Author: Denis TAHIRI and Aurora SHPATAJ
At the beginning of this year, the Minister of Health Orgerta Manastirliu had a different opinion about doctors. "The free movement of doctors is not only an isolated phenomenon for Albania, but for all the countries of the Region as a whole. Free movement has also brought vacations. Facing this phenomenon is a daily battle", the minister insisted at that time, adding that they had not yet found a solution to the phenomenon. But six months later, the formula offered for the situation was laid out by another institution, which means the prohibition of doctors to leave Albania. The Ministry of Education and Sports proposed the draft law "On the special treatment of students who follow the integrated study program of the second cycle "General Medicine" in public institutions of higher education".
The draft law was presented by Prime Minister Edi Rama, Minister of Education Evis Kushi and Minister of Health Ogerta Manastirliu after the government meeting at noon on July 5, 2023, and a few hours later it was submitted to the Assembly, where at the request of the Council of Ministers it was requested to is passed with an accelerated procedure.
But what does this bill provide? The draft law, which is expected to become law within July, provides that students who sign the agreement at the time of registration, after completing their studies, must work as doctors in Albania for no less than 5 years. After the end of these 5 years, the doctor has the right to withdraw the diploma. But affected by this law are also students who are currently studying general medicine, who after completing their studies, if they choose to sign the agreement, must work for 2-5 years at Albanian health institutions, without specifying whether they are public or private. The only case in which students do not have this obligation is if they do not sign the contract and pay the full cost of their studies, which cost has not been made public.
Scenarios to doctors
The Ministry of Education and Sports has also listed several scenarios, but the most realistic is the one where 50% of students will agree to sign the agreement with the Ministries of Education, Health and Higher Education Institutions.
"The financial effect for students who will agree to sign the agreement (except for those who already benefit from the exemption) because they will sign the agreement for a 2-5 year stay in Albania is calculated: 325 additional students*45.000/2 ALL = 7.312.500 ALL necessary funds from the state budget to cover the fee exemption. This category of students is assumed to pay 50% of the fee (45.000/2 ALL)". it is stated in the bill.
Medical students: It will have the opposite effect
On Thursday (06.07.2023), while the fast-track passage of this draft law was being discussed in the Assembly, in front of the assembly hall, hundreds of students came out in protest. Among them, Mikel Seferi, a first-year student. "The doctor should be invited to Albania, he should not be forced to work. We are all affected by this law, working under obligation". says the young man, who needs another 5 years to finish the University of Medicine. Among other things, he says that this draft law is not a solution, but is an impetus to the problem, which will bring a boomerang effect. "We will go to work in the districts, we will see the scandalous conditions, we will work for years under obligation and we will get the diploma and leave".he says, adding that: "No one likes to leave their home, if the conditions are right, no one leaves, that's guaranteed"-the student finishes his story for "Signalizo"..
"This is a knife in the back." says second-year medical student Mateo Shehari. "A few days ago they came out that they were having constructive meetings, they came out without a draft, they came out that they were just meetings and today they came up with a draft law"- says the young man, not hiding his disappointment. Even for Mateo, this law will have the opposite effect. "Loss of interest, especially for graduates, 5 years is too much, 6 years of general medicine, 5 years of forced labor, 4 years of specialization, 3 more years of forced labor after specialization, it's really tiring. he says.
"I have to stay for 2 years and in case I don't stay for two years, I will have to pay a fee that I don't know how much it will be for the two years that I will study here". says the fourth-year medical student, Fabiola Kamberi, who adds that, as medical students, they did not have any information and were not told anything fixed to be more clear and calm.
"It has been discussed. We asked the ministry for a draft, they told us that we don't have a draft, it was thrown as an idea. We thought it would take time, even further discussions to reach a decision, even a compromise with us, but this did not happen, they reached a decision". she concludes.
Experts: Nonsense measure
Migen Qiriaxhi from the Civic Center says that the country reformed 8 years ago and today we are in the conditions where we have to look at the results of the reform. It also raises questions about why reform was needed when we have students today who are being paid to go to school. "We have the case of medical students who we close the border to prevent them from leaving the country if they are educated here. Why would we want a reform when 8 years later we have a situation that has become so bad when we admit that we have no doctors in the health system and no teachers in the education system", he says.
He also dwells on the rhetoric that the country pays a lot for a medical student but that the latter do not give back to the country. "The Prime Minister must first answer a simple question. How much do you pay? I tell you with conviction that there are a number of other professions in our country that can be more expensive than hiring a doctor. The point is, the exit of a veterinarian at the Agricultural University is created with the aim of exiting this student, while a medical student who uses the established structure that is the hospitals, was not created with the aim of the student, says Migen Qiriaxhi, recalling the report of the High State Control (2019) in which it was estimated that universities set a fee without doing a cost analysis.
"We have always talked about what are the main challenges of the medical university, where the main challenge is that it is not well managed in finance. hand, the families that control the hospitals. We have seen the reports of the KLSH, what is done with the quality of medicines, how tenders are managed, what are the conditions of regional and municipal hospitals, but also central ones", he says. For Migen Qiriaxhi, the lack of will to deal with the system has led to this kind of reaction, and it is certainly not just a matter of some students who are being limited to some rights.
"Hoxha's system did not justify anything greater than this when it forbade Albanians to cross the border. And where are we in rhetoric today and in public communication? The Prime Minister says that we will condition the lives of these young people, because they refuse to build the country and give back to the country". he concludes.
For the president of the Federation of Albanian Doctors in Europe, Aurora Dollenberg, taking measures by the government to stop the brain drain is to be congratulated, but on the other hand, she says that the reaction of medical students is also understandable. "This draft law provides for them to serve more, in an area that the student or young doctor does not have the opportunity to choose, and this draft law does not provide for the salary that will be received during this period, nor the possibility for specialization during this time. And it is understandable that the reaction will be a protest, since a public university cannot increase the payment to 5 thousand euros and if this tax is not paid, the diploma is not awarded". she says.
"Albania cannot force students to sign contracts. The student is directed towards European countries, rather than entering a binding contract which ultimately gives an Albanian diploma, which is not even recognized in Europe". she says.
Also, the president of the Federation of Albanian Doctors in Europe, also brought examples of countries that have previously tried the binding contract but failed.
"Even Italy and Germany have had this problem since 20 years ago, the lack of doctors. They came up with a strategy with contracts to keep the doctors connected with the country's hospitals, but thanks to student protests, the taxes imposed on the universities were removed, as well as these compulsory measures". says Dollenberg for "Signalize".
Jurists: There was no external consultation, interest groups were ignored
The introduction of draft laws with an accelerated procedure in the parliamentary agenda of Albania is not something new and does not constitute a violation of the law. According to jurisprudence experts, even the draft law for medical students does not have any legal violation regarding its review with an accelerated procedure, since the applicant is the Council of Ministers.
The lawyer Gylsen Zhllima says that we must bear in mind that our legislator has not provided for a preliminary Constitutional Court that examines how the draft laws are drafted, but has delegated this task to the proponents and various interest groups to start the drafting of the legislative process. Asked about the specific case, about the draft law for medical students, he says that the government did not conduct an external consultation.In the end, the laws must provide a stable solution, which must be in accordance with the Constitution, in accordance with ratified international agreements and with the commitments derived from Albania's participation in international organizations, in accordance with the basic notions of reason and logic. , practice and with as few undesirable side effects as possible", he says. Jurist Zhllima is convinced that if this bill becomes law, apart from compatibility with the Constitution, all other points from the way they will be interpreted and misinterpreted by each party will come to light over time, many shortcomings from which the losers will be the students and not the government.
The lawyer Brizida Gjikondi says that this law cannot be canceled out of the way, but by proceeding judicially.
"I know Italy is doing the same. I also know that these students are lucky enough to file an expedited lawsuit in the Constitutional Court, which is the only constitutional institution that looks at whether this law is in harmony with the Constitution and the Law 'On Higher Education' or is in flagrant violation of the rights of human and in violation of the rights of the Albanian student", she concludes.
