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Evaluating the impact of national hospital plan on healthcare service performance in Albania: evidence from the regional Memorial Hospital in Fier. BMC Health Services Research. 2026;26:634. doi:10.1186/s12913-026-14224-8. https://pmc.ncbi.nlm.nih.gov/articles/PMC13141587/", "country_ids": [ "ALB" ], "coverage_domains": [ "autonomy", "facility_data", "governance", "hospital_organization", "networks", "patient_flows", "referral_design", "reform_history", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "effective regional intermediate level", "institution": "BMC Health Services Research", "locator": { "locator_type": "xml_text_anchor", "source_word_anchor": "effective regional intermediate level", "source_word_count": 4 }, "material_id": "material:c339ced31c4ce6e56840e866", "notes": [ "Display the Fier findings as a single-hospital case and preserve the paper's network-wide and financial-data limitations." ], "origin": "country-evidence-improvement-sources", "period": "Single-hospital implementation evidence from 2021-2024; article published 2026", "publication_date": null, "publication_year": 2026, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/xml", "response_sha256": "36bc45a68991ae0f9bc1ad7d062038e511d07535bb2428f1bcf414a9e10d1463" }, "statement": "The Fier case study reports an emerging regional intermediate role between primary care and Tirana for medium- and high-complexity cases, while explicitly limiting inference because it evaluates one hospital, lacks a network-wide perspective and leaves some advanced services centrally reserved.", "tags": [], "territory": "Fier Memorial Hospital case study; not a network-wide or national evaluation", "title": "Evaluating the impact of the national hospital plan on health-care service performance in Albania", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13141587/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Gabrani J, Schindler C, Wyss K. Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania. BMJ Open. 2020;10:e040398. doi:10.1136/bmjopen-2020-040398. https://pmc.ncbi.nlm.nih.gov/articles/PMC7709502/", "country_ids": [ "ALB" ], "coverage_domains": [ "governance", "market_structure", "networks", "ownership", "patient_flows", "primary_care", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "availability of diagnostic devices", "institution": "BMJ Open", "locator": { "locator_type": "xml_text_anchor", "source_word_anchor": "availability of diagnostic devices", "source_word_count": 4 }, "material_id": "material:10551441d824fda57ae09a76", "notes": [ "Treat the sample as provider users in one region; it does not estimate national public-private market shares." ], "origin": "country-evidence-improvement-sources", "period": "Facility exit survey July-August 2018; article published 2020", "publication_date": null, "publication_year": 2020, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/xml", "response_sha256": "66dbd66be8e4574debd0c19284dadfa945418430e3558304c5d3bef869d921ea" }, "statement": "Among 629 public and private outpatient users in Fier, public-PHC users prioritized proximity while private-clinic users prioritized diagnostic equipment; 70 percent of public-PHC users reported referral to another provider compared with 23 percent of private users, and 85 percent of private users had first consulted a public-sector doctor.", "tags": [], "territory": "18 public PHC centres and five private outpatient clinics in Fier region", "title": "Factors associated with the utilisation of primary care services in public and private facilities in Albania", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7709502/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Gabrani J, Schindler C, Wyss K. Health Seeking Behavior Among Adults and Elderly With Chronic Health Condition(s) in Albania. Front Public Health. 2021;9:616014. doi:10.3389/fpubh.2021.616014. https://pmc.ncbi.nlm.nih.gov/articles/PMC8007873/", "country_ids": [ "ALB" ], "coverage_domains": [ "governance", "hospital_organization", "market_structure", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "40% among adults and 28% among the elderly", "institution": "Frontiers in Public Health", "locator": { "locator_type": "xml_text_anchor", "source_word_anchor": "40% among adults and 28% among the elderly", "source_word_count": 8 }, "material_id": "material:34e57ee22a36791d95d521c4", "notes": [ "Use the age-specific numerators and two-region survey scope; do not convert these findings into national bypass prevalence." ], "origin": "country-evidence-improvement-sources", "period": "Random-cluster household survey in December 2018; article published 2021", "publication_date": null, "publication_year": 2021, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/xml", "response_sha256": "d9328e95a7ec1c46e8cedbe0ae29e4c538ebe08bd1024c748f8a02e90825bd3a" }, "statement": "In a two-region survey of respondents with chronic conditions, 40 percent of adults and 28 percent of older respondents initiated care at government hospitals, while PHC centres were the most common initial public provider; the study preserves referral, unavailable tests and unavailable services as distinct reasons for non-PHC use.", "tags": [], "territory": "Diber and Fier regions; not nationally generalizable", "title": "Health Seeking Behavior Among Adults and Elderly With Chronic Health Conditions in Albania", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8007873/" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Republic of Albania. Law No. 55/2022 of 7 July 2022 on Hospital Service in the Republic of Albania. https://qeverisjavendore.gov.al/wp-content/uploads/2024/08/Ligj-nr.-55-date-7.7.2022-Per-sherbimin-spitalor-ne-Republiken-e-Shqiperise.pdf", "country_ids": [ "ALB" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "market_structure", "networks", "ownership", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "delegimin gradual të të drejtave të vendimmarrjes financiare dhe administrative", "institution": "Parliament of Albania", "locator": { "locator_type": "legal_articles", "source_word_anchor": "delegimin gradual të të drejtave të vendimmarrjes financiare dhe administrative", "source_word_count": 10 }, "material_id": "material:424ad7610b7be4022727f128", "notes": [ "Treat autonomy as conditional and charter-specific; do not imply that every public hospital has identical decision rights." ], "origin": "country-evidence-improvement-sources", "period": "Approved 2022-07-07 and effective after Official Gazette publication; later amendments must be annotated", "publication_date": null, "publication_year": 2022, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "65b68f42fd95a74bd42a7b6cef7f81f402cc81ffb1b160e3ca74f9aa6f9c8c86", "page_count": 12, "response_sha256": "65b68f42fd95a74bd42a7b6cef7f81f402cc81ffb1b160e3ca74f9aa6f9c8c86" }, "statement": "The 2022 law established tiered public and non-public hospital categories, a lower-to-higher-level referral pathway with emergency and paid out-of-referral routes, and conditional managerial or financial autonomy granted progressively through a ministerial charter while ministry audit and reporting duties continue.", "tags": [], "territory": "national statutory framework for public and non-public hospital services", "title": "Law No. 55/2022 on Hospital Service in the Republic of Albania", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://qeverisjavendore.gov.al/wp-content/uploads/2024/08/Ligj-nr.-55-date-7.7.2022-Per-sherbimin-spitalor-ne-Republiken-e-Shqiperise.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ministry of Health and Social Protection, Albania. National Health Strategy 2021-2030. Tirana; 2021. https://extranet.who.int/cpcd/sites/default/files/public_file_repository/ALB_Albania_RENJK-National-Health-Strategy_2021-2030.pdf", "country_ids": [ "ALB" ], "coverage_domains": [ "actors", "authoritative_review", "autonomy", "decision_rights", "governance", "government_responsibilities", "hospital_organization", "networks", "ownership", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "katër (4) Drejtori Rajonale", "institution": "Ministry of Health and Social Protection, Albania", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "katër (4) Drejtori Rajonale", "source_word_count": 4 }, "material_id": "material:ece636485c3e94884aa47f6b", "notes": [ "Do not convert strategy targets for integrated care, regional poles or autonomy into evidence that every action was implemented." ], "origin": "country-evidence-improvement-sources", "period": "Strategy period 2021-2030; achievements, planned actions and target dates remain distinguished", "publication_date": null, "publication_year": 2021, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "d01a55d1d173848d09b33cf6077328ed4fd45bd07a16e16e5dc60e8d9acf92a6", "page_count": 119, "response_sha256": "d01a55d1d173848d09b33cf6077328ed4fd45bd07a16e16e5dc60e8d9acf92a6" }, "statement": "The national strategy reported that the Health Care Services Operator and four regional directorates had assumed planning and administrative functions for primary and secondary care, while setting future actions for integrated patient pathways, regional referral hubs and progressively piloted hospital autonomy.", "tags": [], "territory": "national strategy and action framework", "title": "National Health Strategy 2021-2030", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://extranet.who.int/cpcd/sites/default/files/public_file_repository/ALB_Albania_RENJK-National-Health-Strategy_2021-2030.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Council of Ministers of Albania. Primary Health Care Services Development Strategy in Albania 2020-2025. Decision No. 405 of 20 May 2020. https://arkiva.shendetesia.gov.al/wp-content/uploads/2022/10/Strategjia-Zhvillimit-t%C3%AB-Kujdesi-Paresor-2020-2025.pdf", "country_ids": [ "ALB" ], "coverage_domains": [ "actors", "autonomy", "decision_rights", "governance", "government_responsibilities", "networks", "ownership", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "përgjegjësi për organizimin dhe ofrimin e shërbimeve", "institution": "Council of Ministers and Ministry of Health and Social Protection, Albania", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "përgjegjësi për organizimin dhe ofrimin e shërbimeve", "source_word_count": 7 }, "material_id": "material:f522384c4c5c038c6f04e574", "notes": [ "Separate the strategy's description of existing authority from its proposed referral, integration and management reforms." ], "origin": "country-evidence-improvement-sources", "period": "Strategy period 2020-2025; planned actions are not treated as completed implementation", "publication_date": null, "publication_year": 2020, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "8f0ff464f1ac1bb72dd6a18113679c91ea8a07373813c58445159eff9354b7d4", "page_count": 27, "response_sha256": "8f0ff464f1ac1bb72dd6a18113679c91ea8a07373813c58445159eff9354b7d4" }, "statement": "The official PHC strategy described a family-medicine network administered through the Health Care Services Operator and four regional directorates, retained major ministry powers over staffing and facility organization, assigned municipalities infrastructure responsibilities, and proposed stronger referral, counter-referral and facility-management arrangements.", "tags": [], "territory": "national strategy with national, regional, municipal and facility roles", "title": "Primary Health Care Services Development Strategy in Albania 2020-2025", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://arkiva.shendetesia.gov.al/wp-content/uploads/2022/10/Strategjia-Zhvillimit-t%C3%AB-Kujdesi-Paresor-2020-2025.pdf" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization Regional Office for Europe. Primary health care in Albania: rapid assessment. Copenhagen: WHO; 2018. https://www.who.int/docs/librariesprovider2/default-document-library/alb-phc-ra-eng.pdf?download=true&sfvrsn=dd965525_3", "country_ids": [ "ALB" ], "coverage_domains": [ "actors", "authoritative_review", "autonomy", "decision_rights", "governance", "government_responsibilities", "networks", "observed_referral", "ownership", "primary_care", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "All PHC centres are under the direct supervision", "institution": "World Health Organization Regional Office for Europe", "locator": { "locator_type": "pdf_page_set_anchor", "source_word_anchor": "All PHC centres are under the direct supervision", "source_word_count": 8 }, "material_id": "material:937f6fd453ecdf813982c85b", "notes": [ "Retain the selected-site design and keep the Mother Teresa emergency-department estimate separate from national referral prevalence." ], "origin": "country-evidence-improvement-sources", "period": "Assessment mission 15-18 January 2018; local estimates are not national prevalence measures", "publication_date": null, "publication_year": 2018, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "448a5cfcc9dc78987f8276088f13eba3e5412579c8ec2939d171fc23693f1954", "page_count": 22, "response_sha256": "448a5cfcc9dc78987f8276088f13eba3e5412579c8ec2939d171fc23693f1954" }, "statement": "The WHO assessment described a public PHC network in all 61 municipalities under direct ministry supervision, found limited PHC-manager financial and workforce authority, and observed ineffective self-referral restrictions and weak communication between general practitioners and specialists.", "tags": [], "territory": "selected national, regional, municipal and facility interviews and site visits", "title": "Primary health care in Albania: rapid assessment", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.who.int/docs/librariesprovider2/default-document-library/alb-phc-ra-eng.pdf?download=true&sfvrsn=dd965525_3" } ] }, { "analytical_mapping": {}, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization. WHO Results Report 2024-2025: Albania country profile. https://www.who.int/about/accountability/results/who-results-report-2024-2025/country-profile/2024/Albania", "country_ids": [ "ALB" ], "coverage_domains": [ "actors", "authoritative_review", "autonomy", "governance", "hospital_organization", "networks", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "multidisciplinary teams in 102 out of 362 PHC centres", "institution": "World Health Organization", "locator": { "locator_type": "api_record_anchor", "source_word_anchor": "multidisciplinary teams in 102 out of 362 PHC centres", "source_word_count": 9 }, "material_id": "material:c0be16c1038c229c2cbc6192", "notes": [ "Treat the results report as official implementation reporting and retain its stated governance and role-clarity limitations." ], "origin": "country-evidence-improvement-sources", "period": "Reported activity during 2024 and early 2025", "publication_date": null, "publication_year": 2025, "record_kind": "country_improvement_source_lead", "record_kind_label": "Country Improvement Source Lead", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "50be6d175587e79ed048fc36f7563cd80b89914dd846f39b4049a98927ac809f" }, "statement": "WHO reported multidisciplinary teams in 102 of 362 PHC centres and ongoing family-medicine network work, while hospital-autonomy technical assistance focused on three-year action plans, managerial and financial systems, transparency and accountability and continued to identify governance, role-clarity and change-management obstacles.", "tags": [], "territory": "national WHO country-results reporting with programme-specific implementation", "title": "WHO Results Report 2024-2025: Albania", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.who.int/about/accountability/results/who-results-report-2024-2025/country-profile/2024/Albania" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank Documents and Reports. Albania - Health System Improvement Project. World Bank Documents and Reports; 2015. https://documents.worldbank.org/curated/en/822301468009009546/pdf/PAD10580PAD0P1010Box385412B00OUO090.pdf", "country_ids": [ "ALB" ], "coverage_domains": [ "actors", "government_responsibilities", "hospital_organization", "primary_care", "referral_design" ], "display_status": "shown_in_full", "document_type": "candidate source metadata", "evidence_mode": null, "excerpt": null, "institution": null, "locator": { "paragraph_index_on_page": 2, "physical_pdf_page": 3, "source_word_anchor": "QSUT Mother Theresa National Referral Hospital Qendra Spitalore Universitare RHIS Regional Hospital", "source_word_count": 12 }, "material_id": "candidate-source:ALB:aa18a0ec595fd42db8ec", "notes": [ "Public source projection retained as a distinct stage record.", "Immutable source-version metadata was retrieved from this exact public source URL in the priority traceability audit.", "A recoverable source locator was retrieved from this exact public source URL in the priority traceability audit." ], "origin": "current-public-source-projection", "period": null, "publication_date": null, "publication_year": 2015, "record_kind": "displayed_source_projection", "record_kind_label": "Displayed source projection", "screening": { "page_locator_linked_from_priority_acquisition": true, "previous_visibility": "previously_projected", "source_version_linked_from_priority_acquisition": true }, "source_layers": [ "candidate_source_metadata", "grey_literature" ], "source_system": "global_literature", "source_version": { "detected_media_type": "application/pdf", "page_count": 90, "response_sha256": "27df8b17ae811144f289ca2c9d6258be0cff73211a5f7b82a17e5cd53eb7bd0c" }, "statement": null, "tags": [ "grey_library" ], "territory": null, "title": "Albania - Health System Improvement Project", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://documents.worldbank.org/curated/en/822301468009009546/pdf/PAD10580PAD0P1010Box385412B00OUO090.pdf" } ] }, { "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Bank Documents and Reports. Albania - Health System Improvement Project : Additional Financing. 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