The European Journal of Public Health Advance Access originally published online on April 6, 2006
The European Journal of Public Health 2006 16(3):243-245; doi:10.1093/eurpub/ckl017
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Transition in Eastern Europe |
Building public health associations in the transition countries of south-eastern Europe: the example of Albania
Enver Roshi1, Genc Burazeri1, Vesna Bjegovic2, Lidia Georgieva3, Doncho Donev4, Gabriela Scintee5, Bajram Hysa1 and Ulrich Laaser6
1 Department of Public Health, Faculty of Medicine, University of Tirana, Tirana, Albania
2 Institute of Social Medicine, School of Medicine, University of Belgrade, Serbia and Montenegro
3 Department of Preventive Medicine and Epidemiology, Faculty of Public Health, Medical University, Sofia, Bulgaria
4 Department of Social Medicine, Faculty of Medicine, Skopje, Macedonia
5 Institute of Public Health, Bucharest, Romania
6 Section of International Public Health, Faculty of Health Sciences, University of Bielefeld, Germany
Correspondence: Enver Roshi, MD, PhD, Faculty of Medicine, Rruga ‘Dibres’, No. 371, Tirana, Albania, tel: +355 4262782; fax: +355 4257420; e-mail: e_roshi{at}yahoo.com
Received August 23, 2005, accepted December 7, 2005
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Abstract |
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Abstract
The 'Old' and the...The Albanian Forum of Public Health (AFPH), an umbrella organization including different public health associations operating in Albania, was established in March 2004 with the support of the European Public Health Association (EUPHA) and the Open Society Institute (OSI). Ever since its establishment the AFPH has been an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health.
Notwithstanding the laudable mission of the AFPH, there is an emerging need to establish a regional Public Health Forum in south-east Europe as a basic prerequisite for sustainable development of public health in these countries. Most conveniently, this regional umbrella organization should have a supporting Secretariat based in one of the south-east European countries. Nevertheless, there is a clear call for international funding with participation of different agencies and bodies (OSI, EUPHA, Canadian International Development Agency, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for the development of research in south-east Europe. Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language.
Keywords: Albania, professionalization, public health associations, south-east Europe
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The ‘Old’ and the ‘New’ Public Health and the role of public health associations |
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The ‘Old’ Public Health was concerned with ‘Unhealthy settlements, food safety, air pollution, water and sanitation, and waste disposal, which targeted infectious, toxic, and traumatic causes of diseases’.1 The accomplishments of the ‘Old’ Public Health, on the whole, have greatly contributed to the decrease in mortality rates and change in the patterns of diseases in the United States and western Europe in the early 1900s. Thus, the leading causes of death had changed in the 20th century from infectious diseases to chronic diseases (what was conventionally referred to as the ‘epidemiological transition’). Nowadays, a ‘holistic approach’ to health services is the foundation of what is now referred to as the ‘New’ Public Health: ‘The New Public Health synthesizes traditional public health with management of personal services and community action for a holistic approach’.1 Thus, comprehensive management of health services with a particular focus on disease prevention and health promotion has marked a ‘new age’ for public health. Yet, notwithstanding the enlargement of scope and focus over time, the core value guiding the work of public health professionals has long been to protect the health of the public, especially its most vulnerable individuals. The later has always been on the focus and scope of work of most of the public health associations all over the world.
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Albanian Public Health Strategy and the role of public health associations |
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The Albanian Public Health and Health Promotion Strategy, informed by the WHO European Regional Strategy for Health for All in the 21st century (Health 21), was developed in 2002–2003 as the outcome of a project financed through an agreement between the World Bank and the Albanian Government.2 The Public Health and Health Promotion Strategy responds to Albanian public health challenges and is in close line with the upcoming strategy, namely the ‘Long-Term Strategy for the Development of the Albanian Health System (Draft – Albanian Ministry of Health, May 2004)’. This strategy encompasses the goals, the principles of equity and solidarity in health, the multi-sectoral responsibility, as well as the targets and actions for improving health in Albania.2
Nevertheless, so far, there are no active professional associations of physicians, nurses, or other health care professionals in Albania that have become advocates for better public health. From this point of view, the initiative of the Albanian Forum of Public Health (AFPH) undertaken in 2004 is a good start towards enhancing the advocacy and partnerships for improvement of public health in Albania.
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Public health collaboration in south-east Europe (PH-SEE) |
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Since 2000, a collaborative network (Public Health Collaboration in south-eastern Europe—PH-SEE, a project of the Stability Pact, which strives for social cohesion among countries of south-eastern Europe) is working on a common set of teaching materials and has developed a common database for public health in the region.3,4 Also, a minimum indicator set for regional health monitoring has been developed and practised in postgraduate teaching programmes.5 A joint project of the Open Society Institute (OSI) and the Association of Schools of Public Health in the European Region (ASPHER) has supported the establishment of schools of public health in selected countries of eastern Europe, with the main focus on development of teaching curricula at the MPH level.6
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Support of public health associations as key links between government, the scientific community, and the population in central and eastern Europe |
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A project on ‘Support of public health associations as key links between government, the scientific community and the population in Central and Eastern Europe’ was initiated in 2002 by the OSI and the European Public Health Association (EUPHA) with the following aims:
- To foster a major role for public health associations as venues for the dissemination of evidence-based public health research that is applicable to government policy.
- To encourage a link between public health associations and the general population.
- To promote multidisciplinary networking between public health professionals and institutions.
- To establish a strong public policy role for public health associations.
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Establishment of the Albanian Forum of Public Health |
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The Albanian Epidemiological Association (AEA), a non-governmental organization operating in the health field, implemented the OSI–EUPHA project from May 2003 to May 2004. The twinning partner of the AEA was the German Association for the Health Sciences and Public Health (DVGPH). The aims of this project implemented in Albania included the following:
- To increase awareness of public health professionals from all disciplines about public health challenges of Albania and the need for a common multi-professional association.
- To establish a Public Health Forum in which all stakeholders and associations in public health are participants.
- To increase the awareness of policy-makers and the community about public health challenges in Albania.
- To enhance and foster evidence-based policy.
These developments in Albania have been strongly supported by the twining partner (DVGPH) and the PH-SEE network.
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Features of the AFPH—memorandum of understanding |
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A memorandum of understanding (MoU) was prepared by the AEA with support of the DVGPH in the framework of the OSI–EUPHA project. The content of MoU is summarized below.
- The AFPH is a not for-profit and non-governmental organization.
- The AFPH is an umbrella organization. As such, non-governmental organizations which operate in the health field and other relevant sectors in Albania can become institutional members of this Forum.
- Nevertheless, individuals not adhering to any associations can become individual members of the Forum.
- Individual members of the AFPH can be all Albanian citizens agedat least 18 years, regardless of their gender, political attitudes, religion, and region of the country. Professionals who wish to pursue a carrier and/or work in public health, regardless of their bachelor degree, are strongly encouraged to join the Forum.
- Membership is based on a voluntary approach.
- The activities of the AFPH are regulated and coordinated by an Executive Board, which is responsible for the organization of meetings and conferences with the participation of all public health specialists and civil society in Albania.
- Each institutional member of the Forum elects a representative for the Executive Board according to their own statutes. At a first stage, the actual Presidents or Heads of the organizations (which aim to join the AFPH) may be the born members of the Forum.
- The individual members of the Forum (i.e. those who are not engaged in any other associations) elect two representatives for the Executive Board for a period of 2 years.
- The Executive Board elects a chairperson and a vice-chairperson for a duration of 1 (one) year.
- The chairperson and the vice-chairperson cannot be re-elected, unless all institutional members represented in the Executive Board have experienced such a position. Therefore, each institutional member of the Executive Board will head the AFPH in a (yearly) rotational base. The individual members of the Board can be elected as chairperson and vice-chairperson; however, they are not subject to this rotating scheme.
- All members of the Executive Board (including the chairman and the vice-chairman) have the same voting rights. Decisions are made by simple majority of the members of the Executive Board present in the meeting if they constitute more than 25% of the total membership including the two individual board members.
- At the same time, an Advisory Board will be established by decision of the Executive Board for a period of 3 years composed by the most renowned public health specialists in Albania, as well as international experts who have a long career in public health. This Board will advice and provide counselling not only to the AFPH, but also to all non-governmental organizations, which may not want to join the Forum.
- Individual members of the Forum will pay an annual membership fee of 10 (ten)
.
- Institutional members will pay an annual membership fee of 50 (fifty).
- The AFPH is an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health. This will be a suitable start to enhance counselling and advocacy for efficient and equitable policy-making in Albania.
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Current developments and future trends of the AFPH |
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The AFPH is actively involved in the public health debates in Albania. There is an increased interaction between the community, public health professionals, and the government. To further enhance this interaction, an annual conference of the AFPH was conducted in April 2005, financed by the twinning partner (DVGPH). The positive impact of the AFPH, the technical assistance of the DVGPH, the support of the Stability Pact, OSI, and EUPHA have played a significant role in the recent developments in public health training in Tirana, which culminated with the establishment of the School of Public Health and the initiation of the first MPH course in Albania in December 2004. The current MPH programme enrols 31 students holding leadership positions in local- and central-level institutions, as well as young aspirants who wish to pursue a career in public health.
However, after the end of the OSI financial support, there are serious difficulties with regard to funding issues. Therefore, without international support the problem of sustainability is rather questionable for national public health associations such as the AFPH.
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The need to establish a regional Public Health Forum in south-east Europe |
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Notwithstanding the importance and contribution of local public health associations, the funding limitations pose serious difficulties for the future of such ‘enterprises’. Therefore, there is an emerging need to establish a regional Public Health Forum in south-east Europe with a supporting Secretariat based in a ‘neutral’ place (e.g. Monte Negro). This regional (umbrella-type) association would require mid-term (3–5 years) international funding (mixed funds from the OSI, Canadian International Development Agency, EUPHA, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for development of research in south-eastern Europe.7 It would facilitate consortia research proposals as requested from different funding agencies.8 Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language.
Key points
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References |
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1 Tulchinsky TH, Varavikova EA. The New Public Health: An Introduction for the 21st Century. San Diego: Academic Press, 2000: pp. 17–35.
2 Ministry of Health of the Republic of Albania. Public health and health promotion strategy: Towards a healthy country with healthy people. Tirana: Ministry of Health of the Republic of Albania, 2004.
3 Public Health Collaboration in South Eastern Europe (PH-SEE): A project of the Stability Pact. Available from: www.snz.hr/ph-see (accessed 15 May 2005).
4 Kovacic L, Laaser U. Public health training and research collaboration in South Eastern Europe. Med Arh 2001;55:13–5.[Medline]
5 Bardehle D. Minimum Health Indicator Set for South Eastern Europe, Croat Med J 2002;43:170–3.[Medline]
6 Association of Schools of Public Health in the European Region (ASPHER). Available from: http://www.aspher.org/C_projects/osi/osi_aspher (accessed 1 February 2006).
7 Burazeri G, Laaser U, Bjegovic V, et al. Regional collaboration in public health training and research in countries of South East Europe. Eur J Public Health 2005;15:97–9.
8 Laaser U. The institutionalisation of public health training and health sciences. Proceedings of the international conference on developing new schools of public health. Public Health Rev 2002;30:71–95.[Medline]
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