initial step towards the hospital autonomy to usher in  a new phase and provide an additional fresh impetus to the entire system and embark on a path with each doctors’ performance being the main criteria for the level of remuneration for the medical personnel. This is a step towards transiting to another phase where are not paid the same, nurses are not all paid the same no matter how much the salaries increase, but each and every one of them receive a pay boost based on their performance and contribution.

Of course this could have been done much earlier, but why was it not done?

This was because of the very same reason why hospitals lacked proper medicine supplies previously. This was because of the very same reason why not a single toilet was built for a hospital ward, why not a single doctors’ room was not built through the voluntary contribution of the doctors themselves to meet the professional standards. This was because of the very same reason why not a unified protocol, let alone a system of protocols, was not developed, because it is impossible for one to build a protocol or a system of protocols without primarily building a decent hospital facility and not a three-room train station where health workers heroically resist under threats and pressure coming from all directions.

The transition to this phase will be decisive to our efforts to take our health system, or our health care service system to a whole new level, where the system faces no quality issues compared to other countries and make sure that our doctors and surgeons perform rare operations in the future.

In the meantime, together with the Medicine Faculty, we have embarked on a joint effort to internationalize our higher education system and attract renowned professors from the best European universities and employ them in our universities so that our students are provided fresh opportunities and common university degree programs and diplomas here in Albania.

I am very much confident that we will succeed in establishing an encouraging basis for this new phase for the medicine education system and nursing education during this term in office.

In the meantime, together with the Health Minister we have discussed and explored ways to further strengthen the University of Medicine by equipping it with modern technology, and enable the university to boost its technological capacities with state-of-the-art equipment in addition to the advanced technological capacities that the University Hospital Centre offers today and will continue to further develop under the ongoing major projects.

I would also like to briefly focus on the problem of doctors and nurses leaving or returning to the country. The problem of doctors and nurses is commonly encountered also in the EU member states. This is a problem I have encountered during talks with a good part of the prime ministers of the EU member states. I mean not everyone, because not all the countries face such a problem, but this has been the case during talks with majority of the EU prime ministers, because the doctors’ destinations throughout Europe, you already know also from your personal and your colleagues’ stories, are not many, but just a few, while all other countries really encounter such a problem. Which is the paradox of all this?

The paradox is that as the issue of doctors and nurses is mostly considered in public in Albania as a lost case, as if there are no doctors here and everyone has left, as if there are no nurses here, as if this a butchers and barbers association operating here, who have come together and pretend to provide health care. The truth is that luckily enough we don’t face such a problem to date. We currently face no shortages of doctors and nurses, who cannot be replaced. This is a fact! There are a number of newly graduated doctors and nurses, who are applying for vacant positions when a doctor or a nurse leaves the country or retires, but not everyone can take up a job in the system. This is a fact! A considerable number of nurses are on the waiting list and I am highlighting this fact for those watching us and not for you, since you are part of the system and there is no vacant job position currently indeed.

The crisis we had to deal with was first triggered by the irresponsible decision to suspend the specialist training program. The training program was suspended for four years and gaps were created because of the lack of specialist doctors. We have already overcome this crisis. In the meantime, I have had the opportunity to engage in conversations with a number of doctors who have returned back home, like the doctor who opened this meeting, and the reason why they keep returning is quite obvious. They keep coming back to fulfil a professional ambition, because of the special relation with their homeland, their families. But they keep returning also for another reason, because they now see for themselves the working conditions for them to exercise their profession decently and they no longer feel as if leaving a health care centre or a hospital, where surgical interventions are performed by using medical equipment dating back to the Sino-Albanian love era. I will never forget the day when for the first time I visited an operation room together with the university rector and the health minister, when the new surgical hospital was inaugurated and when professor Besim Elezi said: “I’ve never dared to imagine that I would ever find myself in front of this view during my lifetime.” He then went on telling how the surgical interventions were performed. You certainly know it, but I told him you are not alone, because there are other people who follow us and they are now throwing every possible insult via Facebook, but you are at least insulted collectively. What is obvious is that we have been tasked with different duties. 

Could there be a power of imagination to compare the national health emergency service of today with that we inherited just a few years ago? Could there be any today? Our national emergency service meets the highest European standards today.

Citizens today receive real-time care services provided by the emergency service and we receive real-time calls for any emergency case throughout the country. Nobody would claim today that the emergence service failed to act when the emergency number is dialled by a citizen. Nobody would do so, because if he is to report it by providing his or her name and family name, the computer system would identify the caller, if he or she has really called the emergency service, and whether the ambulance has been dispatched to the caller’s address, telling him the time it took the ambulance to reach his or her home address. So, nobody can make fake statements, claiming that he or she was denied the service. This is a service already in place over the years in other countries, but it was totally imaginable for us just e few years ago, but with all said one should also note and acknowledge the fact that certain corrupt individuals were part of this service and there could still be individuals who lack moral integrity, but still part of the system. However, it is for sure that the majority of doctors and nurses are not part of this corrupt category of individuals and the latter will continuously keep shrinking, although those throwing insults won’t distinguish among the two groups and will claim that “they are all the same.” No, they are not all the same! Not all the trees sleep the same. Instead of collectively throwing insults and alleging that they were forced to pay bribes to doctors, without mentioning names, they should refuse paying tips and raise the outcry and report any suspected corruption practice in any hospital or health care centre all over the country. The corruption practices among health care providers, such as physicians, nurses and pharmacists cannot be combated by the government and the state institutions only and doctors or nurses who charge bribes in exchange of care service should all be reported. This was to say that not that anything will change in this regard from the point of view of those who will continue to level accusations, but I want to assure everyone of you that we will continue stubbornly and resolutely to support your work, to support you with everything we can in all aspects and we will make sure that doctors, nurses and every health worker will see their pay boost by 40% within our third term in office 

In the meantime, I hope that the minister will succeed in advancing the hospital autonomy process so that doctors and nurses receive much higher salaries according to their performance. In order to avoid any misinterpretation, this is about the increase on the base salary, because it won’t be a surprise if you happen to see any web portal story, suggesting that the Prime Minister pledged a pay rise, but shortly after he changed his mind telling doctors that their salaries will increase based on their performance accomplishments. The hospital autonomy doesn’t suggest a lower base salary. Health personnel are entitled to bonus payments more from well-management of the revenue and funds allocated for hospitals, and from the well-management of the hospitals, with the government obliged to provide the base salary, ensure functioning of certain basic elements and grant freedom in administration and the board management.

Thank you very much and I wish you all good health, because having good health and being fit is a must for each and every one of you so that you can care about the others’ health and heal other people. I would also like to wish all the best to your family members, who are the ones who know what working as a doctor and nurse means. Thank you very much!