6 Improve maternal health

Where are we?

One of the main challenges to effective health service delivery and achievement of the MDGs lies in the general low quality of health services on the one hand and some continued difficulties in access on the other. Whereas this is not seen to have affected efforts to reduce maternal mortality, there are concerns in other MDG-related health targets, such as infant mortality as discussed above. Also, while the burden of communicable diseases is generally decreasing, cases of HIV infection and TB are increasing35. There is a common belief that both HIV/AIDS and TB are not a concern for Albania, but the observed trends counter such a belief.

In some respects, health-delivery challenges are not so much a matter of inadequate resources, but rather a matter of how such resources are utilized. System-wide capacities in health administration remain weak, further impeding a cost-effective delivery of health services, especially in rural and mountainous areas. Lack of some key reforms in the health sector has resulted in the continued practice of often bribing health professionals—corruption remains high at almost all levels of the health sector.

Government recognizes the need to upgrade the quality of services and to improve access to (free of charge) services. It is often the case that people are unable to access health services, which are by law provided free of charge, mainly due to complex procedures and lack of access to required information. Roma in particular face considerable difficulties in accessing health services.

On the funding front, and despite recent increases in budgets allocated to the health sector, overall financial resources remain very limited. Whereas the health sector is a stated government priority in the years to come, limited fiscal space available to government in terms of keeping deficit levels within targeted ranges may place constraints on budgets. This may motivate government to look at ways of improving health administration through further reforms and capacity building.

Government reforms are now focusing more on the whole health system to ensure the longer term sustainability of cost effective and quality health delivery. The finalization and implementation of the health reform strategy will go a long way towards achieving the long-term targets, and will also help in achieving the medium-term MDGs. The longer-term reform objectives aim at modernizing the broader system through investments in human resources, reforming sector financing and improving health information systems. Major health sector governance priorities include planning for and measuring the performance of health institutions and professionals, incentive systems, better coordination, combating corruption and instituting more transparent and accountable systems of decision making.

Targets for MDG 5
  1. Reduce by three quarters the maternal mortality ratio
    • Most maternal deaths could be avoided
    • Giving birth is especially risky in Southern Asia and sub-Saharan Africa, where most women deliver without skilled care
    • The rural-urban gap in skilled care during childbirth has narrowed
  2. Achieve universal access to reproductive health & inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health
    • More women are receiving antenatal care
    • Inequalities in care during pregnancy are striking
    • Only one in three rural women in developing regions receive the recommended care during pregnancy
    • Progress has stalled in reducing the number of teenage pregnancies, putting more young mothers at risk
    • Poverty and lack of education perpetuate high adolescent birth rates
    • Progress in expanding the use of contraceptives by women has slowed & use of contraception is lowest among the poorest women and those with no education