ALBANIA

 

DESCRIPTION OF THE CURRENT SITUATION, AIMS AND NEEDS TO BE MET

 

CURRENT SITUATION

 

General situation

 

Ten years after the fall of the Communist dictatorship, and after violent years, Albania works hard again to develop. The economic growth is there certainly real, but it only has a limited impact on the majority of families of which one out five estimates to have sufficiently resources to appropriately live. Situated at the 85th world rank (on 170) according to the UNDP Human Development Index, Albania remains the second poorest country of Europe, after Moldavia. The paralyzed industry and underdeveloped agriculture, low domestic production and deteriorated services and increased imports affect the living cost. On the other hand, sharp disparities between rural and urban zones lead the young people and many families from north to move to central urban areas or out country.

 

In spite of obvious progress, the condition of the country, in all sectors (medical, educational, social, etc.) remains seriously degraded. Infrastructures should be rehabilitated, the facilities are rare or little adapted, and the staff is untrained.

 

Such a context encourages the creation of vulnerability situations. Five categories of people are especially at risk: women, the elderly people, children, the youngsters and the disabled persons.

 

Situation of the disabled persons

 

The situation presented here-below is related to the general context of disabled persons in Albania.

 

Statistics:

 

No general survey, either coordinated investigation has been led in the country, by authorities, professionals or associations. Actually there is no statistical data to tell what is the number of disabled persons in Albania. If applying the international minimum standard disability rate of 7% to Albanian population, we get 245 000 disabled persons, but this hypothesis has not been verified.

 

Some professionals or members of associations have collected numbers, however, but relative to the specific groups. We know for example that Labor Invalids of are more than 32 000, that 33 000 children (one on five) suffer a deficiency (of which 14 000 of a mental or sensory deficiency), that 35 000 disabled persons benefit an allowance of the state (mostly labor invalids).

 

Conditions of life in Albania are such (quasi - absence of gynecological advice of the pregnant women, high number of road accidents, environment extremely polluted, etc.) that they surely contribute to enlist the country among those with high percentage of disabled persons.

 

The existing system, resources and services:

 

Legal frame

 

Albania has a disability legal frame (a set of laws, not a complete frame). Disabled people officially are entitled to all human rights rights, (education, employment, health, etc.) and of the freedoms (opinion, expression, etc.) as other citizens, with whom they are equal in front of the law.

 

The constitution (article 1/f) stipulates that the state and the government must act in favor of disabled persons in fields of health rehabilitation, the special education, the social integration and living conditions improvement.

 

According to these arrangements a certain number of laws and decrees have been approved, notably on legal statutes of various groups of disabled persons (invalid, paraplegic, blind) and on social and health care.

 

Albanian Legislation classifies disabled persons in five categories: 1. Labor Invalids. 2. War Invalids. 3. People with development disorders (to the birth or before the age of 21 years). 4. People suffering from mental disorders. 5. Other invalids.

 

Para-medical and medical services:

 

According to WHO, Albania health level is ranked at the 102^nd place (on 170 countries). The life expectancy of the population, at birth, is of 59,4 years (70 years in France).

 

The ministry of Health is responsible for the national policy concerning public health and health service coordination. However, this ministry doesn't take care as such of the disabled persons, in this sense it has not in its structure any department targeting this specific group.

 

The per inhabitants physicians number is 129 for 100 000, so, 1 for 775 inhabitants (WHO1998). For comparison the report is 303 for 100 000 in France, either 1 for 330 inhabitants or 164 for 100 000 in Great Britain, or 1 for 609. Physicians are graduated in six years at the faculty of medicine in Tirana.

 

Nurses, graduated to the superior school of nurses, are to the number of 4 300, either 1 for 800 inhabitants.

Psychologists (including clinical psychologists) and social workers are not even included in the health administration.

 

The medical frame of reference foresees 3 levels of intervention, through which generally the damaged or sick person goes through, enduring or not invalidating physical consequences:

·         Services of primary health care,

·         Hospitals (34 in the country),

·         The university hospital center of Tirana and the military hospital of Tirana.

 

Regarding to people suffering mental disorders, these are taken in charge by services of primary health care or by the 4 existing psychiatric hospitals.

 

According to the degree of disability or the type of deficiency (except chronic mental disorder), the disabled children are hosted in public institutions: 2 day centers and 5 residential centers, where offered physiotherapy services, psycho - motor and special education.

 

The educational services:

 

Ministry of Education is responsible for the education of the disabled children. Nevertheless, within this Ministry, there is no specific department of special education, even though the Ministry directly manages 8 specialized schools in the country (6 schools for 486 children presenting a light mental disorder, a residency for 200 deaf children, a school for 68 blind children).

 

The social services:

 

Ministry of Labor and Social Affair is responsible for disabled persons. It is responsible for the national policy development related to social services, especially for those that concern the disabled persons. It exists within this ministry a “General Administration of Social Service (GASS) Â», which role is, among others, to manage the concerned public institutions and to provide the economic aid to disabled persons, on the basis of an individual assessment report written by a medical commission.

 

According to the law, a born disabled person and a disabled person with disability acquired before 21 years, receives a monthly 4. 460 ALL disability allowances that is 35 Euro. A person with disability acquired after the age of 21, if socially insured, receives an invalidity pension as per disability degree from 2 200 to 4.400 ALL, between 17 and 35 Euro. The families that incomes are below the poverty line benefit a monthly economic aid of 1.000 to 1.500 ALL, either 8 to 11 Euro, from the Social Insurance Institute. Just for comparison the average monthly income in Albania is 109 Euro, while the necessary minimum income is 199 Euro.

 

The disability associations working with/for disabled persons:

 

In 2002, the socio-economic context of Albania, where the state is not able to protect the citizens, the role of associations is extremely important, to address the needs not met by the state. This role is an explicit expression of the society will to reconstruct the social solidarity, which is still weak and very faltering in all sectors of the society.

 

The civil society is officially recognized and the associations are legally registered (a new law on non-profit associations has been adopted).

 

The disabled persons associations in the country are roughly up to forty, out of them, 17 associations constitute the Albania Disability Forum, established in November 2001 (please refer to the list of associations members of Forum, in appendix 5). Non member associations are those that don't know the existence of the Forum, those that made a request of acceptance that is not yet approved, again or simply those (as the association of Blinds and Partially-sighted) that estimate to be enough strong and influential.

 

They represent physical, mental, sensorial disability and are operating in various fields, according to their means: asking for improvement of services, doing lobbying. All have been created after 1991, and legally registered. The most important, among them, is the Labors Invalids Association counting 32 000 members and organized in 12 provincial branches.

 

Their founding members, active members or professionals are generally very motivated, and are willing to know all techniques and skills to contribute to the improvement of their associations and to their members. They are conscious of their crucial role, in terms of pressure on institutions, of human rights promotion, of the community awareness raising, and implementation of common new projects.

 

The national and international organisms

 

No foreign agency of UN or European Union and any international NGO do have the exclusive mandate to work with disabled people in Albania, as Handicap International does.

Nevertheless:

·         A certain number of organisms (WHO, PNUD, European Union) become their spokesman, particularly during days of special events, or contribute to finance projects helping the disabled persons;

·         Several NGO, of which OXFAM, ASED, Save The Children, Médecins du Monde, have supported the local associations to implement projects.

 

Otherwise, churches, and notably the Italian Catholic Church, push actions in disabled peopleÂ’ favor.

Nowadays, as we know any project dealing with capacity building of disability associations has not yet been implemented in Albania by the initiatives of state or religious institutions, international agencies or Albanian or foreign NGOs.

 

NEEDS TO ADDRESS

 

Needs of disabled persons in Albania cannot be dissociated from those of Albanian population, and more especially from those of poor people. However, a recent report of the World Bank (Vulnerability Needs and Institutional Capacity Assessment - 2001) places disabled persons among most vulnerable because they are facing the serious following problems:

·       Bad quality services, not accessible, geographically limited with untrained staff;

·       Weak access to information (on rights, services, procedures, etc.);

·       Isolation and solitude, self-denigration, weak family cohesion, stigmatization;

·       Unemployment and poverty,

·       Unsuitable education system, using obsolete methods;

·       Limited physical accessibility (displacements, transportation, etc.).

 

Here it is, under another shape, the assessment of lacks and needs, as HI professionals, the disabled persons and their families express them.

 

Legal Frame

 

As we already saw, the legal frame exists. But the legislation doesn't cover all categories of disabled persons and big gaps have been created between these various categories. Otherwise, laws don't cover all disabled persons rights. Finally, by-laws for application of these laws are not always followed by the sufficient funds for their practical application.

 

It is therefore necessary, to clearly redefine a national policy on disability and an operational strategy reflecting a more modern undiscriminating legislation adapted to the disabled personsÂ’ needs and followed by positive actions. It is also very important the legislator to dispose the means for making these laws known and implemented. This objective could not be reached without a close cooperation between disability associations and the public authorities, or without making pressure on the government.

 

The community:

 

Healthy people prejudices against disabled persons are still strong and discriminating. The community is not aware about the harsh problems disabled people face and is little interested on disability needs. Despite stigmatization, there exist the fear, especially from people with mental health problems (still considered as a social danger to the society and public order) and the diversity refusal reinforces the assumptions that disabled persons are useless and a cost-burden. The very difficult socio-economic context does not encourage the social solidarity of healthy people for vulnerable persons whose social statute is depreciated. The disabled persons self-denigration and the family shame for them contribute to the marginalization.

 

Raising the public awareness on the disability problems and needs and sharing the information concerning the positive actions, even modest, are prior to any other action. They go together with advocacy campaigns promoting the disabled people rights.

 

Services:

 

Health:

 

The number of health centers and health posts reduced from 916 to 637 in 1996, 35% less in 5 years, and the number of hospitals from 160 to 51 in the same period.  The number of hospital beds dropped from 13.000 to 9.6000.The health care infrastructures in Albania is under reconstruction.

 

The patients hospital admission, officially free of charge or reimbursable, indeed paid under the - table, is a maximum 21 days. After this hospital period, the patients are sent home, and medical treatment is almost interrupted, because of lack of rehabilitation services, or failure to use the services. No state institution distributes for free orthopedic devices. On the other hand, professions like physiotherapy, ergo-therapy or psycho-motricity are still missing and training sessions are not yet integrated in the superior health care education system. The foreign associations provide only short period training. The competent professionals are therefore rare.

 

In such a context, disabled persons, not receiving health care, are exposed to serious risk factors that directly threaten their life quality and considerably reduce their life expectancy.

 

As for the disability prevention, it is little taken into consideration, as the prenatal and postnatal health care services do not dispose precise diagnosis devices for early identification of disability. Most of the time it is the family or the teacher the first to detect a child deficiency and unfortunately it is often too late.

 

Education:

 

Special education programs are not considered a priority by the public authorities.

The teaching staff is composed of teachers without special education background on disability and not knowing the methods and tools indispensable to work with disabled children. The university curricula for disability are not yet included in the education program.

 

In facts, disabled children are almost excluded from the compulsory education, and also deprived from integration services. Youngsters and teenagers are not attending either vocational or occupational, neither professional education program.

 

Social field:

 

As we have seen, the invalidity pension is given only to people who become disabled prior to the age of 21 and to them that become so after 21 years, if insured. All other disabled persons up to the age of 21, but not insured, and they are numerous, do not receive any economic allowance. They are the most marginalized people in Albania, even within disabled population. However, with such an insufficient economical aid the government gives them through very bureaucratic procedures, the disabled persons, insured or not, survive through relaying above all on their family revenues.

 

The social workers employed at local administration are in charge of economic aid distribution to the disabled persons or their families. Out this responsibility they do not perform any other activity for disabled persons, what explains the weakness or even the absence of social services provided to disabled people by one side, and lack of skills related to professional performance of social workers working in disability field, by the other side..

 

The Law on Employment imposes the employers to recruit one disabled employee out of 25 healthy employees. Nevertheless, the disabled personÂ’s employment is almost never done. Employers prefer to pay the fine rather than to recruit a disabled person. Of course, the unemployment rate in Albania is too high (33% of the active population), but the disabled persons are especially marginalized because of their low level of education and professional qualification generally, what makes them uncompetitive on the labor market. Tailored made professional training, a well-targeted approach of possible employers, and a lot of awareness campaigns, are indispensable to address the needs of disabled persons for employment.

 

Accessibility:

 

The physical accessibility to reach the public or private places and to use the services does not exist in Albania. Streets and bumpy sidewalks, chaotic traffic, absence of rails and elevators in the multi-story buildings, non adapted bus and limited number of wheelchairs or walking devices, all contribute to the reduction of the mobility and limit the freedom of movement of disabled persons, depriving them from normal circulation. It seems that neither the public authorities, nor professionals (architects, civil engineers, etc.) are worried about this problem. As for the sensory disabled persons (blind, deaf), they do not find anywhere the needed facilities for their displacement or for understanding the environment (insufficient in Braille information, and missing interpreters of Signs Language).

 

In brief, regarding the access to the wide range of services, we note that disabled persons have a very limited access to health and social care, to the education system and the employment opportunities, either because the structures providing these services do not exist, or when existing they are weak and insufficient and the staff is little experienced; either because they are not physically accessible. As a consequence, the disabled persons are little served, educated and professionally untrained, so, they cannot self-respond to their daily needs. As we already mentioned, for improving the disabled people quality of life, it is necessary to carry out parallel actions for approaching the public institutions dealing with disability, and for raising the community awareness on disability, and for strengthening public and private structures providing services to the disabled people.

 

Associations:

 

The associations are not state-financed, so, they should be financially self-sustained to survive and very often they experience critical situations of extreme financial difficulty, as they cannot even ask their members (in financial need) to pay the required membership fee. Most of them do not dispose offices and the address is that of the association president.

 

To help disabled persons overcome their difficulties (especially access to health care, to the education system and the employment opportunities) and to efficiently defend their rights, associations should have more financial and technical means and a more skilled human resources to fulfill their missions. Despite the financial constraints, the associations face many other problems not less important like:

·         Problems of internal organization and communication,

·         Problems of external relationship (lack of expertise to build up relations and to create networks),

·         Missing skills for institutional cooperation and among themselves coordination,

·         Missing means and techniques for doing advocacy.

 

Their influence upon the public authorities, the community, professionals and service structures, is very weak because they are still missing some essential knowledge and tools to well-formulate, write-down, sponsor and implement, alone or in partnership:

·         Advocacy Projects: « Advocacy Â» means “each policy, plan or activity aiming to protect a group, an institution, a principle, a reason, considered to be threatened”;

·         Awareness Projects: « Awareness  Â» meaning is “ to become more conscious about the problems, needs, potentiality and contribution of the disabled persons to the society”.

·         Services Set-up and Improvement Projects: « Service Â» means «each service provision in health and social care, in educational and cultural fields, to assure a physical, psychological and social well-being, and developed in a set of environment interventions, including the community, home, school, workplace, institutions».

 

A deep analysis of the situation, taking into consideration the opinion of representatives of 17 associations, has allowed us to identify two simple determining reasons related to the difficulties they face in their actions:

·         The disabled persons associations are not well-structured and well-organized,

·         The disabled persons associations are not enough coordinated.

 

The causal tree of problems, presented in appendix 1, shows how a number of causes and effects are linked together and impact each other based on the two determining causes. Of course, we could not say that because of the bad organization and coordination of associations, disabled people are marginalized, but it is obvious that in the Albanian context, where the government does not play much protective role, their incapacity and the lack of means contribute to their exclusion. A further empowerment of their abilities and potentiality would increase their credibility (towards the institutions and beneficiaries) and their power of influence as well.