Health project, WB takes stock: From the "collapse" of financing reform to digitalization

The World Bank project to improve the health system in Albania, which lasted more than a decade, ended with the rehabilitation of hospital infrastructure and the deployment of digital systems, but without implementing the main reform initially envisaged, which was related to changing the way the sector was financed.

In the final report, the World Bank identifies the lack of institutional conditions for implementing complex reforms as the main problem. According to the report, “Component 3 was removed due to the excessive complexity of its reforms,” referring to the provider payment reform and the pharmaceutical reform.

The document says the component was designed “without the necessary enabling conditions,” while implementation was hampered by “weak institutional capacity,” “unstable leadership,” and a “politically resistant” environment within the Mandatory Health Insurance Fund.

Until the first restructuring, at the end of 2018, all indicators related to the financing reform had remained at the baseline level, leading to the “elimination of the entire component”.

This decision came at a time when the project had only realized 10% of disbursements, more than three years after approval.

The World Bank says the 2018 restructuring aimed to "simplify an overly ambitious design," while the focus shifted from institutional reforms to building core capacities.

The project was approved in January 2015 and was due to be completed in February 2021. It was postponed four times and was only completed in September 2025, after an implementation period of “10 years and 7 months.”

Although the financing reform was abandoned, the project realized some of the investments in digitalization.

The Regional Hospital Information System was deployed in 11 regional hospitals. The report says the system was “established and operational,” but usage remained below target.

Electronic patient registration reached 37.75%, against the target of 40%. The bank assesses this indicator as “almost achieved”, while noting that data was available for only four hospitals. Another problem identified is related to procurement.

The report cites “initial delays due to poor planning and coordination.” The Hospital Masterplan failed to be procured three times between 2016 and 2018 due to “insufficient budget” and inappropriate terms of reference.

The tender for the RHIS system also faced delays. The procedure started in 2019, the contract was signed only in March 2021, and the system became fully operational in all 11 hospitals only in 2025.

In conclusion, the World Bank assesses the overall outcome of the project as "modest", while the quality of monitoring and evaluation as "modest".

The report assesses that in the future, "major components of reform should be preceded by an assessment of political economy and institutional readiness."

Project information

The World Bank project to improve the health system in Albania was approved in January 2015, with an initial financing of 32.1 million euros, and was subsequently expanded with 25 million euros of additional financing, bringing the revised value to 57.1 million euros.

It was conceived on four main pillars: improving hospital services and infrastructure, expanding health information systems, reforming sector financing, and managing and monitoring the project.

Originally scheduled to close on February 28, 2021, the project was postponed four times and ended on September 30, 2025. According to the report, implementation took a total of 127 months, or “10 years and 7 months,” with a cumulative delay of 55 months.

The actual cost of the project amounted to 54.68 million euros. The most sensitive component, the health financing reform, was removed during implementation, as according to the report it was designed “without the necessary enabling conditions”./MONITOR