Alan Fairbank, PhD, Partners for Health Reform-plus, Abt Associates Inc., 4800 Montgomery Lane, Bethesda, MD 20814, 203.453-6828, alan_fairbank@abtassoc.com and Gary Gaumer, PhD, Abt Associates, 55 Wheeler Street, Cambridge, MA 02138.

The Albanian health system has recently experienced organizational and budgetary changes that have significantly changed the roles among various agencies. The effects of these changes have been to fragment the funding and administration of primary health care services in Albania, which had previously been the exclusive responsibility of the Ministry of Health. There is also lack of coherence in accountability among the various actors. The Partners for Health Reformplus Project is assisting the Government of Albania to improve the performance of its health system through a process of health care reform. An element of this project is providing assistance to the Government to design and implement improved methods for the planning, budgeting, and financing of PHC services, which required a thorough analysis of the complex and disparate sets of data on flows of funding, how they have changed, and how those changes have affected accountability for PHC systems performance. Using these data, the authors develop the basis for designing alternative ways to organize and manage the PHC service delivery system, taking account of a recent change in government policy that would unify all funding for PHC in one agency—the Health Insurance Institute. After developing and applying criteria for choosing among two options for reorganizing management of PHC, assuming the change to single source financing is fully implemented, the authors recommend an alternative that would create regional health offices to supervise and manage PHC.

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