Palliative Care Needs Assessment for Albania Stephen R Connor, PhD OSI International Palliative Care Consultant Washington DC Kristo Huta, MD President, National Association for Palliative Care Durres, Albania FUNDED BY THE OPEN SOCIETY INSTITUTE Public Health Program International Palliative Care Initiative – New York for Albanian Ministry of Health Palliative Care Task Force DRAFT 1 DRAFT 1 Table of Contents Albanian Ministry of Health – Palliative Care Task Force ......................................................4 Acknowledgements..............................................................................................................................4 Executive Summary .............................................................................................................................5 Introduction ...........................................................................................................................................9 Aims of this Needs Assessment...................................................................................................................9 Target Audience...............................................................................................................................................................9 Methods ...............................................................................................................................................................................9 Definition of Palliative Care.........................................................................................................................................................9 Data Sources..................................................................................................................................................................................10 WHO Public Health Model ........................................................................................................................................................10 Interviews Conducted .................................................................................................................................................................11 The Country......................................................................................................................................... 12 History………………………………………………………………………………………………………………12 Geography…………………………………………………………………………………………………………13 The People…………………………………………………………………………………………………………13 The Economy……………………………………………………………………………………………………..14 Health and Illness......................................................................................................................................... 15 Major Causes of Death………………………………………………………………………………………...........15 Cancer Mortality ...........................................................................................................................................................16 HIV/AIDS..........................................................................................................................................................................16 The Healthcare System............................................................................................................................... 16 Hospitals………………………………………………………………………………………………..................17 Primary Health Care…………………………………………………………………………………………..17 Other Health Assets……………………………………………………………………………………………18 Non-Governmental Organizations.......................................................................................................... 19 National Association for Palliative Care .............................................................................................................19 Sue Ryder Hospice .......................................................................................................................................................19 Caritas Albania...............................................................................................................................................................20 Mary Potter Palliative Care Association .............................................................................................................21 Open Society Foundation Albania .........................................................................................................................21 The Public Health Situation Related to Palliative Care ........................................................ 22 Policy Development..................................................................................................................................... 22 National Cancer Control Plan ................................................................................................................. 23 Palliative Care Working Group.............................................................................................................. 24 Parliamentary Commission for Health ............................................................................................... 24 Opioid Availability ....................................................................................................................................... 25 Education ........................................................................................................................................................ 26 National Oncology Center.......................................................................................................................... 26 World Health Organization and Global Fund……………………………………………………………………27 The Need for Palliative Care in Albania ..................................................................................... 28 Current Hospice/Palliative Care Services............................................................................................ 28 Mortality.......................................................................................................................................................... 28 Palliative Care Needs Assessment for Albania 2 DRAFT 1 Health Workforce Needs............................................................................................................................ 30 Bed Need ………………………………………………………………………………………………………………31 Plans for Scaling up Palliative Care in Albania................................................................................... 31 Timeline............................................................................................................................................................................32 Summary ......................................................................................................................................................... 34 Recommendations ....................................................................................................................................... 35 Policy…………………………………………………………………………………………………………………….35 Medication Availability…………………………………………………………………………………………..35 Education………………………………………………………………………………………………………………36 Implementation……………………………………………………………………………………………………..36 REFERENCES........................................................................................................................................ 37 Appendix A: WHO Definition of Palliative Care....................................................................... 38 WHO Definition of Palliative Care for Children.................................................................................. 38 Appendix B.: Agenda PCWG June 2010....................................................................................... 39 Appendix C.: Albania Health Profile............................................................................................ 40 Appendix: D.: Scope of work review of laws, policies, and regulations in Albania .... 42 Appendix E.: Decree on formation of National Cancer Control Board............................. 43 Appendix G.: EU Accession Document 2009-11....................................................................... 45 Appendix H.: Ministry of Health Health Indicators ……………………………………………...........49 Appendix H.: Schedule of meetings ............................................................................................. 70 Palliative Care Needs Assessment for Albania 3 DRAFT 1 Albanian Palliative Care Task Force This needs assessment has been developed in collaboration with and with the assistance of the Palliative Care Task Force. This task force was formed to advise the Albanian Ministry of Health on implementation of palliative care in Albania as part of the National Cancer Control Plan. The Task Force is a sub-committee of the National Cancer Control Board. Members of the Task Force include: Dr. Donjeta Bali Pediatrician, Mother Teresa University Hospital Dr. Stephen Connor Open Society Institute, New York Dr. Kristo Huta National Association for Palliative Care, Albania Ms. Irena Laska Mary Potter Palliative Care Service Mr. Vasil Miho World Health Organization, Albania Mr. Albert Nikolla Director, Caritas Albania Dr. Fatmir Prifti Sue Ryder Albania Ms. Rudina Rama Sue Ryder Albania Dr. Agim Sallaku, Chief of Oncology, Mother Teresa Hospital Ms. Blerta Skendaj Open Society Assistance Foundation, Albania Mr. Henrik Zotaj Palliative Home Care Program (SOB) Acknowledgements The authors would like to thank all the interviewees, the officials at the Ministry of Health, the non-governmental