Albania - Health System Improvement Project : Additional Financing

Overview & Synopsis

Ratings of the Health System Improvement Project for Albania were as follows: Outcome was moderately satisfactory; Bank performance was moderately satisfactory; M&E quality was modest. Lessons learned and recommendations are as follows. First, major reform components should be preceded by a political economy and institutional readiness assessment, with reforms sequenced to depend on prerequisite infrastructure: for example, output-based and case-mix payments require a functional Health Information System (HIS) before roll out; where enabling conditions are absent, stage reforms in a subsequent operation rather than embedding them in the same project. Second, digital infrastructure deployment must be paired with robust change management, user training, and incentives to drive adoption, including linking the Regional Hospital Information System (RHIS) to payer platforms such as the Health Insurance Fund (HIF) to convert technical outputs into sustained service delivery outcomes. Third, to avoid extended periods of underperformance, build formal review milestones with pre-agreed restructuring triggers into project design so that early warning signs prompt timely course correction. Fourth, in earthquake-prone settings, embed seismic resilience and climate adaptation into civil works from the outset rather than retrofitting later, and use these investments to layer energy efficiency, waste management, and preparedness enhancements. Fifth, for complex procurement tied to hospital rehabilitation or construction, deliberately sequence civil works packages and apply clear protocols to redesign or cancel stalled lots; treat high-stakes technical assistance such as hospital master planning as a distinct risk that must be legally anchored early with realistic costing and detailed terms of reference, supported by targeted procurement capacity building. Sixth, where national procurement rules and Bank guidelines differ, provide early, unambiguous guidance to all actors to prevent systemic bottlenecks. Finally, for internationally sourced medical equipment, stipulate phased delivery milestones with liquidated damages and include adequate buffers between delivery, installation, training, and loan closing to mitigate supply chain disruptions and ensure operational readiness.