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For a
health care closer to citizens
24.02.2009
In the context of its mission for
the protection and observance of human rights,
Albanian Helsinki Committee (AHC) has initiated
the monitoring for the observance of citizen
rights in some primary health care institutions,
psychiatric hospitals, orphanages and some
regional hospitals. Throughout January 2008, AHC
monitored health care in the area of Bathore and
Babrru. Some of the findings of the observations
are concisely presented as follows:
Generally the infrastructure of
the health centers was good. Health care was
provided in new facilities, hygienic-sanitary
conditions appeared to be good with the
exception of a health center in the area of
Bathore in which the most minimal means were
inexistent like: visiting beds, desks, file
stands, sheets, etc.
Throughout the monitoring period
there was a conspicuous power shortage that
lasted from some hours a day to all day long.
The health care center in the area of Kafja e
Rremës had a 5 year-long black-out. Electric
power shortage affects preserving vaccines in
refrigerated conditions and poses difficulties
to medical visits for the patients, especially
children and pregnant women, as the facilities
were cold. As a result of the conditions, the
doctors in the health care center in Bathore
were not wearing their uniforms. In some of the
monitored health care centers there was a lack
of water supply, and in those centers where it
did exist, it was undrinkable.
In the health care centers in
Bathore there is a lack in supply with the file
stands for the arrangement of the files for the
inhabitants. There is lack in both areas for
ambulance cars, telephone line, chairs in the
hall for the reception of the patients, normal
beds, sheets, or other equipments also that are
necessary to carry out visits with the women and
children.
Health care in the area of
Bathore and Babrru was limited in time. All the
health care centers were open up to 14.40 hours
and 1 hour in the afternoon for the injections.
In the afternoon there was no health care
provided and there was no emergency center. The
inhabitants of this area voiced their concern
about the way health care was organized.
Moreover, the inhabitants of the area of Babrru
complained about the failure to respect the
official working hours on the part of the
doctors and also about the delays and numerous
perambulations. In some cases, AHC observers
identified that the doctors were not present in
their working places during the official hours,
and what’s more there were health centers like
the one called Kafja e Rremës that was closed.
AHC gathered the complaints form the inhabitants
who claimed that some doctors especially in the
area of Babrru work in private clinics during
the working hours. There were also claims about
some corruptive cases when the citizens are
compelled to pay in exchange for the health
care.
Another identified problem is the
issue of double-employment of the doctors in the
private clinics opened up in the area of Bathore
and Babrru and AHC recommends the respective
institutions to check if they are licensed or
not from the Ministry of Health.
In the entire area of Babrru and
Bathore there is no state laboratory for the
simplest testing of blood and urine to be
performed and there is no Echo-graphy apparatus,
thus violating the patient’s rights to benefit
from the primary health care. Despite the
difficult economic situation, the inhabitants
were obliged to pay money to make simple tests
in the private clinics set up in these areas.
A problem identified during the
monitoring was that the pregnant women do not
benefit from the free prophylactic treatment
such as: vitamins, fluoride, folic acid and
calcium. Considering the difficult economic
situation of many families in this area, the
purchasing of these medicines is neglected on
the part of the pregnant women and as a result
of this their children are born with hypotrophy.
As for the aforementioned, AHC recommends the
responsible state institutions that the vitamin
provision and food supplements for the pregnant
women should be free and should be included in
the list of reimbursed medicaments. Furthermore,
part of the pregnant women in these areas do not
possess medical cards, which leads to the
failure to carry out visits about their medical
conditions and in failure to detect sexually
transmitted diseases and other diseases.
As regards family planning the
work is not effective in the monitored areas.
From the meetings held, we learnt that it
consists in providing counseling when this is
asked for on the part of the patient and in
offering free condoms although there was a lack
of the latter in Babrru. Family planning is
necessary for the prevention of different
diseases and if we consider the fact that most
part of the inhabitants in Bathore and Babrri
come from the northern area and lack
information.
Premature deliveries are a
problem in the area of Bathore especially for
the young mothers as a result of
undernourishment during pregnancy. A problem
that has been identified in this area is the
inaccuracies in the documentation for the
children as changes as the child sex, date of
birth and in issuing the residence permit for
their family members. According to the
information received from the medical staff, a
considerable number of births are unregistered
in the civil registry office because their
mothers are under 18. This issue has an impact
in the failure to offer health care towards this
part if the population.
Child vaccination posed problems
in these areas due to the low level of awareness
raising of the citizens. The medical staff and
the inhabitants of these areas complained about
the reimbursed medicine list which is considered
as limited. In order to have effective remedy of
their diseases the inhabitants are obliged to
get treatment that is not included in the
reimbursement list and to buy them themselves.
As a result, the legal limitations set in the
medicine list have an impact in the infringement
of the individual right to get efficient
treatment.
A considerable number of the
inhabitants of the area of Bathore and Babrru
had no health insurance and were not equipped
with the medical cards. Considering the
difficult economic situation of the population,
doctors were obliged to visit them although
there was no payment for this service. This
influences the failure to demonstrate the family
doctors’ work, but on the other hand this
procedure can be a source of corruption.
The medication of the emergency
service in Babrru was kept in the nurses’
handbags. In the health care center near Kafja e
Rremës a considerable part of the medicines had
expired years ago.
Despite the huge number of the
inhabitant and pregnant women in Bathore the
position of the supervising midwife that would
help their medical treatment is inexistent. In
the area of Babrru there is only one doctor per
nearly 10.000 children. Furthermore, in the
entire area of Bathore and Babrru there is no
pediatrician despite the huge number of
children. The pediatrician is necessary to
provide a more qualitative and professional
service for the treatment of the children in
these areas. Another finding is that the
medium-level medical staff is scarce in relation
to the number of patients. As a result, they
could not carry out their assigned legal tasks.
Also the professional capacity of the medical
staff and especially of the paramedic staff is
less than satisfactory. A considerable number of
the nurses in these areas had only medical high
school education.
There is a low -level awareness
raising of the population in theses area about
different health issues, the right and their
legal duties, the prevention of different
diseases. There are different factors
contributing such as the difficult economic
situation of the population, the numerous
problems they encounter, their mentality etc. In
addition knowledge on the role of different
institutions for the protection of their rights
is very low. The function of the Doctor’s Order
as a state body that has a mission preserving
high standards in exercising the medical
professions and protecting patients and public
in general from the malfunctioning of medical
profession was almost unknown on the part of the
citizens of these areas.
Reform for a primary health care
is facing different problems. From the meetings
with the staff of this service it is found out
that the medical staff is not part of the
reforming process and the absorption and the
assessment of their feedback is not done
institutionally.
As a follow-up, AHC is monitoring
the identified breaches and is going to brief
the relevant bodies about them.
This initiative of AHC is
achieved with the financial support of the Small
Grant Program of the Commission for Democracy of
the US Embassy in Tirana. The opinions,
findings, conclusions and recommendations
expressed in the afore-mentioned are the
author/authors’ and do not indispensably present
the ones of the State Department.
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