Problem: High NCD burden, notably from cardiovascular disease; suboptimal population health linked to lifestyle-related risk factors such as poor dietary habits, tobacco use and high blood pressure; health services reactive in orientation, limiting focus on health promotion and disease prevention.
Solution highlights: The government, which was strongly committed to establishing universal health coverage, launched a four-year Free Check-Up Programme to introduce free screening services for chronic conditions; adopting a proactive approach to prevention was essential for reaching and engaging the target population (all citizens aged between 40 to 65 years); significant efforts were made to improve the systematic collection and monitoring of population health data; government support for activities, and a key partnership with the Health Insurance Institution to reimburse health check-up services, helped embed the initiative into the health system.
Description of practice
In Albania, noncommunicable diseases are the leading cause of mortality. Measured through Disability Adjusted Life Years (DALYs), cardiovascular disease represents the highest burden (25%), followed by cancer (12%), diabetes (7%) and mental health (6%). And cardiovascular disease alone accounted for almost 50% of all-cause mortality in 2010. Much of the noncommunicable disease burden can be attributed to lifestyle-related risk factors, including high blood pressure, smoking, high sodium intake and obesity. However, the reactive orientation of health services, and limited focus on health promotion and disease prevention in primary care, left lifestyle-related risk factors inadequately addressed by the health system.
In 2014, as part of the newly-elected government’s four-year agenda and wider strategy to achieve universal health coverage, the Free Check-Up Programme was launched to expand preventive health services in Albania. Designed and financed by the government, in partnership with the Health Insurance Institute, the Programme offers free screenings for chronic conditions, such as high blood pressure, diabetes, certain cancers and depression, to all citizens aged 40 to 65 years. Eligible citizens are proactively invited to participate in screenings by their local primary health care centre, through a letter mailed to them near their first eligible birth date, and offered health education, motivational interviewing and brief interventions to support them to adopt healthier behaviours. Primary care nurses and family physicians work as a team to conduct the screenings. Nurses are responsible for assessing patients through collecting measurements and samples, performing electrocardiogram tests and conducting questionnaires. Family physicians are responsible for interpreting and delivering results to patients and handling any necessary follow-up care. Short trainings for primary care providers were delivered by the Swiss Agency for Cooperation and Development, which acted as a development partner throughout the initiative. A detailed manual, along with specially-developed risk assessment tools and questionnaires, guides the Programme’s delivery. A quantitative scoring system, which categorizes patients’ risk level based on screening results, has been developed to guide treatment according to set algorithms. To enable them to carry out the Programme, health centres have been modernized and equipped with internet connections, computers, refrigerators, scales and electrocardiogram machines. Currently 360 of the country’s 415 primary health centres are equipped to deliver the Free Check-Up Programme. An additional 14 centres are currently undergoing improvements and the Programme continues to expand. The potential of extending the Programme to cover other screening services in Albania will be explored following an evaluation at the end of the current Programme.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
Through a top down approach, the Ministry of Health, in partnership with the Health Insurance Institute, drove the initiative forward. The Ministry of Health assembled an expert working group, headed by the Deputy Minister of Health, to design and oversee activities. The Swiss Agency for Cooperation and Development provided support during the design process.
The initiative is still in the early stages and information on its impact is not currently available.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Milva Ekonomi
- Ministry of Health