Management challenges and opportunities in Albania’s local primary health care network
DOI:
https://doi.org/10.59476/mtt2026.v2i22.782Keywords:
primary healthcare, network management, governance, decentralization, digital healthAbstract
Aiming to strengthen the management of Primary Healthcare services at the local level in Albania, this study examines and analyzes the main challenges and opportunities affecting the PHC network’s performance. The purpose of this paper is to conduct a literature review focusing on governance and decentralization, human resources management, service coordination, and resource allocation in the context of digital transformation. The findings of this paper showed persistent challenges. To achieve its aim, the current paper adopts a narrative review methodology, which is also combined with thematic analysis. This methodological approach allowed the comparative examination of information from international healthcare systems and, at the same time, the identification of conceptual patterns relevant to the Albanian PHC context. At this point, it is noted that the persistent challenges examined include limited managerial capacity and workforce shortages. They also include weak coordination mechanisms and infrastructural constraints. At the same time, some opportunities were also presented. Indicative opportunities include digital health technologies and integrated care models, which can enhance efficiency and the quality of care. In addition, the current literature review highlighted that the effectiveness of PHC management is closely aligned with and associated with an organization's leadership capacity and with other equally important factors, such as interdisciplinary collaboration and the ability of local healthcare systems to adapt to demographic and epidemiological changes. Even more, the existing literature emphasized the importance of sustainable workforce policies and the necessity of integrated care pathways and patient-centered approaches. All of these actions strengthen the continuity and accessibility of healthcare services at the community level. Overall, the current paper offered a conceptual basis for future research and policy actions to further improve the effectiveness and equity of Albania’s local PHC system.References
1. Beheshti, L., Kalankesh, L. R., Doshmangir, L., & Farahbakhsh, M. (2022). Telehealth in primary health care: A scoping review of the literature. Perspectives in Health Information Management, 19(1), 1n. https://pmc.ncbi.nlm.nih.gov/articles/PMC9013222/
2. Borgermans, L., Marchal, Y., Busetto, L., Kalseth, J., Kasteng, F., Suija, K., ... & Devroey, D. (2017). How to improve integrated care for people with chronic conditions: Key findings from EU FP-7 Project INTEGRATE and beyond. International Journal of Integrated Care, 17(4), 7. https://doi.org/10.5334/ijic.3096
3. Dieleman, M., Gerretsen, B., & van der Wilt, G. J. (2019). Human resource management interventions to improve health workers’ performance in low and middle income countries: A realist review. Health Research Policy and Systems, 7(1), 7. https://doi.org/10.1186/1478-4505-7-7
4. Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in the rural USA. Public Health, 129(6), 611–620. https://doi.org/10.1016/j.puhe.2015.04.001
5. Espinosa-González, A. B., Delaney, B. C., Marti, J., & Darzi, A. (2019). The impact of governance in primary health care delivery: A systems thinking approach with a European panel. Health Research Policy and Systems, 17, 65. https://doi.org/10.1186/s12961-019-0456-8
6. Gabrani, J., Schindler, C., & Wyss, K. (2020). Perspectives of public and private primary healthcare users in two regions of Albania on non-clinical quality of care. Journal of primary care & community health, 11, 2150132720970350. https://doi.org/10.1177/2150132720970350
7. Ismaili, E., Rama, R., & Dragoti, E. (2024). Access to healthcare services among vulnerable groups in Albania: unveiling barriers and proposing solutions. KONTAKT-Journal of Nursing & Social Sciences related to Health & Illness, 26(4), 369–375. https://doi.org/10.32725/kont.2024.050
8. Karakolias, S., & Polyzos, N. (2025). Health inequalities under decentralized governance: Challenges in resource allocation and funding in Greece. Frontiers in Health Services, 5, 1701887. https://doi.org/10.3389/frhs.2025.1701887
9. Kellici, N., Dibra, A., Mihani, J., Kellici, S., & Burazeri, G. (2015). Physicians’ perceptions about the quality of primary health care services in transitional Albania. Med Arh, 69(2), 123–126. https://doi.org/10.5455/medarh.2015.69.123-126
10. Kluge, H. H. P., Kelley, E., Swaminathan, S., Yamamoto, N., Fisseha, S., Theodorakis, P. N., ... & Mossialos, E. (2018). After Astana: building the economic case for increased investment in primary health care. The Lancet, 392(10160), 2147–2152. https://doi.org/10.1016/s0140-6736(18)32859-9
11. Knoblauch, A. M., Rajkumar, S., Canavan, R., Ramadani, Q., Katanolli, A. B., Bahtiri, S., ... & Gerold, J. (2025). Assessing the quality of care in primary health care facilities in all municipalities in Kosovo 2016–2023. Frontiers in Public Health, 13, 1596249. https://doi.org/10.3389/fpubh.2025.1596249
12. Kringos, D. S., Boerma, W. G. W., Hutchinson, A., & Saltman, R. B. (2017). Building primary care in a changing Europe: Case studies. European Observatory on Health Systems and Policies. https://iris.who.int/server/api/core/bitstreams/a8edc80e-8677-47c6-90a3-f086a0663d43/content
13. Kuupiel, D., Bawontuo, V., Drain, P. K., Gwala, N., & Mashamba-Thompson, T. P. (2019). Supply chain management and accessibility to point-of-care testing in resource-limited settings: A systematic scoping review. BMC Health Services Research, 19, 519. https://doi.org/10.1186/s12913-019-4351-3
14. Mechili, E. A., Saliaj, A., Xhindoli, J., Bucaj, J., Sifaki‐Pistolla, D., Peto, E., ... & Chatzea, V. E. (2022). Primary healthcare personnel challenges and barriers on the management of patients with multimorbidity in Albania. Health & Social Care in the Community, 30(1), 380–388. https://doi.org/10.1111/hsc.13411
15. Mone, I., Vasil, S., Alia, A., Xinxo, S., Muça, K., & Burazeri, G. (2023). Socio-demographic correlates of barriers to access healthcare services among children in post-communist Albania. Sustainability, 15(11), 8455. https://doi.org/10.3390/su15118455
16. Muja, H., Vasil, S., Qendro, A., Clemens, T., Toçi, D., Toçi, E., ... & Burazeri, G. (2024). Socio-demographic factors related to children’s knowledge about their rights to healthcare services in transitional Albania. Frontiers in Public Health, 12, 1391265. https://doi.org/10.3389/fpubh.2024.1391265
17. Neves, A. L., & Burgers, J. (2022). Digital technologies in primary care: Implications for patient care and future research. European Journal of General Practice, 28(1), 203–208. https://doi.org/10.1080/13814788.2022.2052041
18. Oliveira, R., Santinha, G., & Marques, T. S. (2024). The impacts of health decentralization on equity, efficiency, and effectiveness: A scoping review. Sustainability, 16(1), 386. https://doi.org/10.3390/su16010386
19. Qirjako, G., Qosja, A., Çumashi, R., Meksi, A., Hala, R., Zikaj, L., ... & Tomini, E. (2024). Strengthening youth mental health capacities in Albania: Training primary healthcare professionals. European Journal of Public Health, 34(3), ckae144.1869. https://doi.org/10.1093/eurpub/ckae144.1869
20. Reed, M. E., Huang, J., Graetz, I., Lee, C., Muelly, E., Kennedy, C., & Kim, E. (2019). Patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians. JAMA Network Open, 3(6), e195873. https://doi.org/10.1001/jamanetworkopen.2020.5873
21. Rustami, E., Toçi, D., Poshi, K., Peka, E., Pano, I., & Pula, A. (2023). Determinants of inadequate health literacy among Faculty of Medical Technical Sciences students in Albania: Cross-sectional survey. JMIR Formative Research, 7(1), e46476. https://doi.org/10.2196/46476
22. Saltman, R. B., Bankauskaite, V., & Vrangbaek, K. (2007). Decentralization in health care: Strategies and outcomes. McGraw-Hill Education.
23. Saric, J., Kiefer, S., Peshkatari, A., & Wyss, K. (2021). Assessing the quality of care at primary health care level in two pilot regions of Albania. Frontiers in Public Health, 9, 747689. https://doi.org/10.3389/fpubh.2021.747689
24. Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care, 13, e010. https://doi.org/10.5334/ijic.886
25. WHO. (2007). Task shifting: Rational redistribution of tasks among health workforce teams. World Health Organization. https://iris.who.int/handle/10665/43821
26. WHO. (2018). Primary health care in Albania: Rapid assessment. World Health Organization. https://www.who.int/docs/librariesprovider2/default-document-library/alb-phc-ra-eng.pdf
27. WHO. (2020). Primary health care on the road to universal health coverage: 2019 global monitoring report. World Health Organization. https://www.who.int/publications/i/item/primary-health-care-on-the-road-to-universal-health-coverage-2019-monitoring-report
28. WHO. (2022). Health workforce: Global strategic directions for nursing and midwifery 2021–2025. World Health Organization. https://www.icn.ch/resources/publications-and-reports/who-global-strategic-directions-nursing-and-midwifery-2021-2025
29. Willis, V. C., Thomas Craig, K. J., Jabbarpour, Y., Scheufele, E. L., Arriaga, Y. E., Ajinkya, M., Rhee, K. B., & Bazemore, A. (2022). Digital health interventions to enhance prevention in primary care: Scoping review. JMIR Medical Informatics, 10(1), e33518. https://doi.org/10.2196/33518
30. Yaro, P. B., Asampong, E., Tabong, P. T.-N., Thornicroft, G., & Tindana, P. (2025). Leadership and governance for integrating mental healthcare at the primary healthcare level: A mixed methods study in Ghana. PLOS Global Public Health, 5(8), e0002672. https://doi.org/10.1371/journal.pgph.0002672
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Afrodhiti Ngjelo, Fatma Jaupi
This work is licensed under a Creative Commons Attribution 4.0 International License.
