Albania
In the coastal town of Durrës, Albania, over 100.000 residents are witnessing a transformation in their primary healthcare service with the Local Healthcare Unit leading the change. We spoke to Eriona Petro who has held the pivotal position of the Chief of Primary Healthcare Services in the region since 2016 and has a decade-long career as a lecturer at the public university in Durrës, a dedication that inspires trust. Petro's academic journey led her to earn a Master's Degree in Pharmacy from the University of Tirana. Yet, it's her additional qualifications in Pharmaceutical Policy Analysis, Epidemiology, and Healthcare Quality from prestigious institutions like Utrecht University, the Albanian Institute of Public Health, and the International Society for Quality in Health Care that truly distinguish her in the field.
In the meantime, amidst Albania’s healthcare landscape, the SDC-funded Health for All Project (HAP) has been driving change since 2015. The project’s innovative approach and interventions have consistently aimed to improve the accessibility and quality of primary healthcare services in the country for the population at large and for vulnerable groups in particular – a challenging mission in the complex health sector of a country in a decades-long transition. However, in strong partnership with Albania’s leading health institutions, Health for All has managed to raise awareness, drive change in policies and strategies, improve infrastructure and equipment, and empower healthcare professionals – ultimately providing improved primary healthcare for the Albanian population. Presently, the Local Health Authorities are leading the implementation of innovative interventions in Primary Health Care piloted by the project in many areas across the country.
In this exclusive interview, we delve into Petro's experience with the project’s interventions and her insights throughout the process. Our focus? The story of how the effective cooperation of the Local Healthcare Unit of a small town defied a social climate hesitant to change and dubious of novelty yielding positive results in the local quality of care and in the implementation of the Health for All Project interventions.
Q1: What are the main interventions that the Durrës Healthcare Unit has implemented in collaboration with the Health for All project?
Petro: Over these years of collaboration with the HAP project, there has been significant work towards enhancing the capacities of the family medicine teams, most notably training them in the implementation of the updated protocols for non-communicable diseases. Critical in this regard has been enhancing their monitoring capacities in the implementation of these protocols, a key factor in the sustainability of the practice. Another successful intervention we are currently working on is the implementation of home-based care, targeting mainly the elderly and chronically ill in advanced stages of illness who are unable to visit healthcare centres. HAP’s technical and logistical support has been present throughout the process, from the presentation of this new service to the training of staff and setting up the database of eligible patients. Of great help in this regard has been having an updated Manual of Elderly Care, again drafted and approved with the support of the project.
Q2: The Healthcare Unit you lead manages about 18 healthcare centres in the region with over a hundred family physicians and nurses. Yet, although your cooperation with the project is quite recent, you are advancing faster and at a higher success rate than other comparable units. What is your strategy?
Petro: It is true, we only started cooperating with the project in the last couple of years. However, my team fully embraced the project’s innovations and was eager to adopt them in our daily practice. We decided to take the leadership in this process, instead of leaving the initiative to the individual healthcare centres. Thus, we took charge by setting up dedicated teams of trainers who, after being trained by the project, would then go on and train family doctors and nurses from each health centre, and they in turn would go on to train their colleagues, creating some kind of ripple effect - thus multiplying the project’s efforts …and results…beyond the initial plan. At the same time, we have periodically monitored the health centres' progress throughout the implementation of these interventions, which has given us the opportunity to keep improving our results.
Q3: How have these interventions contributed to improving the health and well-being of your community? How about the access of vulnerable groups to healthcare services?
Petro: Certainly, all implemented interventions, which focus on enhancing the professional skills of medical staff, directly translate into the provision of higher-quality healthcare services in the community. And the better health service the community receives as a result of trained staff, the better their health conditions and well-being will be. There has also been significant improvement in the access of vulnerable groups to healthcare services, especially now that we are implementing home-based care. I must say, now every step of the procedure is better planned and documented, and follows standardized nursing procedures, ensuring the improved quality and sustainability of the service.
Q4: Have you encountered challenges or obstacles during the implementation of these interventions and how have you overcome them?
Petro: Throughout the two years of collaboration with HAP, one of the main challenges has been finding suitable ways to motivate medical staff to adopt new approaches to healthcare services. However, it hasn’t been too difficult for us to overcome this challenge. Once the presentation of the interventions and the steps to follow were clear and well-organized, they were readily embraced by the staff. Naturally, the logistical support provided by HAP has facilitated the implementation of interventions both for Durrës Healthcare Unit and for the individual health centres.
Q5: Sustainability is a critical aspect of project success. What strategies do you plan to follow to ensure the continuity of the results of these interventions beyond the project duration?
Petro: Maintaining the achieved positive results in the long run requires ongoing efforts and commitment. Continuous monitoring of the work done so far and building the capacities of our medical staff to monitor the implemented interventions will be key. Simultaneously, the ongoing training for medical staff based on their specific needs will play a crucial role in ensuring the sustainability of these interventions. These two components are the most important.
Q6: Looking ahead, what are your plans or aspirations to further build upon the achievements of the Health for All project?
Petro: Our immediate plan is to extend home-based care in the health centres where it hasn't been implemented yet, leveraging our experience in collaborating with HAP and the qualifications of our medical staff. Meanwhile, we have already completed the establishment of peer-group-based trainings in all our health centres with regard to the Elderly Care Protocol and we will focus on monitoring its implementation.
Q7: What are the key lessons and best practices you have drawn from the success of these interventions that, in your opinion, might be valuable for other Local healthcare units aiming to achieve similar success?
Petro: In my opinion, the main factors contributing to the success of these interventions are twofold. Firstly, organized teamwork and continuous communication between the health centre management and Local Healthcare Unit management have been vital for the successful implementation of the mentioned interventions. When the staff is well-informed about their designated tasks, the implementation becomes smoother. Secondly, drawing lessons from each element of the implementation that went wrong and finding practical alternatives to overcome those challenges. Maintaining open lines of communication is the key to finding solutions for any challenges encountered during the process.
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