Access to paediatric medicines in Albania

Abstract

This PhD thesis examines access to paediatric medicines in Albania, addressing one of the most overlooked dimensions of health equity and universal health coverage. Although international frameworks increasingly recognize children’s right to essential medicines, significant gaps persist in ensuring the availability of safe, effective, affordable, and age-appropriate treatments for paediatric populations, particularly in transitioning health systems such as Albania. Using an integrated multi-method approach, this research combines pharmaceutical policy analysis, qualitative health systems research, and quantitative assessments of medicine availability, affordability, and accessibility. The thesis evaluates the alignment of Albania’s national pharmaceutical policies with the World Health Organization (WHO) Model List of Essential Medicines for Children (EMLc), revealing important discrepancies in paediatric formulations, dosage strengths, and therapeutic coverage. Through qualitative interviews with community pharmacists and family physicians, the thesis further identifies systemic barriers affecting access to paediatric medicines, including recurrent stock-outs, limited therapeutic alternatives, prescribing constraints, and the financial burden of out-of-pocket expenditures. Quantitative analyses applying the WHO/Health Action International (WHO/HAI) methodology and an adapted version of Sustainable Development Goal (SDG) indicator 3.b.3 demonstrate that medicine availability rather than affordability alone remains the principal challenge within the Albanian context. The findings highlight a persistent gap between policy commitments and implementation in practice. The thesis calls for the development of a national paediatric essential medicines list, stronger integration of WHO standards into pharmaceutical policy and reimbursement systems, improved supply chain governance, and the establishment of routine monitoring mechanisms using child-sensitive indicators. Overall, this research provides one of the first comprehensive evaluations of paediatric medicine access in Albania and contributes important evidence to support more equitable, evidence-informed, and child-centred pharmaceutical policies.