The WHO Regional Office for Europe Situation analysis on the prevention of child maltreatment in Albania: The World Health Organization (WHO) the way forward is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Situation analysis on the prevention Albania Andorra Armenia of child maltreatment in Albania: Austria Azerbaijan Belarus the way forward Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization, Regional Office for Europe Original: English UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00. Fax: +45 45 33 70 01. E-mail: [email protected]. Web site: www.euro.who.int Situation analysis on the prevention of child maltreatment in Albania: the way forward ABSTRACT This situation analysis report on prevention of child maltreatment in Albania has been prepared with the cooperation of many stakeholders from different ministries, such as Social Welfare and Youth, Education, Justice, the police as well as nongovernmental organizations. Studies conducted in Albania suggest that many children needlessly suffer from child maltreatment. As in other countries, most maltreatment occurs in the community and may not come to the attention of child protection agencies. It is nevertheless a grave public health and societal problem with far-reaching consequences for the mental, physical and reproductive health of children, and for societal development. Health systems have a key role to play, not only in providing high-quality services for children who experience violence, but also in detecting and supporting families at risk. They should also implement prevention programmes such as home visitation and parenting support, and hospital-based interventions to support parents, along with programmes against abusive head trauma. Collaborative actions are required between all partners in order to tackle this public health and societal problem. One way of ensuring this is to develop a national policy on the prevention of child maltreatment. Keywords Child abuse – prevention and control Violence – prevention and control Health policy National health programmes Albania Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2016 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Acknowledgements iv Acronyms v Preface vi Executive summary vii 1. Intoduction 1 2. Scope of the document 1 3. Key facts and figures on children in Albania 2 4. The extent of child maltreatment in Albania 3 4.1 Background 3 4.2 Studies of child maltreatment in Albania 4 5. Policy and legal frameworks to protect children from abuse and neglect in Albania 7 5.1 Policy framework 7 5.2 Legal framework in Albania 8 6. Services and systems for the prevention of child maltreatment 10 6.1 Social protection sector 10 6.2 Health-care sector 11 6.3 Education sector 12 6.4 Police sector 13 6.5 Justice sector 13 6.6 Nongovernmental organizations 13 6.7 Assessment of existing interpersonal prevention programmes in Albania 14 7. Conclusions and recommendations 16 7.1 Conclusions 16 7.2 Recommendations 16 8. References 18 ANNEX 1. List of the relevant stakeholders: assessment mission on prevention of child maltreatment 22 ANNEX 2. Summary report of the national policy dialogue on prevention of child maltreatment 24 ANNEX 3. International and national legislations 26 ANNEX 4. Types of services and support provided by NGOs 28 iii ACKNOWLEDGEMENTS This report on Situation analysis on the prevention of child maltreatment in Albania: the way forward was developed within the framework of the WHO Country Office in Albania/WHO Regional Office for Europe Biennial Collaborative Agreement 2014–2015 with the Ministry of Health in Albania. This report has been written by Ms Dimitrinka Jordanova Peshevska, WHO Consultant in Violence Prevention; Dr Gentiana Qirjako, Institute of Public Health, Medical Faculty Tirana; Dr Dinesh Sethi, Programme Manager, Violence and Injury Prevention, WHO Regional Office for Europe; and Dr Ledia Lazeri, Head of the WHO Country Office in Albania. Exceptional thanks to the key stakeholders who kindly contributed to the document by participating in the semi- structured interviews and sharing their knowledge, experience and commitment in the area of prevention of child maltreatment (see Annex 1). Special thanks to Ms Tamara Jordanova, psychologist, for her contribution to this report and provision of valuable comments. iv ACRONYMS ACE adverse childhood experience ADHS Albanian Demographic and Health Survey ANCH ALO 116 – Child Help Line BECAN Balkan Epidemiological study on Child Abuse and Neglect CM child maltreatment COMBI communication for behavioural impact CPU Child Protection Unit CRC Convention on the Rights of the Child CRCA Children’s Human Rights Centre of Albania CRU Children’s Rights Unit CSA child sexual abuse CSO civil society organization GP general practitioner IECD Institutions for Executing Criminal Decisions INSTAT National Institute of Statistics of Albania MICS Multiple Indicator Cluster Survey NSDI National Strategy for Development and Integration NGO nongovernmental organization SAPCR State Agency for the Protection of Child Rights UNESCO United Nations Economic, Scientific and Cultural Organization UNFPA Unied Nations Population Fund UNICEF United Nations Children’s Fund UNDP United Nations Development Programme WHO World Health Organization v PREFACE Child maltreatment has long been regarded as a criminal justice and social issue, and has only recently been seen in a public health perspective. This approach supports the view that child maltreatment is not inevitable and argues that prevention is more cost−effective than dealing with the consequences. Evidence gathered elsewhere such as in the European report on preventing child maltreatment indicates that organized responses by society can prevent child maltreatment. Child abuse and neglect are a product of social, cultural, economic and biological factors, and occur in all societies and countries in the World Health Organization (WHO) European Region. They are a leading cause of health inequality and social injustice, with the socioeconomically disadvantaged more at risk. Studies conducted in Albania suggest that many children needlessly suffer from child abuse and neglect. These studies have shown that, as in other countries, most child abuse and neglect occurs in the community and may not come to the attention of child protection agencies. They are nevertheless grave public health and societal problems with far-reaching consequences for the mental, physical and reproductive health of children, and for societal development. Maltreatment is also closely linked to other adverse childhood experiences. The consequences of such adversity may affect people throughout the life-course, with high societal costs. This situation analysis report on prevention of child maltreatment in Albania has been prepared with the cooperation of many stakeholders from different ministries, such as Social Welfare and Youth, Education, Justice, the police as well as nongovernmental