Weekly Briefing, Vol. 64. No. 3 (Al) July 2023
Prospects of medical students and the healthcare system in Albania
Summary
When the brain-drain phenomenon in a country takes massive proportion, some effects are felt sooner, some are felt later, but they always impact society, one way or the other. While in the first decades of this Albanian transition, there were mainly low-skill workers that migrated to wealthier/western countries, in the past decade the trend is reverting. There are more high-qualified professionals leaving than at any time before. Mid-career executives, finance, IT, sales, academics, doctors and nurses, and more.
The first, and continuous effects, are being felt in the healthcare system, the lack of doctors is one of the major concerns and it is widely spread throughout the country. When it is a matter of life and death, the perils are anticipated and the future becomes clearer, sooner.
Introduction
The higher education system is facing serious challenges in Albania. In one of the countries that used to take pride in the percentage of youth enrollment in universities, fewer and fewer students are enrolling in public university auditoriums every year. Albanian youth have the right to education. According to the Constitution, education is a right that is earned by merit, and these students have earned it according to the procedures that the Ministry of Education itself has established, and by an entry exam for specific academic paths such as medical studies.
General data and overview
According to the Albanian Institute of Statistics (INSTAT) data, for the academic year 2022-2023, about 91 thousand students pursued their studies in higher education programs. The total number goes to 121 thousand, including the private system. Compared to 2018, the number of students enrolled in public education has decreased by 19.7%, or about 22.3 thousand students less. The gradual aging of the population that has reduced the young age group, together with the emigration of young people, are considered to be the main reasons that have influenced this trend.
The University of Tirana is the largest in the country, with 22 thousand students, or 24% of the total number of registered students. Nevertheless, this same university has also scored a high contraction by 25% of the number of students in the last 5 years. One example, in the Faculty of Medicine, in the academic year 2022–2023 there were 5,842 registered, or 18% less than in 2018.
What is noted is that private universities are still growing, but not per se, they are taking a share of the public universities. The private system is still increasing in enrollment numbers, albeit starting from a small base. Compared to 2018, almost 5 thousand students have been added to the private sector, or 18% more.[1]
Government decision on the University of Medicine
At the beginning of July 2023, the Albanian government decided that medical students who start university in September of the same year must sign a contract to provide health services for 5 years in their country before/if they decide to go and work abroad. While for students who are currently studying medicine, the obligation “may be fewer years”. Prime Minister Edi Rama made the announcement stating that Albanian people cannot pay taxes for doctors who are trained with symbolic fees at the university and then flee the country on the first possible occasion. This draft law will be presented in the Parliament of Albania with an accelerated procedure, according to the Minister of Education. The justification for this decision was that every medical student who will enter the University of Medicine will have to be aware in advances of the fact that medicine studies cost plenty to the government. Therefore, if they want to obtain a degree in Albania, it will take 5 years after finishing their studies to “be in the service of their own people”.[2]
The Minister of Education also stated that those graduates who will gain the right to register at the Faculty of Medicine, before registration, will first have to sign an agreement, to accept that they will work 5 years after graduation in Albanian health institutions. Only after those 5 years, they can retrieve their diploma. The argument was that this action is needed to prevent the departure of doctors and to meet the needs of health institutions for professionals. The effect of this draft law has been predicted for the new academic year, 2023-2024, and until the year 2027-2028.[3] If students do not sign an agreement with the government, then they must bear the full value of the cost of their studies.
How was it received?
Immediately after the announcement of the new conditions, hundreds of medical students protested in front of their University as well as in front of the Parliament, demanding the cancellation of a draft law. They declared during the protest that if the initiative is not canceled, they will boycott the academic year. Furthermore, they emphasized that there is a need for clarifications and consultations for such projects, but the university officials had previously denied the existence of such a draft law. Yet, as a “surprise,” it was approved by the government and quickly entered the proceedings of the Parliament.[4] The students oppose the discussions that come from the Rector and from the Minister to sign a work contract after the completion of their studies. They are against forced employment, which in any way would keep them in Albania; with this law, they will be deprived of opportunities for their career.
While authorities have met with the medical students and have proposed employment and their contribution to the country as they have characterized it as a “patriotic gesture or act”. The students did not agree with that, because they want to be free in their choice of employment, they want to work where they want or to create experience in the places they want. For medical students, it is not fair that this conditionality is placed only on the faculty of medicine and no other faculties as well. Furthermore, they argue that this kind of pressure is causing even those who wanted to work in Albania to leave the country. This proposal directly affects the students’ families who most of the time pay for their studies, but also their future personally. If regulations are changed every 2 or 3 years, the lack of stability and fair game makes them want to look for options elsewhere. Medicine studies require a lot of investment and definitely, sacrifices. Quite often students of medicine have years of education and more specializations, so once they become doctors they want some certainties. Yet, in their words,[5] they feel like they are powerless and voiceless in a country where they are part of a bigger experiment.
The cause and Consequences of Albanian doctors leaving the country
The problem of students leaving Albania has been going on for many years and this can be definitively named as a mass departure, almost an exodus, not only from the healthcare system but also from all other areas. Yet, the departure of doctors has escalated in recent years, mostly in EU countries, mainly Germany and Italy. It is mostly felt in the healthcare system because it is one of those critical and vital sectors of society. It is a basic issue and a matter of survival and no compromise can be made. The truth is that many young doctors have and do not have Albania as their preferred choice. This is where the problem starts and where its solution should start. By all considerations, developed countries are more alluring for doctors and Albania cannot compete with them, but if work is put in constantly, then more reasons to stay would be available.
Experts estimate that the cause of this “brain drain” from the country is the unreformed and poorly financed healthcare system, while doctors work in inappropriate conditions. Weak economic conditions and little fight against corruption are listed by them among the factors of the emigration of doctors.
Many studies by Albanian researchers have conducted interviews with the doctors who have left and realized that there are several factors involved. Firstly is the financial side, then in order are work conditions, work practices, nepotism, corruption, and also the general condition of Albania where the future looks neither positive nor stable. In Western countries, the ones that attract Albanian doctors, incentives are higher to work and live there. While in Albania, especially in the last decade, there are an overwhelming number of qualified professionals who do not feel they are treated fairly. This is grim for the present and the future because this loss of professionals will affect also the academic and professional formation of the new generation.
According to the latest data, 22% of doctors have left the country, this is for the ones registered, but some experts argue that the number is higher. There is a specific study regarding the graduations from 2018-2022, where among 1,322 graduates, 801 have left or have requested the documents to leave the country, which means 61% exactly.[6] This has been accompanied by a lack of doctors in firstly rural areas and the direct effects are felt immediately in those areas.
Conclusion
Every country, as every workplace and company, should create the appropriate conditions for people to stay and work. These Albanian doctors-to-be want to leave because they know too well by now that conditions for them to flourish and grow professionally are not met in their homeland. Instead of forcing medical students to stay, a dignified healthcare system should be built, so that they would want to stay and contribute to their country. Better living conditions, dignity, institutional protection, and some kind of assurance that they can have a decent life at home, could persuade medical students to stay in their homeland.
[1] In the last 5 years, there were 22.3 thousand less students in Public Higher Education; Universities, with the biggest decline. https://www.balkanweb.com/ne-5-vitet-e-fundit-kishte-22-3-mije-studente-me-pak-ne-arsimin-e-larte-publik-universitetet-me-renien-me-te-madhe/
[2] Medical students must complete 5 years of work in Albania in order to obtain a diploma. https://top-channel.tv/english/medical-students-must-complete-5-years-of-work-in-albania-in-order-to-obtain-a-diploma/
[3] 5 years mandatory in Albania, the Minister presents the draft law for medical students. https://top-channel.tv/2023/07/11/5-vite-me-detyrim-ne-shqiperi-ministrja-kushi-prezanton-projektligjin-per-studentet-e-mjekesise/
[4] Albania, medical students protest against forced employment for 5 years within the country. https://www.zeriamerikes.com/a/7169812.html
[5] Against the government’s decision, medical students warn of a protest. https://www.gazetaexpress.com/kunder-vendimit-te-qeverise-studentet-e-mjekesise-paralajmerojne-proteste/
[6] The faculty speaks, not the ministry… impossible to keep the doctors, that’s why the professionals are leaving. https://sot.com.al/politike/flet-fakulteti-jo-ministria-alimehmeti-kunder-rames-smund-ti-mbash-mjek-i598954