Albania, situated in the western Balkans, has an area of 28 748 km2 and a population of 3 069 275 (year 2001), almost one-third of whom are aged 0–14 years. Life expectancy is estimated to be 70.4 years for both sexes (World Health Organization, 2003a). According to the World Health Organization's classification, Albania is a country with low child and low adult mortality rates. The nation's total expenditure on health in 2001 amounted to 3.7% of gross domestic product.

For more than a decade Albania has been undergoing a transitional process of democratisation of its society and decentralisation of its systems, including systems of care in general. However, its relatively recent totalitarian past had created a culture of lack of community initiative, participation and decision-making, and the care system remains prey to financial and regulatory rigidity. The system is still highly centralised and lacks a focus on the social welfare of citizens. Decentralisation and open governance within a framework of comprehensive reform are prerequisites for better services. Furthermore, any intervention to improve the health system will need to take into account the fact that Albania is not a rich country and health is not the top priority when it comes to the allocation of national resources.

Education in psychiatry

Formal psychiatric education is provided by the only university department of psychiatry in the country; it is part of the Faculty of Medicine of the University of Tirana. Education in psychiatry has had to be transformed in order for it to meet international standards. While psychiatry constitutes 1.4% of the overall training hours in the university curriculum for medical doctors, in 1994 postgraduate psychiatric education was extended from 9 months of internship to 4 years of residency in the university clinic.

Residents annually discuss their training plan with their supervisors. They attend to and follow clinical cases in their charge. The professional qualification for psychiatrists involves several yearly examinations across the entire residency period, and one final examination (oral and written). While the curriculum offers satisfactory training in biological psychiatry, it is difficult to train young residents properly in the psychosocial aspects of practice, as there are few supervisors with sufficient experience and knowledge in this area.