Dr Edona Tafa is a family doctor at the “Shtoj i Ri” health post in Shkodër, which serves approximately 5,000 residents. She is also the Director of the Rrethina Health Centre, of which this health post is a part. She graduated as a general practitioner from the University of Tirana and has worked in health administration, emergency services, and primary healthcare.
Could you briefly describe your role in identifying and providing healthcare to patients with NCDs?
My name is Edona Tafa, and I graduated from the University of Medicine five years ago as a general practitioner. Over the past five years working in medicine, I’ve gained experience in health administration, emergency services, and primary healthcare. Currently, I serve as a family doctor at the “Shtoj i Ri” health post, which provides care to 5,000 residents and is located about 4 kilometres from the city of Shkodër. At the same time, I am also the Director of the Rrethina Health Centre, which includes the health post where I work.
In our daily work, alongside the medical team, I look after and monitor all patients diagnosed with chronic conditions, including the five major NCDs. In addition to periodic treatment based on diagnosis and clinical evaluations, we also provide lifestyle counselling to help patients improve their overall health.
When it comes to identifying these conditions, in the past three years, we have focused intensely on screening high-risk age groups -particularly middle-aged individuals – for conditions such as hypertension, type 2 diabetes, dyslipidaemia, bronchial asthma, and COPD. Basic medical check-ups, frequent patient contact, and further diagnostic tests are some of the tools we use to detect these diseases early and at their onset, aiming for better long-term outcomes.
What do you see as the biggest challenges in delivering healthcare in your community?
I believe we currently face two major challenges, both driven by demographic changes and the growing incidence of disease.
The first is the rise in mental health disorders, which now affect all age groups. The Rrethina Health Centre still lacks a psychologist or social worker in its team structure, which complicates the proper diagnosis and treatment of patients with mental health issues.
The second is the increasing incidence of NCDs in the 35–50 age group, which is typically the most active demographic but also, paradoxically, one of the most negligent when it comes to their own health.
How would you describe the relationship between the medical staff and the community? Do residents trust your team? Do they come to you for advice and guidance?
At the “Shtoj i Ri” health post, where I work as a family doctor, I collaborate with a team of four nurses. One is assigned to work directly with the family doctor, one is based in the child consultation unit, one in women’s consultations, and one is engaged in community outreach.
Beyond the core services – whether home-based health care or the full range of services offered at the health post – the medical team performs all its duties diligently and maintains ongoing contact with the community.
Thanks to the team’s dedication to delivering quality care, the community now actively seeks out our clinic for most healthcare services, recognising it as the first point of contact in the medical system.
The consistent good work carried out not only by me but also by the entire staff over the years has contributed to a situation where basic medical check-ups, child and seasonal flu immunisations, various screenings, as well as consultations for acute and chronic cases and medical therapies are all carried out at the “Shtoj i Ri” clinic.
This is a source of great pride and motivation for us, as we now run scheduled consultations and services every day of the week, addressing both adult and paediatric patient groups.
What are the main factors that influence the quality of healthcare delivered to the community, particularly for NCDs?
I believe the most important factor is the willingness of patients to seek care at the health post and engage more frequently with the medical team, whether at the clinic or within the community.
For us, patient interaction is essential, as it allows us not only to perform objective physical examinations but also to gather a complete medical history to better understand disease progression. In this regard, I want to emphasise again that our entire team has worked and continues to work hard to build a mutually trusting relationship with the entire community.
Another important aspect contributing to the rise in patient visits for certain conditions is the availability of specialised equipment that many patients don’t have at home, such as glucometers or peak flow meters.
How useful do you believe the training on NCD protocol implementation has been? How has it influenced your clinical practice and patient care?
The establishment and functioning of Peer Groups for the prevention and treatment protocols of the five major NCDs, along with the provision of head-to-toe examination tools for family doctors and nurses, were among the first interventions supported by HAP in our health centre. These initiatives were very well received by our entire team, and now, two years later, their impact is clearly felt, particularly in the role of the family nurse and in the quality of care we provide to patients.
Do you feel you now have greater knowledge and skills to manage NCDs in the community?
Absolutely! As a team of doctors and nurses, we not only have more theoretical knowledge, but our medical practice has also become more standardised through the implementation of protocols. These protocols guide both diagnosis and staging, as well as the treatment we provide, depending on each individual case.
Equally important in our daily practice is the health education of patients for managing NCDs, as outlined in the relevant training manual.
What challenges do you foresee in implementing these protocols in daily practice?
As with any new approach or innovation, there are both “welcoming” and “resistant” elements. In my experience, even when medical staff are eager to embrace new protocols, there are some difficulties. Firstly, the degree to which clinical supervisors from the Health Insurance Fund Directorates accept and support these protocols can be a barrier. Secondly, the infrastructure and physical spaces available for medical consultations are often critical for successful implementation. For example, examining a patient with diabetes requires a setting that ensures adequate privacy. Similarly, providing counselling or health education to a patient is difficult in environments where other medical services are being offered at the same time.
So, it is essential that all staff within the primary healthcare system not only have the appropriate knowledge and medical tools (which HAP has provided and for which we are deeply grateful) but also the right facilities and infrastructure to deliver quality services.
What kind of support do you think would be necessary to ensure the successful integration of protocols in primary care?
The integration of protocols into clinical practice is a joint effort: if our role as a health centre is to translate these protocols into sustainable daily practice for family doctors and nurses, it is the responsibility of higher authorities to facilitate their implementation. The first support is expected from the Health Insurance Fund to enhance the competencies of family doctors in diagnosis and initial treatment. Equally important is the collaboration and coordination with specialists in these pathologies, with the aim that they also become familiar with and apply the protocols for the 5NCDs, ensuring alignment with family doctors. It would also be necessary to reduce the administrative procedures or statistical reports we prepare for the Local Units of Health Care/Regional Directorates of the Health Operator, so that staff have the necessary time to properly dedicate themselves to chronic patients, as these protocols require.
How do you plan to engage and educate patients about managing the respective chronic diseases within the framework of these protocols?
Besides the routine health education carried out with patients, especially when issuing reimbursed prescriptions, we have long initiated a programme related to health education and promotion. Approximately once a month, in one of our health posts, the team, mainly the health education and promotion nurse—holds meetings with different target groups, where special attention is given to the 5 chronic diseases. During these meetings, not only medical information and advice are shared by the staff, but also experiences from the patients themselves, with the goal of promoting positive examples of adaptation and lifestyle changes, leading to better control of the chronic disease by the patients.
Have you noticed changes in the health status and quality of life of patients since the start of implementing these protocols?
Yes, there has been a noticeable improvement, especially among patients with Type 2 Diabetes Mellitus, Hypertension, and Dyslipidemia. We believe that due to the work carried out by the entire staff based on the 5NCD protocols, we have better outcomes in patient health. The biggest challenge remains with patients suffering from COPD and Bronchial Asthma, as they are more resistant to quitting smoking or avoiding exacerbating factors.
Do you think there is room for improvement in these trainings? In which aspects?
For us, the support from HAP and all its interventions has been a transformative mechanism for primary care. Specifically, the medical protocols are clearly summarised and easy to implement in practice by both doctors and nurses, which makes them very useful in our daily work. Undoubtedly, in the long term, we hope their updates will continue regularly. But overall, the training has been an added value and a very significant support for us. Thank you very much!