Doctors’ exodus makes Albania’s healthcare system more vulnerable

Doctors’ exodus makes Albania’s healthcare system more vulnerable

By Ervin Lisaku TIRANA, Jan. 15 – Albania has been facing an exodus of doctors in the past few years, making the country’s healthcare system, already facing one of world’s lowest number of doctors, even more vulnerable. More than 500

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Evidence points to heavy clientelism in Rama’s public administration

Evidence points to heavy clientelism in Rama’s public administration

TIRANA, Jan. 15 – Serious Crimes Prosecution Office investigations on former head of Prisons Arben Cuko which were made public on Monday by the Voice of America tore down the facade of public competitions by exposing how local officials, Socialist

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Albania’s PM Edi Rama to assume role of foreign minister

Albania’s PM Edi Rama to assume role of foreign minister

TIRANA, Jan. 15 – Albania’s Prime Minister Edi Rama announced on Monday following President Ilir Meta’s rejection of 26-year-old, Kosovo national Gent Cakaj as the country’s new foreign minister, that he will be temporarily assuming the role.   “The President

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Clash between media and gov’t as state institutions deny favoring DH Albania

Clash between media and gov’t as state institutions deny favoring DH Albania

FOLLOW-UP TIRANA, Jan. 11 – After the Voice of America raised allegations that state institutions had favored DH Albania in winning the government tender for the construction of a lot from the Great Ring road project, Albanian authorities claimed the

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Shell’s new Albania oil search plans met with resistance

Shell’s new Albania oil search plans met with resistance

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Evidence shows gov’t institutions helped DH Albania win Great Ring project tender

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Editorial: A foreign minister that cannot be the face and the voice of Albania in the world

TIRANA TIMES EDITORIAL The newly appointed Minister for Europe and Foreign Affairs of Albania, the 28 years old boy from Kosovo who has three Bachelor degrees and two masters, cannot represent Albania in the world. He cannot be the face

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Albanian President rejects new foreign minister

Albanian President rejects new foreign minister

TIRANA, Jan. 10 – Albania’s President, Ilir Meta, rejected on Wednesday evening Prime Minister Edi Rama’s proposal to appoint 28-year-old, Kosovo national Gent Cakaj as the new foreign minister, creating a new rift in the President-PM relationship. In a public

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Corrupt district judge’s arrest highlights need for all-inclusive justice reform

Corrupt district judge’s arrest highlights need for all-inclusive justice reform

TIRANA, Jan. 9 – Albanian investigative TV show Stop published a video on Tuesday showing Fier judge Roland Hysi receiving monetary bribes and asking for sexual favors from a divorced woman in exchange of granting her daughter’s custody, proving the

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The Prime Minister burns down his house

The Prime Minister burns down his house

NEWS ANALYSIS  In an unprecedented move which was planned to shock and awe, the Prime Minister used the last days of 2018 to bring down his cabinet, removing and replacing the key members of his cabinet. The change in the

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                    [post_content] => By Ervin Lisaku

TIRANA, Jan. 15 - Albania has been facing an exodus of doctors in the past few years, making the country’s healthcare system, already facing one of world’s lowest number of doctors, even more vulnerable.

More than 500 doctors are reported to have left the country in the past few years, mainly heading for Germany, Europe’s largest economy, which has eased work procedures for medical staff coming from the Western Balkans as it tries to fill the huge gaps in its healthcare system.

The current numbers represent about a tenth of total number of doctors in Albania, but what’s worse is that an overwhelming majority of medical staff working at the country’s public and private hospitals would be willing to leave the country if they were offered an opportunity, leaving the country’s vulnerable healthcare system without key experts with decades of experience.

Many hospitals outside Tirana and healthcare facilities at remote areas in Albania already face shortage of specialty and even family doctors, leaving thousands without access to basic service and emergency health problems.

Monthly bonuses of up to €2,000 a month for working outside Tirana and in remote areas suffering shortages of specialty doctors since early 2018 have not been much appealing and facilities like the Dibra regional hospital, north of the country, continue redirecting their patients to Tirana, which becomes quite difficult in winter due to heavy snowfall that often makes helicopter transportation the sole opportunity to save lives.

Albania currently has only 1.2 doctors per thousand residents, in one of the lowest coverage rates comparable only to war-torn countries.

The Balkan country has regularly lost medical staff since the early 1990s following the country’s transition to democracy and a market economy following decades of a hardline communist regime and a planned economy.

However, the brain drain has sharply picked up in the past five years following a relaxation in procedures by Germany due to its huge needs for medical staff, mainly nurses in homes for the elderly.

“Germany has relaxed the doctor-recognition procedures. They accept them from all Balkan countries, though they first have to work in a rural area and undergo training,” says Dorina, an Albanian PhD holder in medicine as quoted at a recent brain drain study commissioned by the UNDP office in Albania.

“Almost 30 percent of students that completed studies in the same year as me have gone to Germany. Each year, around 180 doctors graduate [in Albania], and in the last 3–4 years around 30 percent have emigrated to Germany. This is, regrettably, a very high percentage, because there has been a six-year investment for these doctors,” she adds.

 

Almost everybody wants to leave

Doctors and nurses are among certain groups of mostly younger-age professionals such as engineers, IT specialists, legally leaving the country and heading mainly to Germany following a wave of ungrounded asylum-seekers of mainly non-qualified Albanians that have either voluntarily come back or been repatriated after overwhelmingly having their asylum applications turned down since 2014.

The situation is especially concerning among Albania’s poorly paid medical professionals, more than three quarters of whom say they are willing to leave the country if given the opportunity, according to a recent survey by a local Albanian NGO.

A survey with 1,000 doctors nationwide, including private hospitals, showed around a quarter of surveyed staff say they would immediately leave the country. Another 54 percent said they would consider leaving if they were given an opportunity and only 19 percent said they would continue working at home.

The situation is no better at the private sector offering better wages and working conditions where two-thirds of doctors say they would consider leaving the country, according to a study conducted in mid-2018 by Tirana-based ‘Together for Life’ association with support by Germany’s Friedrich Ebert Foundation.

The situation appears more alarming in the region of Durres, the country's second largest, and in the northern Lezha and Dibra regions where only 5 percent of surveyed doctors are willing to continue working at home.

Albania’s public healthcare system is perceived as one of the most corrupt, with bribes to doctors and nurses to get faster and more careful treatment having become quite normal practice and culture that is little denounced.

 

‘Certificates of good standing’

Some 762 doctors were issued certificates of good standing from 2013 to 2017, among whom 94 specialty doctors in documents that are issued upon doctors' request when attending post-graduate studies abroad or looking for a job outside the country, according to the Order of Albanian Physicians, the authority that issues the certificates.

However, in late 2018, a deal between the health ministry and the Order of Physicians put an end to the issue of ‘certificates of good standing’ for doctors that are already under contract in a bid to stop the brain drain from Albania's healthcare system.

The average departure of doctors from the country, including experienced ones, from 2013 to 2017 was at 190 annually, a figure considerably higher to the average 150 graduates a year produced by the University of Medicine in Tirana, the sole public higher education institution offering studies for family and specialty doctors in studies that last between six and eight years.

Bigger in numbers and with wages almost half of what doctors receive, nurses are also more willing to leave the country.

German Dekra Akademie says it has been offering free German language courses and training for hundreds of nurses in Albania during the past three years, managing to take up to 1,200 nurses to Germany where they mainly work in homes for the elderly, earning around €1,300 a month.

Around a thousand other nurses are currently receiving training throughout the country.

 

Reasons for leaving

Low job income, poor working conditions, few opportunities for career development, exposure to political pressure, verbal and even physical violence are some of the reasons that drive doctors to abandon Albania’s public sector, sometime even to work for private hospitals offering much better wages and working conditions.

Albania's Order of Physicians says frequent legal action against doctors charged with carelessness and negligence also has an impact on the decision to leave, with doctors often ending up in prison, fined or having their licence revoked.

"Some 20 doctors were sentenced to prison in 2015-16 in Albania at a time when there were only three sentenced in the US where the number of doctors is 70 times higher compared to Albania. In addition, there are many doctors facing charges and a lot of others that have been fined," Fatmir Brahimaj, the president of Albania's Order of Physicians has said.

Doctors have appealed for new provisions to divide human error from negligence in treatment, the latter punished by fines or imprisonment of up to five years for negligence in treatment.

A negative perception on doctors has reduced patient confidence in the Albanian health sector, increasing pressure and insecurity among doctors, the doctors’ departure study shows.

Germany which has considerably eased procedures for medical staff from the Western Balkans is no surprise as the top destination for those wishing to work abroad with a 26 percent share.

Another 20 percent say they would prefer moving to the UK and 13 percent to Nordic countries.

Due to tight procedures for being hired in the local healthcare systems, Italy and Greece, home to around 1 million Albanian migrants, are not among the top three destinations.

Around a quarter of surveyed doctors say they constantly feel under pressure, disrespected and dissatisfied at their workplace and often face work overload.

Albania has more than 5,800 doctors, of whom more than half, some 3,347 working in the region of Tirana, home to the country's sole tertiary healthcare facility and several private hospitals.

A third to half of doctors say they are dissatisfied with the poor financing of the healthcare system, the system's weak management and bureaucracy.

Albania's healthcare system receives only around 3 percent of the GDP in government funding, some €360 million, in a budget that is insufficient for the system’s huge investment and staff needs.

Around three-quarters of doctors in the country believe they are unfairly highly criticized. Two-thirds fully or partially agreed with the statement that the "practice of not declaring their cash gifts with authorities is tough, but financially understandable."

Doctors say their wages have to increase by 30 to 100 percent in order to turn down bribes or cash gifts by patients. Current net wages that doctors receive are at around €500 a month, considerably above average wages, but almost half of what MPs, judges and prosecutors or other senior officials get.

Around half of doctors perceive their Albania future as uncertain. Women doctors are more prone to leave the country.

Doctors are also dissatisfied with the work culture in the country's healthcare facilities such as lack of respect, inefficient communication, poor team work and insufficient efforts for their professional development.

 

An inefficient system

"Albanian authorities do not assume responsibility, but simply put the people against doctors. Patients don't pay insurance, they bribe and the government accepts that doctors get bribed and not have their wages increase,” a Tirana obstetrician is quoted as saying on condition of anonymity.

“At a country where there is no rule of law, you face the population's pressure and doctors are suffering from this system. There are endless physical conflicts and doctors keep silent. In some case they receive media coverage and in other go silent. The pressure is a result of inappropriate functioning of the system," he adds.

Another doctor blames lack of transparency and ill-guided investment.

“There is lack of transparency. We really have a small budget, but even that small budget is not consulted with doctors on how it is going to be spent and there is no vision with investment and continuity with health policies," a Tirana kidney doctor is quoted as saying.

A cardiologist in Durres says departures are an issue related both to finances and dignity as the money they get is not enough to make ends meet for their households and bribes don't make them feel good.

The study suggests investment in the health infrastructure, the review of the legal framework on medical errors, more opportunities for professional and academic growth, improving the internal management at healthcare facilities, and engaging Albanian doctors working abroad more in the country's public health sector.

 

‘Quit Germany plans, earn more at home’

Prime Minster Edi Rama has downplayed exodus concerns saying the country has new doctors willing to get a job and invited doctors to work outside their residence areas to earn more through bonuses of $2,000 to $2,500, in income which he says is much better compared to Germany where most Albanian doctors and nurses are heading to.

"Everybody who contributes out of their residence areas will get paid the same as they started working in Germany. Doctors serving outside Tirana as experts will get their standard wage and a bonus of $2,000 to 2,500 a month. Taxes here are much lower than in Germany and what you have at the end of the day here is much better," Prime Minister Rama said in late December 2018, announcing the employment of 300 new specialty doctors for 2019.

Tritan Shehu, a doctor by profession who served as former health minister for the now opposition Democratic Party says “doctors find themselves out of a system that fails to guarantee them the appropriate technical and scientific level, qualifications, technology, the pharmacological ‘arsenal,’ literature, income and dignity and that the collapse that is knocking on the door requires fundamental changes in the whole system and not only facelifts.”

 

 A push for migration

Lack of proper healthcare, together with the low quality of the education system and poor income at home are the primary reason why Albanians migrate away from their native land, surveys show.

Albania has around 1.2 million migrants abroad, almost 40 percent of its 2.8 million resident population, making it one of the countries with the highest per capita migration around the world, with a series of social and economic consequences for the country’s future prospects.

Experts says Albanians are mostly leaving the country because of economic reasons, looking to escape poverty in their homes, but also to integrate into leading European economies and take advantage of better education, health and social protection infrastructure for their families.

Albania’s public health sector is perceived as one of the most corrupt and inefficient sectors, with patients often choosing to get treated at private hospitals in the country or go abroad.

Albanians are estimated to spend about €60 million annually in private hospitals and clinics whose number has significantly increased in the past decade.
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                    [post_content] => TIRANA, Jan. 15 - Serious Crimes Prosecution Office investigations on former head of Prisons Arben Cuko which were made public on Monday by the Voice of America tore down the facade of public competitions by exposing how local officials, Socialist Party MPs and, in one case, even Prime Minister Edi Rama’s own cabinet, hamper a fair employment process by encouraging clientelism.

Intercepts show how on April 30, 2018, Cuko received a phone call from Rama’s cabinet as requested by cabinet chief Vali Bizhga for one female’s employment. 

Under surveillance by the serious crimes prosecution, Cuko confirmed he had signed the female’s employment papers that same day.

“I spoke to Mrs. Bizhga half an hour ago and told her that Vitjona was working,” he is quoted having said in the transcripts. 

Voice of America evidence ensured by the prosecution’s own interceptions and exchanged messages prove that similar employment-related or employee transfer-related phone calls were a substantial part of Cuko’s work description.

Local officials, SP lawmakers and local elected officials were intercepted shifting influence dynamics and asking for employment favors or employees’ transfers within the prisons’ system based on political and personal ties, instead of meritocracy.

Interceptions also exposed how a massive recruitment competition at the Prison Police turned into an employment campaign for SP supporters or people tied to power - a widely-spread phenomenon in Albania’s public administration which the SP claimed to fight.

Cuko, ex-commander at the Guard of the Republic and a former SP MP, ended up at the top of the prisons’ system in July 2017, but only months later he was included in the prosecution’s investigations due to his phone communication with criminal group members for a convict’s transfer.

He was dismissed without making it a year in office and, in October 2018, he was arrested under corruption charges by the serious crimes. 

Cuko has denied the charges and is currently under house arrest.

The Serious Crimes Prosecution Office confirmed that the employment procedures of the prison system in Albania are under investigation, but one of the case leaders was reserved in commenting whether people under suspicion of exercising unlawful influence had been questioned. 

Bizhga herself has admitted the phone conversation during an interview with Voice of America, justifying her mediation as a favor to the Mother Teresa missionaries of charity sisters. 

Her statements were also confirmed by Sister Theresa Maria of the Tirana-based mission, who claimed to have asked Bizhga for help during a meeting at the PM’s Office, which she called privately.

The VoA writes the PM’s press office has declined requests to comment on the prisons’ recruitment process up the time the article was published.

As per common practice, Rama instead responded to the VoA article through a tweet, in which he said VoA had “fallen” to the standards of Tirana’s "garbage bin journalism" by defaming people based on “phone chats.”

“Go check the competition documents with the recruitment results, then slander away! You remembered the party appointments in the administration 30 years later and by grossly , and not professionally, attacking exactly those who are doing their best to curb the phenomenon,” Rama wrote. 

 

VoA: Clientelism in Albania runs strong 

The division of job positions in the country’s public administration based on political ties instead of meritocracy is a problem that has followed Albania’s transition closely. Public administration reform is another pre-condition for membership to the EU, whose latest progress report called for further steps in securing an efficient, depoliticized and professional administration.

Building a non-political administration is also one of Rama’s main campaign promises - during his 2017 campaign, Rama blamed then-allied Socialist Movement for Integration Party for political employments and promised changes.

However, the Cuko surveillance tapes prove these promises are deeply hampered by a system built on clientelism and exercised influence by officials of all ranks and levels.

The prosecution’s surveillance tapes uncovered other names in addition Bizhga, such as the head of the Laws Commission Ulsi Manja and SP lawmakers Klodiana Spahiu, Blerina Gjylameti and Paulin Sterkaj. Much more influence has been exercised by local officials and employees. 

Bizhga explained during her Voa interview that Mother Teresa missionaries has asked for help for 15 recent graduates coming from vulnerable families and experiencing difficulties in finding a job, adding she had felt bad during the meeting and had forwarded their CV-s to the National Employment Service.

According to VoA, the female mentioned in Cuko’s conversation - 30-year-old Vitjona Dervishaj - was also present in the meeting and insisted for a spot at the public administration as, according to Bizhga, her father was a Prison Police employee who had died on duty and whose colleagues had promised her his job position.

Bizhga insisted she had simply put in a word to enable Dervishaj access to the public competition, which is either way open to anyone who is qualified, not to ensure her a job position. Asked whether she had deservingly won the competition, Bizhga said she had not followed the process closely.

Meanwhile, Sister Teresa Maria, who was reached through phone, said she had asked for the meeting at the Prime Minister’s Office out of necessity and that only Dervishaj had been assisted - although not in the position she requested - while the rest of the graduates had “wandered from one employment office to the other.”

Concerning Manja, the interceptions showed him asking Cuko to transfer one prisons’ employee from Kruja to Tirana, and similar favors were recorded coming from Durres MP Klodiana Spahiu.

Similarly, Blerina Gjylameti is mentioned in a conversation between Çuko and a third person, for interfering in the employment of a person associated with the SP, while Paulin Sterkaj is heard complaining about the transfer of a police officer from Tropoja, from the Ali Dem area 313 prison.

Gjylameti and Manja have answered to VoA allegations by saying they cannot give comments regarding an ongoing penal investigation and prior to the comments of the competent legal bodies.

 

The competition facade 

The penitentiary system in Albania consists of 23 correction facilities and counts a considerable number of employees, both in the police and administration. For both categories, recruitment procedures are conducted through public vacancies.

However, according to VoA a mass recruitment public competition turned into an employment campaign for SP militants and people tied to power.

The public competition for positions as policemen was announced late last March and aimed to recruit more than 250 employees for 17 penitentiary institutions in Albania. The examination was conducted on April 3 and the call was answered by more than 1300 candidates.

Exposing the facade, Cuko was heard complaining by mid-April that the entire process was blocked by the PM and that the candidates belonged to SP lists.

“Everything is blocked by the prime minister and I don’t know when it’ll be unblocked,” Cuko said on April 14th. "I expect to be told tomorrow afternoon who I will take, from number one to 250.”

Further on, Cuko is heard telling the person on the other end of the line that “Lushnja has no longer vacancies, Fier has 20 and they have brought 200 people. 1358 people were tested and they all belonged to party lists. They were clear that they will just put them in the prison system.”

Intercepts also highlight cheating on the testing process, where results are manipulated to favor candidates brought from the SP. 

“We will also go over the whole procedure faking that she won and all the rest of them lost. 217 people came to me, supposedly from the famous public contest,” Cuko is documented saying.

The Cuko files are not the first in the prison system, nor in the public administration as a whole. In June 2017, shortly before the general elections, the Ministry of Justice denounced LSI officials in Shkodra for fictitious employment in the still unfinished at the time Reci prison.

Whereas in March 2018, the Commissioner for Civil Service Oversight submitted to the Albanian assembly a report according to which 1/3 of public administration employment is made by order of title and outside of the law procedures.

 
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                    [post_content] => TIRANA, Jan. 15 - Albania’s Prime Minister Edi Rama announced on Monday following President Ilir Meta’s rejection of 26-year-old, Kosovo national Gent Cakaj as the country’s new foreign minister, that he will be temporarily assuming the role.  

“The President did not decree the foreign minister’s dismissal within his constitutional deadline. In line of the many violations that the new Constitutional Court will inspect. Until that day that is soon to come, I will be in the position de jure because we don’t have time to lose searching for the president,” Rama tweeted. 

During the weekend, the clash between Rama and Meta escalated, as Meta said the country’s foreign ministry can’t be turned into a “driving school,” while Rama called Meta’s decision to reject Cakaj “a masquerade.”

Speaking through a Facebook post, Meta stated on Saturday that "today, during these important moments of our regional challenges, Albania's Ministry for Europe and Foreign Affairs can not turn into a driving school where the master seeks to teach the “genius” how to change the borders of the entire Western Balkans.”

According to the president, both the Socialist Party and the state have the capacity and right diplomats who can guide the country’s foreign policy, thus pointing again to Cakaj’s young age and lack of experience.

In turn, Rama responded by posting a tweet saying he will no longer deal with a “Constitutional kidnapper at the president’s office,” while adding that “the new Constitutional Court will put an end to this masquerade.”

The government has considered Meta’s decision not to sign current foreign minister Ditmir Bushati’s dismissal without offering any explanation unconstitutional, marking another precedent regarding the powers of the Head of State in relation to appointing and dismissing cabinet members.

Meanwhile, Bushati has so far continued to be in office and this week he is scheduled to hold two important meetings in Tirana, where he will be hosting the Italian Foreign Minister as part of the OSCE Troika along with Slovakia and Albania. Another visit is also expected by the Foreign Minister of the Netherlands.

However, on Monday, local media also reported that Bushati had canceled his own scheduled meetings abroad, which included meeting German homologue Heiko Mass and the chief of the European Union’s Foreign Policy Federica Mogherini.

Last Thursday, in a public letter directed to Rama published by Meta himself, the president addressed Albania’s upcoming OSCE presidency as part of the Trojka organization, its expectation to open accession negotiations with the EU and the need to take the normalization talks between Serbia and Kosovo further, and wrote the country doesn’t have the time to experiment with the young deputy minister’s knowledge.

Although Rama has bluntly disagreed with Meta’s decision, a number of local experts and political actors supported Meta’s decision and even dubbed it as a second chance for Rama to give the leadership of the country's diplomacy to someone with more experience. 

 
                    [post_title] => Albania’s PM Edi Rama to assume role of foreign minister 
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                    [post_date] => 2019-01-11 16:07:47
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                    [post_content] => FOLLOW-UP

TIRANA, Jan. 11 - After the Voice of America raised allegations that state institutions had favored DH Albania in winning the government tender for the construction of a lot from the Great Ring road project, Albanian authorities claimed the licenses for DH Albania were issued in compliance with legal procedures.

The information was published via a three-page letter from the Technical Secretariat of the Special License Committee, and argued DH Albania had submitted all necessary documentation in respect of all the deadlines before it was issued a license.

Meanwhile, VoA has so far defended its investigation, and on Friday it called on state authorities to prove their claims with facts, which, according to the international media organization, state authorities still haven’t done.

Since the DH Albania scandal was made public, Albanian officials have tried to justify their themselves in their reactions by claiming it is impossible to verify whether the documents submitted for tenders are forged or not. The reactions so-far lack accountability for these easily-verifiable violations,” VoA writes.

News 24 TV-show “The Unexposed,” uncovering how US offshore Dunwel Haberman had falsified its founding act and the signature of the Delaware Secretary of State to prove it had not legal issues in the US, also uncovered how DH Albania, its official branch, had won two government tenders mounting up to 30 million euros in the past year.

A number of media - including "The Unexposed" host and journalist Ylli Rakipi, who was threatened two weeks after the scandal broke out - have further alleged that behind DH Albania is not its legal executive - 28-year-old, inexperienced Avdjol Dobi - but Albanian oligarch Bashkim Ulaj. 
                    [post_title] => Clash between media and gov’t as state institutions deny favoring DH Albania
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                    [post_date] => 2019-01-11 15:52:54
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                    [post_content] => By Ervin Lisaku

TIRANA, Jan. 11 – Exploration surveys that oil giant Shell is planning to conduct during this year in a southern Albanian region have triggered concerns among some local government officials who fear local protected areas and tourism prospects could be hampered.

In a public hearing that the global oil giant held this week in Gjirokastra, a UNESCO World Heritage site in southern Albania, Shell’s ambitious plans to search for oil and gas in the county of Gjirokastra were met with resistance by local government officials of the Libohova municipality, one of the seven Gjirokastra municipalities were Shell is going to search for oil and gas this year.

The British-Dutch multinational oil giant, already engaged in some major oil exploration projects in Albania, is planning to initiate a seismic survey in the second quarter of this year in the southern Albanian county of Gjirokastra, investigating geological structures and their potential for exploration of petroleum, natural gas and mineral deposits by using explosives or specialized trucks.

The Zagoria national park, part of the Libohova municipality in the county of Gjirokastra, is among the affected areas.

Ilia Kuro, the deputy Mayor of the Libohova Municipality, says that the seismic survey that Shell plans to carry out at the Zagoria nature park could have severe consequences for the local fauna and flora.

"There is a government decision that has designated Zagoria as a national park. We will either have tourism or oil and gas extraction. The Shell interventions will have consequences for the local flora and fauna causing damage to it," Kuro is quoted as saying by local Libohova Online portal, questioning the legality of oil exploration in a protected area.

Located about 35 km east of Gjirokastra, the Zagoria park has been a protected area since 2015 and in May 2018, the whole area was declared a nature park by the government for its unique ecosystem and rare animals such as the brown bear and the wild goat and pig that breed there.

A Zagoria administrator said the local government unit is not even allowed to use concrete for the pavement of local streets due its protected area status.

"We asked for the reconstruction of a 500-meter street with concrete this year, but were not allowed because it's a protected area and we are now talking about the use of explosives," Akile Puleshi, a local Zagoria official, is quoted as saying.

A hilly area with only few hundreds of residents, Zagoria has been recently emerging as an adventure travel destination, with tour operators offering ‘travel back in time’ horse riding tours.

 

‘Minimal impact’

Shell’s Albania representatives have assured the environmental, social and health impacts during the seismic survey that could last up to six months will be minimal.

"The residual impacts from the proposed seismic survey activities, – which are mobile and transient operations over a six months period, are mostly likely to be low and insignificant overall," says a Shell-commissioned environmental assessment conducted by AECOM, a US-based engineering and environmental consultancy.

"In the unlikely event of fire, explosion or major fuel spill, the impacts on the environment and communities may remain significant. Shell Upstream Albania’s preparedness to deliver the emergency response to respond to such unlikely events (fire, explosion, spills) will ensure that impacts are prevented and minimized," the report adds.

Shell plans to drill around 3,000 shot holes and place small (1 to 4kg) non-toxic degradable explosive charges during its seismic survey in Gjirokastra in a bid to identify possible locations of future potential drilling as part of its newly acquired onshore Block 4, southern Albania.

Shell assures buffer zones of up to 200m will be provided to protect cultural heritage monuments where no explosive or specialised truck activities will be undertaken as part of its mitigation measures and a 50m buffer zone will be adopted for natural monuments with the exception of Zagori and Zhej, both protected areas in Gjirokastra.

Shell says the project is expected to create positive effects through the employment of local residents and use of accommodation, goods and services by a staff of around 200.

“Key social and health impacts relate to the access and use of the land by project activities in areas used for cultivation or grazing, the potential development of or use of worker accommodation within villages, potential damage to buildings and disturbance from seismic survey activities, the potential for excessive use of community water sources and medical facilities, and the risk of disturbance created by project workers or traffic,” says the environmental assessment report.

 

Shell’s ambitious Albania plans

Albania expects good news from Shell’s oil exploration operations in the country and is hopeful the British-Dutch multinational oil giant will soon engage in oil production that could give a boost to Albania’s oil industry and much-needed foreign direct investment at a time when two major energy-related projects are set to complete their investment stage by the end of this year, leaving a huge gap in Albania’s FDI.

Albania is one of the few countries where Shell did not suspend its oil exploration operations following the mid-2014 slump in oil prices.

Last year, Albania concluded an oil exploration contract with Shell that will see the oil giant invest another $42.5 million over the next seven years in southern Albania, making it one of the few big Western investors with a presence in Albania. In case of oil discovery in Block 4, the development/production contract will be valid for 25 years with an option of renewal, according to the Albanian energy ministry.

The oil giant has included Albania on its map of more than a century-old key discoveries thanks to its early 2013 Shpirag 2 oil well discovery, in the southern region of Berat, in excess of 800 million of oil and flowing at rates of 800 to 1,300 barrels of oil per day.

The Albanian government says the contract with Shell is the first in the oil sector that enables the country to earn a portion from the first oil production in addition to the mining royalty.

The oil industry produces Albania’s second largest exports and employs more than 3,000 people, but what the Albanian government gets from exports is only a 10 percent royalty tax as no company currently pays the controversial 50 percent corporate income rate, which under current contracts, concessionaires start paying once they meet investment costs.

Most oil extracted in Albania is exported as crude, making it a low value added product and a portion of it goes to a local refiner which has changed hands several times following its failed 2008 privatization.

Bankers Petroleum, the country’s largest oil producer which in mid-2016 was fully acquired by China’s Geo Jade, accounts for the overwhelming majority of 90 percent of total domestic oil production.

Brent crude oil prices currently stand at $60 a barrel, having dropped from a three and a half-year high of $80 a barrel last October, with a negative impact on the country’s oil industry and new drilling plans.
                    [post_title] => Shell’s new Albania oil search plans met with resistance 
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                    [post_date] => 2019-01-10 20:28:44
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                    [post_content] => TIRANA, Jan. 9 - New evidence made public on Wednesday show the company DH Albania - which won the government tender to build one lot of the Great Ring road currently under construction by using falsified documents of US offshore company Dunwel Haberman - was favored by the Albanian administration, which issued a construction license prior to the company’s registration at the National Business Centre.

News 24 TV-show “The Unexposed,” uncovering how US offshore Dunwel Haberman had falsified its founding act and the signature of the Delaware Secretary of State to prove it had not legal issues in the US, also uncovered how DH Albania, its official branch, had won two government tenders mounting up to 30 million euros in the past year.

So far, in all public appearances, the country’s Prime Minister Edi Rama has insisted this was a case of company fraud and, cancelling the tenders, parallely began a constitutional investigation.

“You can find companies that enter tender competitions using falsified documents everywhere in the world. A government, a minister, a ministry, should not be judged on whether a company enters the race with falsified documents. They are judged based on how they act when the facts are unveiled. Concerning this case, where is the corruption that has happened?” Rama said at the end of December, speaking about DH Albania.

However, information gathered by the Voice of America testify that Albanian institutions were put to the company’s full service, even in violation of laws and regulations.

According to an official response the infrastructure ministry issued to VOA’s information request, it results that "DH-ALBANIA Company, branch of the foreign company, with its request dated 13.07.2018, accompanied by the relevant documentation, has applied to have its foreign license recognized in the field of construction.”

The infrastructure ministry’s website also states, in the listed documentation necessary to recognize foreign licenses, that is is required for companies to submit proof of registration at the NBC, which among others proves the tie of the still-unlicensed company with the mother company and its active status, among others.

However, on July 13, when the application was made, DH Albania was still an non-existent company. Referring to the NBC, the company was registered there on July 18, run by unknown, 26-year-old Avdjol Dobi. 

This indicates the Licenses Commission Secretariat began procedures to legalize an non-existent entity which was unable to identify as DH Albania, as it was lacking NBC proof at the time.

The licenses commission, headed by Gerta Lubonja, appointed with a Council of Ministers decision, also consists of three ministry of infrastructure directors. 

VOA has shown that based on the predetermined deadlines of the commission’s activity, now removed from the website, “the documentation, accompanied by summarized material compiled by the Technical Secretariat, shall be made available to the members of the Commission three working days prior to the meeting’s set date.”

The license for DH Albania was issued at the July 30 meeting, which was on a Monday. Consequently, the documentation for it should have been submitted to the commission at least on July 25. But according to the official response of the infrastructure ministry, DH Albania has completed all the documents only on July 27.

The violations in favor of DH Albania suggest it was clear to the commission it was not simply helping Dobi, but also the people hiding behind the entire fraud - allegedly, the Albanian oligarch Bashkim Ulaj.

Certain facts made public by VoA, show that Dobi and Ulaj have family ties, in addition to the fact that Ulaj’s employees from his owned Gener 2 company helped fill up DH Albania’s documentation and made payments on its behalf.

The country’s prosecution, which is investigating as crimes both the fraud and the misuse of institutional duty, has not yet been able to call Dobi to testify although he is not known to have officially left Albania. 

The DH Albania case has been ignored by the government on the surface, while “The Unexposed” show host and journalist Ylli Rakipi reported his life was threatened two weeks after going public with the story. 

 
                    [post_title] => Evidence shows gov’t institutions helped DH Albania win Great Ring project tender
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                    [post_date] => 2019-01-10 13:48:28
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                    [post_content] => TIRANA TIMES EDITORIAL

The newly appointed Minister for Europe and Foreign Affairs of Albania, the 28 years old boy from Kosovo who has three Bachelor degrees and two masters, cannot represent Albania in the world. He cannot be the face of Albania in the meetings, conferences, summits and consultations where Albania takes part in the global arena. Gent Cakaj cannot be the voice of Albania in the delicate and complex negotiations with neighbors, regional countries or global powers. It is wrong to place this person at the helm of the country’s effort to join the European Union. He is simply not a minister who can represent our country in the right way in all the foreign policy developments and events around the world.

That said, we need to proceed with the reasons why.

First and foremost, the figure of the Minister of Foreign Affairs needs to encompass the genuine and therefore native language, culture, concerns, aspirations and archival knowledge of the country’s diplomacy. In this context the newly naturalized Cakaj’s uneasiness and accent, perceived lack of real connection with the issues of Albanian foreign policy and relative lack of experience is a true problem. He might have pursued several degrees and might have read all the relevant books, he is still deeply inappropriate. That is because countries chose to have at the top of their foreign policy a figure that can best summarize the whole country in one face and one voice. Cakaj is not that person. He might be brilliant but in this field he is still an amateur.

This year Albania will hold the chairmanship of one of the most important organizations in the worlds, the OSCE. Albania will celebrate its 10th anniversary of NATO membership. It will intensify its lobbying at the EU tor reach a positive decision at the Council in June for the opening of accession negotiations. Albania needs to restart the pending talks with Greece as well as pursue the Prime Minister’s ambitious agenda of Schengen dynamics with the immediate neighbors.

Considering the gravitas of this year and the symbolic and real weight of all these developments, one would expect that at the head of foreign policy the Prime Minister would either leave the former minister or appoint a figure of the most excellent background. Furthermore this figure would ideally generate some kind of consensus even on the side of the opposition since he or she represents the whole country in the international arena.

To step aside from all this responsibility and perform a magic trick, to shock and awe Albanians by choosing a random and anonymous however talented young boy with severely limited genuine knowledge of Albania and with a total lack of legitimacy since he is not a member of the Socialist party, is the worst act of political spectacle.

The Prime Minister said that he despises and pities those who are against this appointment on the grounds that Cakaj is from Kosovo. This is a cheap shot at playing the ostrich, hiding your head in the sand. Cakaj’s problems and deficiencies do not originate only form his origins which still play a part. Furthermore it would be an additional liability for Cakaj if the media comments that this a figure which stands behind a potential plan for the corrections of borders as a way to reach a Serbia-Kosovo solution, are true.

To assign a foreign minister just so there will be no objection to a plan that is still obscure, severely contradictory and controversial and about which the major powers still do not have a consensus or a concrete agenda is another faux pass of the government leader.

Albania is at one of the most vulnerable cross-roads of its transition path and its aspiration of EU membership, with all the complex challenges of foreign policy it entails and which require excellence, experience, grounding, leadership, communication and presentation skills. And if one watches the few videos that are available of Mr Cakaj performance, we might have just shot ourselves in the foot.

In this context, the President of the Republic has taken the right decision and with the right elaborate and serious motivation to refuse his appointment. One is left only with the hope that the Parliament will show the same thoroughness and not a knee-jerk reaction by overthrowing this decree as they have done in the past. This is the last call for reflection for the PM to find a minister that can be truly and deservedly the face and voice of Albania in the world.
                    [post_title] => Editorial: A foreign minister that cannot be the face and the voice of Albania in the world 
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                    [post_date] => 2019-01-10 11:08:18
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                    [post_content] => TIRANA, Jan. 10 - Albania's President, Ilir Meta, rejected on Wednesday evening Prime Minister Edi Rama’s proposal to appoint 28-year-old, Kosovo national Gent Cakaj as the new foreign minister, creating a new rift in the President-PM relationship.

In a public letter directed to Rama published by Meta himself, he addressed, as political experts have been doing over the last week, all the regional and global challenges Albanian diplomacy will be facing next year.

Some of these challenges include Albania’s upcoming OSCE presidency as part of the Trojka organization, its expectation to open accession negotiations with the EU and the need to take the normalization talks between Serbia and Kosovo further, and Meta wrote the country doesn’t have the time to experiment with the young deputy minister’s knowledge.

Further on, Meta told Rama that during his duty as deputy minister of Europe and foreign affairs, Cakaj has shown with facts and stands that he lacks the necessary experience in the field of diplomacy in addition to having expressed unacceptable public opinions on regional issues of vital importance.

The president stopped at some of Cakaj’s statements about the border correction idea between Serbia and Kosovo, which was strongly opposed by most experts after it was proposed a few months back.

Meta said those statements went against the official state response, which was to also oppose the border correction idea, and calls them “dangerous” in his letter. 

Cakaj has also shown according to the president lack of responsibility in exercising his deputy minister post by ignoring law and article enforcement that guarantees safe circulation of classified state information.

Moreover, Meta wrote that “in the way it has been conducted, the process of security verification for Mr. Cakaj does not guarantee the right reliability of the Security Certificates issued by the Directory of Secure Classified Information.

He argues the DSCI has conducted all necessary verification for the proposed foreign minister within a day, which is not enough time to conduct all necessary verifications according to the official procedures provided by state institutions.Meta also said that due to Cakaj’s dual citizenship and his obtained degrees in different countries, he would need an even more extensive verification.

“Mr. Gent Cakaj’s candidacy does not meet conditions, does not create reliability and does not offer the necessary guarantee for the objective and skilful exercise of a post so important as that of the minister for Europe and Foreign Affairs. 

On thursday afternoon, Rama reacted to Meta’s decision with a tweet, calling the rejection “unconstitutional.”

“The President’s refusal to decree the new minister for Europe and Foreign Affairs is not only unconstitutional, but also embarrassing. The arguments used by the President are scary for their scandalous level and shameful for the institution. Apologies to Kosovo for this shame,” Rama tweeted.

However, other political actors have expressed support towards Meta’s stand on the issue.

“Rightful and totally justified rejection! You can’t mock the state and play with its boundaries,” Genc Pollo, MP and Head of the EU Integration Commission wrote on twitter.

Remzi Lani, head of the Albanian Media Institute and member of the European Advisory Board, said that Meta has actually given Rama a chance to revoke his “mistake” and appoint someone who is more capable and appropriate for the most important diplomatic post.
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                    [post_content] => TIRANA, Jan. 9 - Albanian investigative TV show Stop published a video on Tuesday showing Fier judge Roland Hysi receiving monetary bribes and asking for sexual favors from a divorced woman in exchange of granting her daughter’s custody, proving the country’s judiciary reform has a long way to go before getting completely rid of the corruption that causes deep injustice.

On Wednesday, a day after the show aired and the hidden camera video went viral, state police announced it had arrested both Hysi and psychologist Elona Mecani, who played the role of mediator between the judge and the mother seeking her daughter’s custody.

As clearly seen in the hidden camera, the woman, who remained anonymous throughout the show, was asked by Mecani, to give Hysi 500 euros prior to the second hearing that would appoint the custody finally, meet up with him and give him 500 euros after the case was settled. 

“After the first court hearing ended, at the court's door, psychologist Elona Meçani brought me inside a room and told me I should speak to the judge. I did not understand why I had to do that, as i thought I had submitted all the documents that were asked of me. The judge did not speak in the presence of the secretary, rather the secretary came out and said she’d arrange a meeting for us at a bar. I've been living in France for seven years and Fier has changed, so I went,” the mother told Stop.

Explaining how she had been granted her daughter’s custody upon their divorce and then had to emigrate in France, leaving her daughter with her parents until the father decided to appeal the decision, the mother said she initially argued with the judge and then decided to contact investigative journalists and bring Hysi upon justice. 

The hidden cameras further showed the woman met with Hysi, who in addition to promising her he’d give her the custody in exchange for the money, also asked her sexual favors in return. Later on, the woman had to pay an extra 500 euros for judge Taulant Banushi, who was shortlisted to handle the case that had to be re-opened, and a fee for the mediator, psychologist Mecani. 

Over the last two weeks, three first instance court head judges have been ousted by the justice reform’s vetting process - the heads the Berat, Sarand and Korca courts - while head of the Shkodra court Arben Zefi is facing allegation of being involved with corruption by the Independent Qualification Commission. 

Since the official start of the vetting process in March 2018, the IQC has verified and ousted a big number of judges and prosecutors, mainly based on the three pillars - the cleanliness of figure, the accumulated wealth and professional skills.

The vetting process first verified those applying to become part of the country’s new and reformed justice system and it is set to then evaluate any individual holding a legal position in the country. 

As local and international rule of law organizations have criticized time and time again the prolonged time it is taking for the vetting process to be finalized and the clutter of criminal cases that has been created as a result of a partially functioning justice system, cases like judge Hysi’s prove that faster and much more intensive work needs to be done to claim the justice reform has really been implemented in Albania. 

 

 
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                    [post_content] => 
NEWS ANALYSIS 
In an unprecedented move which was planned to shock and awe, the Prime Minister used the last days of 2018 to bring down his cabinet, removing and replacing the key members of his cabinet. The change in the key Ministries of Energy and Infrastructure, that of Europe and Foreign Affairs as well as Education, Culture and Agriculture indeed brought surprise to everyone. In addition, Rama replaced also the Deputy Prime Minister.
 
These are radical changes that come only one year after the Socialist Party received a popular mandate to govern. They come in the context of several key developments:
 
First and foremost the student protest that rocked the main university towns and the capital were massive and despite their refusal to be politicized their requests had to do with major changes about the way the Rama cabinet was governing. This is due to the fact that students asked and still are asking for the annulment of the Law on Higher Education, one of the most trumpeted so called achievements of this government. In essence, the student movement of December tore right through the heart of the large scale facade that the propaganda machine had painted with neon colors.
 
Additionally these protest were held alongside other perhaps smaller but still considerable protest from groups of the society which were hit hard by polices of the government in favor of the now famous PPP or concession beneficiaries. These protesters are in fact deprived or impoverished due to the fact that the government through mainly corruptive practices such as that unearthed in the case of the Tirana Outer Ring Road segment construction, are favoring the enrichment of a handful of oligarchs and monopolization of key sectors.
 
Indeed the scandal uncovered by the media in the case of the company that had forged documents to get the tender for the construction of the Ring Road part is one of the most abhorrent cases of flagrant corruption, of arrogance and impunity. This was a state- sponsored theft of no less than 45 million euro to give out to three companies without any competitive procedure to build less than 2.5 kilometers.
 
The state thieves’ enterprise used all their bag of tricks to expel any potential foreign companies from the tender procedure by dividing the segment of 2.2 kilometers into three parts so that the value would be less than 18 million euro for each, therefore exempting foreign capital from competition. At the same time the alibi of the tender was provided by a ridiculous offer of 0 lek by a ghost enterprise. The arrogance of pre-selection was open and did not take long to uncover the fraud company that had not shied away from forging documents from none less than the state of Delaware in the United States.
 
Dig a little deeper as investigative journalists did and the real deal behind it were unveiled to be one of the richest oligarchs’ company that has benefitted from other multiple construction tenders. Law enforcement was hesitant to proceed with investigation until the United States authorities opened its own inquiry. The government’s own explanation was that such forgeries could happen to anyone. In a cabinet rumored to check and assign even grants of 3000 euros it is ridiculous to believe that the control mechanism failed to catch inconsistencies in a 30 million project that would go to the same company that just months ago was allocated more than 450 million euro for a road connecting Tirana to the north.
 
Amidst these scandals, protest and palpable discontent of large social groups the Prime Minister brought down his key ministers therefore de-facto burning down his house in order to fight the pests that was risking his very power. Disregarding blatantly all the party institutions such as the leadership group and the spirit of consultation the Prime Minister did this in a show fashion during the Assembly meeting. The ministers’ reactions made it quickly clear that they had no forewarning and learned simultaneously with the public. This was unjustifiable as a political maneuver deprived of any trace of seriousness. It resembled in all details to the public processes where dictators would converse with the people and blame all ills on the administrators rather than on themselves. Even dictators had a better feeling of formal respect for party institutions. 
 
Right now it is painfully clear that the Socialist party is in its last gasps of breath and the Rilindje (Renaissance) movement which exists due to Rama and exclusively for him has taken over in every cell of political life of the majority.
 
Additionally and maybe most importantly the outgoing ministers are replaced with anonymous, unexperienced and unfit individuals which have no stature to hold these posts. They have no connection to the Socialist Party and the legitimacy it bestows upon the governance. The only exception is the deputy Prime Minister which realistically holds no executive power and not even any budget. The record of some of them as administrators of public companies is deeply concerning. The lack of record for some others such as the new Minister of Foreign Affairs is alarming.
 
In drawing this lifeline to himself and his power the Prime Minister is actually bleeding dry any form of experienced governance that even before this move was deeply troublesome. Rama will likely survive. However his governance has shattered. 
[post_title] => The Prime Minister burns down his house [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-prime-minister-burns-down-his-house [to_ping] => [pinged] => [post_modified] => 2019-01-09 13:46:15 [post_modified_gmt] => 2019-01-09 12:46:15 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.tiranatimes.com/?p=139980 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post] => WP_Post Object ( [ID] => 140085 [post_author] => 29 [post_date] => 2019-01-15 18:33:16 [post_date_gmt] => 2019-01-15 17:33:16 [post_content] => By Ervin Lisaku TIRANA, Jan. 15 - Albania has been facing an exodus of doctors in the past few years, making the country’s healthcare system, already facing one of world’s lowest number of doctors, even more vulnerable. More than 500 doctors are reported to have left the country in the past few years, mainly heading for Germany, Europe’s largest economy, which has eased work procedures for medical staff coming from the Western Balkans as it tries to fill the huge gaps in its healthcare system. The current numbers represent about a tenth of total number of doctors in Albania, but what’s worse is that an overwhelming majority of medical staff working at the country’s public and private hospitals would be willing to leave the country if they were offered an opportunity, leaving the country’s vulnerable healthcare system without key experts with decades of experience. Many hospitals outside Tirana and healthcare facilities at remote areas in Albania already face shortage of specialty and even family doctors, leaving thousands without access to basic service and emergency health problems. Monthly bonuses of up to €2,000 a month for working outside Tirana and in remote areas suffering shortages of specialty doctors since early 2018 have not been much appealing and facilities like the Dibra regional hospital, north of the country, continue redirecting their patients to Tirana, which becomes quite difficult in winter due to heavy snowfall that often makes helicopter transportation the sole opportunity to save lives. Albania currently has only 1.2 doctors per thousand residents, in one of the lowest coverage rates comparable only to war-torn countries. The Balkan country has regularly lost medical staff since the early 1990s following the country’s transition to democracy and a market economy following decades of a hardline communist regime and a planned economy. However, the brain drain has sharply picked up in the past five years following a relaxation in procedures by Germany due to its huge needs for medical staff, mainly nurses in homes for the elderly. “Germany has relaxed the doctor-recognition procedures. They accept them from all Balkan countries, though they first have to work in a rural area and undergo training,” says Dorina, an Albanian PhD holder in medicine as quoted at a recent brain drain study commissioned by the UNDP office in Albania. “Almost 30 percent of students that completed studies in the same year as me have gone to Germany. Each year, around 180 doctors graduate [in Albania], and in the last 3–4 years around 30 percent have emigrated to Germany. This is, regrettably, a very high percentage, because there has been a six-year investment for these doctors,” she adds.   Almost everybody wants to leave Doctors and nurses are among certain groups of mostly younger-age professionals such as engineers, IT specialists, legally leaving the country and heading mainly to Germany following a wave of ungrounded asylum-seekers of mainly non-qualified Albanians that have either voluntarily come back or been repatriated after overwhelmingly having their asylum applications turned down since 2014. The situation is especially concerning among Albania’s poorly paid medical professionals, more than three quarters of whom say they are willing to leave the country if given the opportunity, according to a recent survey by a local Albanian NGO. A survey with 1,000 doctors nationwide, including private hospitals, showed around a quarter of surveyed staff say they would immediately leave the country. Another 54 percent said they would consider leaving if they were given an opportunity and only 19 percent said they would continue working at home. The situation is no better at the private sector offering better wages and working conditions where two-thirds of doctors say they would consider leaving the country, according to a study conducted in mid-2018 by Tirana-based ‘Together for Life’ association with support by Germany’s Friedrich Ebert Foundation. The situation appears more alarming in the region of Durres, the country's second largest, and in the northern Lezha and Dibra regions where only 5 percent of surveyed doctors are willing to continue working at home. Albania’s public healthcare system is perceived as one of the most corrupt, with bribes to doctors and nurses to get faster and more careful treatment having become quite normal practice and culture that is little denounced.   ‘Certificates of good standing’ Some 762 doctors were issued certificates of good standing from 2013 to 2017, among whom 94 specialty doctors in documents that are issued upon doctors' request when attending post-graduate studies abroad or looking for a job outside the country, according to the Order of Albanian Physicians, the authority that issues the certificates. However, in late 2018, a deal between the health ministry and the Order of Physicians put an end to the issue of ‘certificates of good standing’ for doctors that are already under contract in a bid to stop the brain drain from Albania's healthcare system. The average departure of doctors from the country, including experienced ones, from 2013 to 2017 was at 190 annually, a figure considerably higher to the average 150 graduates a year produced by the University of Medicine in Tirana, the sole public higher education institution offering studies for family and specialty doctors in studies that last between six and eight years. Bigger in numbers and with wages almost half of what doctors receive, nurses are also more willing to leave the country. German Dekra Akademie says it has been offering free German language courses and training for hundreds of nurses in Albania during the past three years, managing to take up to 1,200 nurses to Germany where they mainly work in homes for the elderly, earning around €1,300 a month. Around a thousand other nurses are currently receiving training throughout the country.   Reasons for leaving Low job income, poor working conditions, few opportunities for career development, exposure to political pressure, verbal and even physical violence are some of the reasons that drive doctors to abandon Albania’s public sector, sometime even to work for private hospitals offering much better wages and working conditions. Albania's Order of Physicians says frequent legal action against doctors charged with carelessness and negligence also has an impact on the decision to leave, with doctors often ending up in prison, fined or having their licence revoked. "Some 20 doctors were sentenced to prison in 2015-16 in Albania at a time when there were only three sentenced in the US where the number of doctors is 70 times higher compared to Albania. In addition, there are many doctors facing charges and a lot of others that have been fined," Fatmir Brahimaj, the president of Albania's Order of Physicians has said. Doctors have appealed for new provisions to divide human error from negligence in treatment, the latter punished by fines or imprisonment of up to five years for negligence in treatment. A negative perception on doctors has reduced patient confidence in the Albanian health sector, increasing pressure and insecurity among doctors, the doctors’ departure study shows. Germany which has considerably eased procedures for medical staff from the Western Balkans is no surprise as the top destination for those wishing to work abroad with a 26 percent share. Another 20 percent say they would prefer moving to the UK and 13 percent to Nordic countries. Due to tight procedures for being hired in the local healthcare systems, Italy and Greece, home to around 1 million Albanian migrants, are not among the top three destinations. Around a quarter of surveyed doctors say they constantly feel under pressure, disrespected and dissatisfied at their workplace and often face work overload. Albania has more than 5,800 doctors, of whom more than half, some 3,347 working in the region of Tirana, home to the country's sole tertiary healthcare facility and several private hospitals. A third to half of doctors say they are dissatisfied with the poor financing of the healthcare system, the system's weak management and bureaucracy. Albania's healthcare system receives only around 3 percent of the GDP in government funding, some €360 million, in a budget that is insufficient for the system’s huge investment and staff needs. Around three-quarters of doctors in the country believe they are unfairly highly criticized. Two-thirds fully or partially agreed with the statement that the "practice of not declaring their cash gifts with authorities is tough, but financially understandable." Doctors say their wages have to increase by 30 to 100 percent in order to turn down bribes or cash gifts by patients. Current net wages that doctors receive are at around €500 a month, considerably above average wages, but almost half of what MPs, judges and prosecutors or other senior officials get. Around half of doctors perceive their Albania future as uncertain. Women doctors are more prone to leave the country. Doctors are also dissatisfied with the work culture in the country's healthcare facilities such as lack of respect, inefficient communication, poor team work and insufficient efforts for their professional development.   An inefficient system "Albanian authorities do not assume responsibility, but simply put the people against doctors. Patients don't pay insurance, they bribe and the government accepts that doctors get bribed and not have their wages increase,” a Tirana obstetrician is quoted as saying on condition of anonymity. “At a country where there is no rule of law, you face the population's pressure and doctors are suffering from this system. There are endless physical conflicts and doctors keep silent. In some case they receive media coverage and in other go silent. The pressure is a result of inappropriate functioning of the system," he adds. Another doctor blames lack of transparency and ill-guided investment. “There is lack of transparency. We really have a small budget, but even that small budget is not consulted with doctors on how it is going to be spent and there is no vision with investment and continuity with health policies," a Tirana kidney doctor is quoted as saying. A cardiologist in Durres says departures are an issue related both to finances and dignity as the money they get is not enough to make ends meet for their households and bribes don't make them feel good. The study suggests investment in the health infrastructure, the review of the legal framework on medical errors, more opportunities for professional and academic growth, improving the internal management at healthcare facilities, and engaging Albanian doctors working abroad more in the country's public health sector.   ‘Quit Germany plans, earn more at home’ Prime Minster Edi Rama has downplayed exodus concerns saying the country has new doctors willing to get a job and invited doctors to work outside their residence areas to earn more through bonuses of $2,000 to $2,500, in income which he says is much better compared to Germany where most Albanian doctors and nurses are heading to. "Everybody who contributes out of their residence areas will get paid the same as they started working in Germany. Doctors serving outside Tirana as experts will get their standard wage and a bonus of $2,000 to 2,500 a month. Taxes here are much lower than in Germany and what you have at the end of the day here is much better," Prime Minister Rama said in late December 2018, announcing the employment of 300 new specialty doctors for 2019. Tritan Shehu, a doctor by profession who served as former health minister for the now opposition Democratic Party says “doctors find themselves out of a system that fails to guarantee them the appropriate technical and scientific level, qualifications, technology, the pharmacological ‘arsenal,’ literature, income and dignity and that the collapse that is knocking on the door requires fundamental changes in the whole system and not only facelifts.”    A push for migration Lack of proper healthcare, together with the low quality of the education system and poor income at home are the primary reason why Albanians migrate away from their native land, surveys show. Albania has around 1.2 million migrants abroad, almost 40 percent of its 2.8 million resident population, making it one of the countries with the highest per capita migration around the world, with a series of social and economic consequences for the country’s future prospects. Experts says Albanians are mostly leaving the country because of economic reasons, looking to escape poverty in their homes, but also to integrate into leading European economies and take advantage of better education, health and social protection infrastructure for their families. Albania’s public health sector is perceived as one of the most corrupt and inefficient sectors, with patients often choosing to get treated at private hospitals in the country or go abroad. Albanians are estimated to spend about €60 million annually in private hospitals and clinics whose number has significantly increased in the past decade. 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