Home Care Service is one of the most significant interventions of the HAP Project in Albania. Successfully piloted in May 2021 across nine health centres in Dibra and Fier, this new service model was approved by the Ministry of Health and Social Protection (MHSP) in December 2021, with the goal of extending it to six Local Units of Healthcare (LUHCs) by 2025. However, the growing need for this service, driven by an ageing population and the increasing burden of non-communicable diseases, has drawn more attention from the MHSP. In April 2024, the Ministry requested HAP’s support to expand the service to 62 new health centres within six LUHCs. Currently, HAP is working to extend home care to 120 health centres across 17 LUHCs nationwide.
But what exactly is home care?
Home care is a new service provided to homebound patients, mainly those suffering from chronic diseases and the elderly, who are unable to visit health centres. Eligible patients are selected through an individual assessment of their autonomy, based on the Karnofsky Performance Scale.
Home care is delivered by a family nurse in coordination with a family doctor, following a standardised plan that includes regular visits aimed at treating and monitoring patients’ health conditions, as well as providing health education to better manage their chronic illnesses.
How informed are citizens about home care, and how has demand for this service evolved?
Data shows that thanks to HAP’s interventions, awareness of home care services and access to this information from health personnel in Dibra and Fier—where the service was first introduced—has significantly increased. From 2021 to 2023, public awareness in these two regions about home health care grew from 57.3% to 70.1%. Additionally, in 2023, 89.7% of patients were informed about home care services by nurses (compared to 66% in 2021), and 60.1% by doctors, an improvement from 39.3% in 2021.
An analysis of the demand and use of home care also shows a significant rise. In 2023, 82.4% of patients requested health care at home, compared to 66.1% in 2021. Moreover, 84.8% of patients in the intervention group received home services, compared to 65.0% in the reference group.
What has been HAP’s support for the introduction and expansion of home care?
Documentation and literature: HAP has supported the development of all documents underpinning home care services, including the regulatory framework for reorganising work in health centres, documents for identifying and monitoring eligible patients, support documents for home visits, and documents for reporting and monitoring home care implementation. In addition, it has developed training curricula for medical personnel and a variety of materials (manuals, guides, etc.) to support nurses’ ability to provide the service.
Training of family medicine team: By September 2024, HAP had supported the training of 792 nurses on standard and advanced nursing procedures required for delivering HHC.
Provision of equipment: 58 health centres have been equipped with the necessary medical and pre-medical tools and equipment to provide home care and with personal medical bags for family doctors and nurses. These tools are crucial in improving the diagnosis, treatment, and monitoring of home care patients.
Strengthening central and regional institutions: 58 professionals from LUHCs and the Health Insurance Fund (HIF) have been trained to monitor home care, with the aim of continuously improving service quality and ensuring the sustainability of operations in health centres.
What is the current situation regarding HHC delivery?
Currently, home care is offered in 52 health centres across 11 LHCUs in 9 districts of the country. Around 2,000 patients have been identified as eligible for home care, 1,650 patients have received home care, and in the past two years alone, over 20,000 home visits have been made to patients with limited autonomy.
Meanwhile, HAP is working to extend HHC to 62 additional health centres, fulfilling the objective of offering this service in 120 health centres across 17 LHCUs, specifically in Shkodër, Kukës, Lezhë, Mirditë, Dibra, Bulqizë, Mat, Durrës, Tiranë, Kavajë, Elbasan, Lushnjë, Fier, Berat, Mallakastër, Pogradec, and Korçë.
In addition to service expansion, HAP is working to include home care services in the basic package of primary care services, which will also contribute to increasing health centres’ budgets.
Another positive development is HAP’s support for integrating home care with social services. The MHSP has decided to hire social workers and psychologists in 104 health centres (out of 358 nationwide), and HAP is assisting in the development of professional tools for social workers in primary care. It is also committed to developing and piloting a model/methodology for processing information in the Municipality’s Socio-Health Services Network, which will serve as a support tool for referring cases that cannot be resolved by primary care.
The Expansion Map of Home Health Care with HAP Support
Patient satisfaction
According to the Assessment of Quality of Life and Home Health Care Needs in Fier and Dibra, from 2021 to 2023, there has been a significant increase in the number of patients who trust the professional skills of health personnel and in the quality of care they receive from the home service.
What challenges has the expansion of this service faced?
The expansion of home care faces several key challenges. Although the MHSP has expressed political will to extend the service nationwide, in practice, there is a lack of strong leadership from the MHSP, the Central and Regional Operators, and LUHCs, which hampers service expansion beyond the areas where HAP operates. Furthermore, the MHSP has not taken the necessary steps to allocate additional financial resources needed to support home care, which are essential for the efficient implementation of the service and for motivating staff. While primary health care resources have increased, this growth remains insufficient to meet the population’s needs, particularly for the most vulnerable groups. Public trust in the health sector remains low, shaken by a series of scandals. Additionally, the 2025 legislative elections present a further challenge, potentially affecting the stability and focus of reforms in this field.
Next steps
HAP will continue to support 62 additional health centres for the expansion of home care while also monitoring all centres that have been supported since the beginning of this intervention. The project will also support the development of a “Manual for the Implementation of Home Health Care,” compiling all materials and documents produced so far regarding this service.