Social Cohesion: Health, education, social protection, child protection, and gender-based violence

(Text from the Programme of Cooperation 2017-2021)

All women, men, girls and boys, especially those from marginalized and vulnerable groups, are exercising their entitlements to equitable quality services, in line with human rights; and more effective and efficient investments in human and financial resources are being made at central and local levels to ensure social inclusion and cohesion.

Overview

Overall, the population has decreased by 9% since 2001 and the share of children under age 15 dropped from 33% to 21% leading to a decline in the dependency ratio 62 to 47%. This provides Albania with a demographic dividend of about 10 years where the majority of the population will be in their prime working years. At the same time, the poverty rate increased in 2012 to 14% and extreme poverty in both urban and rural areas doubled to 2%. The proportion of children living in absolute poverty or in families with less than US $125 a month is 17% or 147,432 children. Albania remains one of the poorest countries in Europe and disparities affect the enjoyment of basic health, education, and social care and protection. In this context, seizing the demographic dividend will require sound policies and effective implementation that reaches all areas and groups in the country and involves investments in children, efforts to prepare and support people for productive employment, and increasing inclusive social care and protection. It will be particularly important to seize this opportunity for increasing investments directly benefitting health, education, developmental opportunities and the overall wellbeing of Albania’s children and youth, especially in light of the relatively low levels of the current state expenditure on early education, preventing and primary health care, social care and child protection services.

While infant mortality has decreased to 13 deaths per 1,000 live births, it is three times higher than the EU average. According to the UN Inter-agency Group for Child Mortality Estimation (IGME), in 2015, Albania’s IMR and U5MR declined to, respectively, 13 and 14 per 1,000 live births – which is still the highest level in South East Europe (SEE). There is a considerable discrepancy with the nationally-generated data, including, due to widespread undercounting of child deaths in national vital statistics. In the underserved areas of mountainous Albania the infant and child mortality rates are twice the national average. Maternal mortality has decreased to 21 deaths per 100,000 live births in 2013, still the highest in the region. Between 2006 and 2012, the use of modern contraceptives was 69% with an average unmet need for contraception of 13%. Inadequate communication and a lack of access for all women to quality information about family planning options is a challenge and contribute to poor health outcomes. And while Albania is not a high HIV prevalence country, While Albania is not a high HIV prevalence country, there is an upward trend in the number of new cases diagnosed and about 70 per cent of HIV positive cases are younger than 34 years old. Knowledge amongst young people about modes of transmission of HIV is only 29%, attributed to the lack of comprehensive sex education. Cases of tuberculosis have been increasing slowly with 18 new cases per 100,000. The low rates of detection and cure are due to difficulties in administering the Directly Observed Treatment, particularly in rural and remote areas. Albania has joined the majority of European countries that face an increasing burden on non-communicable diseases (NCD) including cancers, cardiovascular disease, diabetes and chronic obstructive pulmonary disease. Premature death or chronic illness related to a NCD has grave socioeconomic consequences. Reduced incomes can push households into poverty and increased demands for social care and welfare support contribute to surging health care costs. 

Spending on health care is about 2.6% of GDP, substantially lower than the average 4.5% of GDP spent by countries with similar levels of income. Household out-of-Pocket expenditures are very high, estimated to be around 60-70% of total health expenditures. Limited resources in the health sector as well as high out-of-Pocket expenditures negatively impact health and wellbeing outcomes of the Albanian population as well as offer little protection from impoverishment due to health expenditures, with a disproportionate effect on poor families.Poor governance is a major cause of inefficiency and mismanagement in the sector. The unequal distribution of health care services, and weak performance monitoring and incentive systems for health care workers contribute to the poor quality of health services.

Albania has significantly increased access to all levels of education. Primary and lower secondary enrolment are nearly universal, and between 2009 and 2013, pre-primary net enrolment improved from 47 to 79% and upper secondary enrolment from 76 to 92%. There is no gender disparity in the pattern of access to primary and secondary education for girls and boys, with the respective Net Enrolment Rates (NER) being 94.8% and 96.2% (in primary school), and 84.5% and 86.0% (in secondary school). The rate of transition from primary to secondary education is equal for girls and boys, at 99.8%. However, there are severe disparities in access to education for vulnerable groups, including low income families, Roma, street children, and children with disability. Despite an increase in education spending to 3.8% of GDP in 2009, the proportion of expenditures on education remains low at currently around 3% compared to EU country averages of 5%. Despite progress in improving quality of education, Albania’s overall performance remains low. Albania’s PISA 2012 scores are the lowest in all of Europe and Central Asia and among the lowest of all PISA-participating countries. Key education challenges involve ways to increase the efficiency of public education spending, improve the quality of teaching and learning, and implement inclusive education policies. There is no gender disparity in the pattern of access to primary and secondary education for girls and boys, with the respective Net Enrolment Rates (NER) being 94.8% and 96.2% (in primary school), and 84.5% and 86.0% (in secondary school). The rate of transition from primary to secondary education is equal for girls and boys, at 99.8%.

Albania’s social care and protection systems are neither able to protect people against poverty shocks nor to help them escape poverty. Social protection in Albania is narrowly defined as the provision of economic aid (EA). The current scheme does not take into account the multiple and intersecting dimensions of poverty and deprivation: education, health care, and housing conditions. It does not address social care and does not address deep-rooted gendered social determinants of poverty and related economic, social, cultural and environmental risks. Vulnerable groups, in particular, are being left behind. Elderly people in Albania are faced with multidimensional exclusion. In particular old-age people who rely on economic assistance are most excluded, followed by rural pensioners. Public spending on cash assistance is currently at only 1.6% of GDP.

The prevalence of gender-based violence has increased from 56% in 2007 to 59% in 2013 and more than half of Albanian women (aged 15-49) have experienced at least one form of domestic violence in their lifetime. National and local institutional capacities for child protection are not providing adequate support to groups of children already excluded or at risk of exclusion from the enjoyment of their rights. Albanian legislation does not deal with all aspects of violence against children in a comprehensive manner and the government has not earmarked funds for public and private entities that serve children in difficult circumstances. The punitive nature of the criminal justice system, the weak child protection system - underpinned by legislation that is not in compliance with international juvenile justice standards - and the lack of parental and family accountability are some of the driving factors of child vulnerability. Stronger linkages are needed between social assistance measures, social services, and the justice system to enhance the ability of parents to care for their children and avoid formal care. Creating these linkages is an important step in using social protection as a tool for enhancing child protection outcomes. Specific area of need include: social work standards that address the situation of children at risk, a national child helpline as a main referral mechanism, and targeted communication and behaviour change initiatives in communities and schools to address violence and abuse.

Strategies:

To respond to these challenges and achieve results for greater social cohesion in Albania, programme strategies will:

  • Generate evidence and arguments that support reform of legal, regulatory, and financing frameworks to strengthen the governance and responsiveness of the health, education and social protection systems;
  • Develop data and skills that bring an equity focus in planning and budgeting processes for the delivery of quality, inclusive services; 
  • Augment health, education and social protection information systems to bolster the collection, dissemination, and use of data and evidence for policy formulation and decision-making;
  • Promote changes in Social and Child Protection laws in line with EU and international standards;
  • Strengthen social protection and child protection measures and mechanisms at national and local levels with service standards, budgets, and clear targets that reflect equity and social inclusion standards;
  • Strengthen LGUs to implement social inclusion and social protection policies;
  • Support the introduction of quality improvement measures such as public feedback and rating systems;
  • Support the scaling-up of innovative service delivery models for persons with disabilities, older persons, and victims of violence, abuse and neglect; 
  • Support stronger institutional responses to violence, abuse, exploitation and neglect in relation to children, in line with national and international commitments;
  • Assist national stakeholders, both at national and local levels and from government and non-governmental sectors, in scaling the application of effective models of support to families as primary care givers aiming to prevent incidences of abuse, exploitation, violent treatment or neglect of children;
  • Strengthen families’ capacities to cope with various socio-economic hardships to prevent parents’ sending their children to residential care institutions, work or to the street.

Enhance monitoring and supervision mechanisms for LGUs and CSOs providing social services.

For more information, please see Joint Work Plan 2017-2018 - Outcome 2 Social Cohesion.