TIRANA- In the past five years it is estimated that 857 doctors have left Albania mainly heading for Germany, but not only. The reasons are countless, starting with low salaries, disparagement of the doctor’s figure, the trust crisis publicized by them which has even degraded in violence and the institutional neglect in front of this violence; the long working hours, the lack of proper equipment, and a genuine legal protection.
The only reaction the government has taken so far is to toughen the Penal Code in cases of violence against doctors, but avoiding going to the root of this issue and given a better solution. Kosovo is also in a similar situation, however, their government approach was to first double the salaries of the medical body in order to at least prevent the leaving of doctors. The issue of doctors leaving Albania is being faced everyday as Europe is demanding more medical professionals. Thus the Albanian healthcare and medical system is being emptied as due to wage differences, but also because of neglect of treating the other issues that are pushing doctors to leave.
The European Core Health Indicators (ECHI) listed Albania in the red are in Europe for 2018 as a country with high problematics in the medical system. The index points out that Albania has very limited sources for health care, it has the highest diseases burden for the region, and the lowest ratio of doctors per residents. Medical professionals of this country are massively leaving, whereas the current one are approaching retiring age, thus the perspective for substitution remains vague. The salaries doctors receive are still the same, and the public funds efficiency has been violated by some unprecedented concessions which are absorbing funds that could be used for a better reform on wages. Moreover, the needs for caring services are on the rise as Albania’s population is quickly aging.
The Haradinaj government with its new reforms for medical professionals risks to become another gravitational center for Albanian doctors. The Kosovar government doubled the wages for the medical sector by paying a specialist doctor around 1200 euros, and a nurse 500 euros. Albatrit Matoshi who is counselor to Health Minister in Kosovo said for economy news media Monitor who has prepared a report on the issue, that the rising wages to the personnel was implemented in order to stop the medical body of Kosovo to emigrate towards Germany. The results were almost immediate, and now Kosovo is listed as one of the highest paying countries in the region for doctors.
Albania-Kosovo wage gap
A specialist doctor in Albania is paid a net salary of 527 euros for hospital service. According to data from the Ministry of Finances the net wages in the primary healthcare service is 408 euros. With the new reform that Kosovo is implementing as of 2019, a specialist doctor will have a net salary of 1195 euros both in the hospital and healthcare centers. Thus, a doctor in Kosovo is paid 2.5 times more than in Albania. This makes Kosovo more attractive for Albanian doctors, as for the higher wages but also for its close geographic position.
What is interesting to note is that with the new salary reform that Kosovo is approaching, a nurse gets paid more than a specialist doctor in Albania. The salary of a head nurse in Kosovo is 621 euros as of 2019, whereas the salary of a hospital nurse is 537 euros. Also other regional countries have higher wages for the medical sector than Albania.
Official sources from the Ministry of Health admitted that in the last two years the government has undertaken the highest salary growths for the medical sectors by 17 percent. The same sources explain that for the Emergency Services, Reanimation, etc., the wages for doctors have increased by 25 percent in the last two years. The Ministry of Health has declared that starting April 2019 the wages for 18,416 medical workers will increase by 7 percent. 4,650 doctors and 13,765 nurses will profit from this increase, which will amount to a budget of 1 billion lek (8 million euros). Meanwhile the bonuses for specialist doctors which serve on regional hospitals is expected to double.
Yet, Kosovo is showing itself more explicit in its policies for preventing the doctors’ emigration. The wages were doubled precisely for this reason, and Matoshi said that the new focus is on the improving the hospital infrastructure by investing in new equipment and technology. What is to be added on this note is that the health authorities in Kosovo do not recognize the Public Private Partnerships (PPP) as a form to improve the situation both in services and investments.
Low salaries are the main reason doctors are leaving
According to the World Health Organization the average gross salary of an immigrant specialist doctor in Europe is around 160 thousand euros per year or around 13 thousand euros a month, whereas the salary for a local doctor is 30 percent higher. The salary level varies from 4 thousand euros for an inexperienced general doctor, to 20 thousand euros or more for specialist doctors.
The medical workers are in the professions with a high emigrating tendency since the wages and working conditions have drastic changes from one country to another. According to a survey conducted by the Friedrich Ebert Foundation during 2018, around 78 percent of the Albanian doctors wish to emigrate to Germany for practice their profession. In another survey conducted with all local doctors in Germany two years ago highlighted that 30 percent of the doctors wished to work outside Germany, not for a higher salary, but for better working conditions and for a warmer working environment. The German doctors preferred to work in New Zealand and Australia.
Germany and Great Britain are the two main countries in Europe which have the highest demand for foreign doctors. In Britain this demand is met mostly by Indian doctors, whereas Germany is filling its vacancies through Easterners. According to statistics from the Organisation for Economic Co-operation and Development (OECD), Germany counted over 38 thousand foreign doctors in 2017. The doctors are mostly incoming from the Eastern bloc, mainly from the Balkans, Hungary, Romania, Bulgaria, etc..
875 doctors have left Albania in five years
By calculating the number of the certificates requested near the Order of Doctors, it is estimated that in the years 2013 through 2018, 857 doctors have left the country. In 2018 alone, 164 mjeke have departed, while 250 students were graduated from the Medical Faculty. From the data provided it is noticed that three to four generations of graduated doctors have left. Based on statistics it is evident that the avulsions became more visible after 2014, when more than 150 specialist doctors were moving away.
President of the Order of Doctors, Dr. Fatmir Brahimaj said that the emigration of doctors is a phenomenon that all Eastern and Southeastern European countries have been lately experiencing. The Order of Doctors has highlighted a number of reasons why medical professionals are choosing to depart the country, like finding a better material and moral appreciation, as here the Doctor’s public figure has been degraded, and they have been experiencing a moral and trust crisi on behalf of the public. They are in search of better qualifications opportunities, better working conditions with less work volume, a more updated technology with more and better equipment to help them diagnose patients more accurately and treat them efficiently.
Brahimaj pointed out that more than anything the health public sector is suffering a moral and trustworthiness crisis on behalf of society. This crisis has been exhibited in its extreme forms recently, such as violence. Within a month three doctors were violated, their life was risked while they were practising their lawful obligations. The Together for Life Association which is financially supported by the Friedrich Ebert Foundation Tirana, conducted a study at the end of last year by questioning 1000 doctors about the causes of their departure from Albania. The findings of this study show that doctors’ removal remains a worrying factor, which is experienced by 78 percent of doctors, 24 percent of whom are ready to leave immediately, while 54 percent would leave if they were granted the opportunity.
The study notes that the most problematic situation is presented at university centers where doctors have the greatest tendency to leave the country immediately at 54 percent, while the lowest is in municipal hospitals, but the sample from these hospitals is smaller. There is a tendency of departure from doctors with scientific degrees, 40 percent of whom consider their departure from Albania crucial. Of the major causes that physicians are urged to go to another country are work gravity, financial support, and better working conditions. Most doctors complain that they have shortages in services, 26 percent of whom claim shortage in all services and 60 percent in some of the services. It is worrying that those who complain the most about absenteeism are doctors in university hospitals, 56 percent of whom claim shortages in all services. Doctors in this country feel unhappy, overworked, undervalued, and stressed.
According to the study, the funding of the system, the deficiencies in managing the health system and the lack of financial security, result to be the main causes that affect the dissatisfaction of male doctors. Meanwhile, female doctors consider the financing of the health sector and system bureaucracies more problematic together with the lack of financial security (monthly wages). In fact, 71 percent of doctors complain about the fact that physicians are being criticized more than they should in Albania. Economic and professional reasons occupy the first place for why physicians want to leave them from Albania. Only 1 percent of doctors say they’d leave due to judicial reasons. It is noted that the number of female doctors who want to leave for economic, professional and judicial reasons is higher than that of men. 50 percent of doctors think that the future in Albania is not safe. Asked what their dissatisfaction with the health system (response to many alternatives), it results that 42 percent of doctors are dissatisfied with system funding, 37 percent are dissatisfied with poor system management, 36 percent are dissatisfied with lack of of financial security, and 33 percent of them are dissatisfied with system bureaucracies.
Trust crisis and increased violence
A survey from the Order of Doctors conducted last year found that around 40 percent of respondents felt violated in the exercise of duty. Psychological violence was more widespread. Order president Fatmir Brahimaj said that violence against doctors is emerging at a higher intensity this year. The health sector is experiencing a moral crisis beyond reality in Albania. The survey data on violence against doctors indicated that in five districts the predominant response is that violence is professed and in other regions 30 percent of doctors claimed to face violence. It is noticed that violence is mainly exercised by other persons, specified by doctors such as: family members and relatives of the patient, from colleagues, service/institution chiefs; but there are patients who also profess verbal and psychological violence against doctors. It has been noticed that violence is induced in both sexes, but women seem to be more exposed.
The survey found that most exposed doctors are family doctors, surgeons, pediatricians, obstetricians-gynecologists and emergency doctors. It is found that the perpetrators, in a good part, are unknown to the doctor who is violated. It is reported for psychologically damaged aggressors, but also on drugs and mainly alcohol dependency. Generally doctors report that they have no consequences from the violence exerted on them, but in some cases serious injuries are reported, or even decline in the desire to work, fear, stress, insecurity, and violation of dignity.
Regarding the assistance provided by private police, doctors in most cases comment that it does not interfere, while the State Police has responded in time to the majority of cases. Doctors report that there is no security coordinator in the institutions and cases of violence are reported to their superior, institution chief or the police calls; in some rare cases to the Ministry of Health, too. Albanian doctors think they are more prejudiced in their profession than their peers in other countries, while they work with a greater workload and lack of infrastructure. The survey from the Order of Doctors indicates that there is a need for increased safety in health institutions, especially in the Emergency and Intensive Care Service, and that security cameras should be installed. In exchange for greater security, doctors have asked for placement of police posts in hospitals and private police in health centers so they can intervene and manage the situations of violence.
Demand for doctor creates departure opportunities
In recent years, emigration has been facilitated by the unification of their education level in many countries (1,000 hours per year, for six years of university). Also, the recognition of titles from bilateral or multilateral agreements within the EU is facilitated in the field of medicine. Doctors want to do good medicine and this guarantees the good working conditions that are not offered in Albania. In 2010, the World Health Organization adopted the practice of recruiting health personnel. Today, their movement has made, for example the Zurich Hospital to have 40 percent of its young doctors as foreign. Germany, Britain and Belgium are also seeking foreign personnel. The countries of the East have fallen prey to this process, from where the doctors are moving to the West because of the high pay gap and working conditions. Brahimaj said that Albania has fallen prey to this process, so the government must take measures to contribute in improving the working conditions and increasing wages. The situation will improve with the increase in the number of students in Medical Universities and the increase of quotas for specialists, which were blocked for a period of time. Brahimaj said that doctors’ specializations should be simplified and formal recruitment of foreign doctors should be considered. Brahimaj said that during the last year 35 foreign doctors requested a certificate from the Order of Doctors to work in Albania.
Albania is invaded by diseases
The transition period has adversely affected the health of the population for some diseases such as cancer, cardiovascular and mental health, whose prevalence is increasing year after year because of the wrong food regimes, lack of physical activity and the country’s quick urbanization. Last year, one out of five women and one in six males aged 15-59 reported being diagnosed with at least one non-transmissible disease (hypertension, neoplasms, diabetes etc), according to findings of the joint survey for “Demography and Health” developed during 2018 to 15,800 people from the Public Health Institute and the Albanian Institute of Statistics (INSTAT). The research on the population’s health status showed that morbidity in our country is under-diagnosed especially for cardiovascular diseases and depression.
The prevalence of cardiovascular disease and cancer in the country is increasing. According to official data in 2017 they accounted for 70 percent of deaths in the country, while in 2008, these diseases were responsible for 52 percent of lost lives. The trend of hypertension in Albania has deteriorated for males and females in the last 10 years. According to the 2018 survey, the prevalence of hypertension is 24.3 percent for women versus 20 percent in 2008. For men it has increased by about 10 percentage points compared to 2008. Fier county has the highest number of males with hypertension.
The survey found a severe state of mental health. About 70 percent of respondents said they had experienced depression during their life. Of these, 13 percent of women and 18 percent of men aged 15-59 were depressed two weeks before the survey. 2018 data on population health show that obesity has further increased for women. The percentage of overweight or obese men was 53 percent in 2018, the same as in 2008, while the percentage of overweight or obese women increased from 39 percent in 2008 to 45 percent in 2018. The experts of the Public Health Institute state that the challenge due time is to reduce the risk factors that are mainly related to nutrition, diet and physical activity, paying particular attention to girls and women, while a slight decline in tobacco and alcohol consumption has been noted. The study on population health evidenced that Albanians are not regular consumers of fruits and vegetables and do not exercise physical activity.
Moreover, data from the global portal www.healthdata.org show that by the end of 2016, Albanians had the highest burden of disease in the region, as well as the highest mortality for each diagnosis. Albania ranks in the red zone for premature deaths, which were above predictions. Mortality from ischemic heart disease in Albania is the highest in the Southeast European region referred to the Global Burden of Disease, and tumors are also increasing. Apart from the scary figures of increasing the morbidity level, Albanians have moved forward with longevity. By 2016, life expectancy at birth was estimated to be 76.1 years for males and 79.7 years for females. In 1990, life expectancy for women was 71 and for men 67 years. But experts at the Public Health Institute claim that the increase in life expectancy is related to improving the level of living in the Albanian population, but on the other hand, the increase in the burden of illness indicates a high level of inequality and a higher level of diagnosis.
Doctors explain that the respiratory diseases that are the third cause of death in the world, but also in Albania, have advanced the treatment, significantly increasing the life expectancy for the patients of this category. Two decades ago, lung diseases caused premature deaths at the beginning of the third age. But early diagnosis and advancement of medical treatment makes it that this category of patients has greater life expectancy. But the situation is seen to be exacerbated by the increase in cancer cases. Figures show that in recent years there is an increase in tumor cases, especially in younger ages. Those tumor types that were characteristic of old ages have descended to young ages. Women are more and more affected by breast and uterine cancer, while men from the prostate. Oncology sources claim that cancer cases have doubled in recent years and the statistics are not accurate.
(This article appeared on print on April 12)
