The Vetting Show, News24
In August 2023, the Supreme State Audit published a report revealing an alarming situation at the Oncology Hospital at the “Mother Teresa” University Hospital Center. More than two years have passed since this report, but the Albanian government and the Ministry of Health and Social Protection have not taken any measures to change the problem.
"It's my third year of chemotherapy, I continued for two years in Durrës, I bought it, the doctor in Durrës says, "Nazmi, we don't have anything to do, you buy it", he says, we don't have anything to do. We bought it for two years, week after week, but 5 thousand lek is not a little", Nazmi Picirri, a patient at Onkologiku, tells "Vetting". Nazmi Picirri is not the only one who experiences this situation, but he is one of the few who comes out publicly and tells it. More than two years have passed since the "Vetting" editorial office denounced the situation at Onkologiku, but the same situation continues. According to public health expert Dr. Erion Dasho, this is a very serious situation.
"This is a problem that directly affects patient safety, up to the safety of life," expert Dasho told "Vetting." Nazmi's story calls into question not only the Oncology hospital, but the entire health system. When there is a lack of medicines and funds for patients, why are concession contracts paid even when they are under investigation? According to pharmaceutical expert Ilir Pecnikaj, it is rare for patients to leave the Oncology and receive full treatment. "This is not a problem of the doctor, the hospital, but of the way the government treats this problem," expert Pecnikaj told "Vetting."
From "Vetting"'s research and the evidence collected, it results that the problem is also related to the way in which funds are distributed in healthcare.
A significant portion of the investments go to concession contracts, some of which are under investigation for corruption. These contracts are even one of the main reasons that patients with tumor diseases do not undergo tests to monitor their health parameters. The situation becomes even more serious when drug shortages also affect children in pediatric oncology.
"After two years, they told me to buy it in Tirana, even here when we had the tests done here at the entrance to Durrës, we had the tests done once at the hospital, once at a private one, because they didn't have it, "the date is past the 20th, it's not there" the hospital says, go do it at a private one", Nazmiu recounts, unmasking the health concession for the test laboratory.
The change in the law distorted the pharmaceutical market
The lack of drugs in Oncology is not just a supply problem in a hospital.
This situation is also related to the way the drug system functions, from the laws that regulate the Albanian market to the institutions that must guarantee their quality and safety. Drugs are the main tool with which the health system treats patients and without drugs there is no therapy for chronic, tumoral, infectious and cardiac diseases. For this reason, the way drugs are controlled and introduced into the market has a direct impact on the quality of treatment.
The changes in the drug law in 2014, 2015 and then in 2021 have affected the conditions for the entry of drugs into the Albanian market, price control and the role of institutions that guarantee quality. “Today we are after drugs that have the cheapest cost and of course the quality leaves something to be desired,” says pharmaceutical expert Ilir Pecnikaj. The 2014 law imposed a stronger filter for drugs coming from Balkan countries. To enter the Albanian market, they had to be registered not only in the country of origin, but also circulate in a country of the European Union.
In 2015, this condition was removed at the proposal of former Minister of Health Ilir Beqaj. After this change, a drug produced in a Balkan country could be marketed in Albania as long as it was authorized in its home country.
Officially, this was justified by the CEFTA agreement and the free movement of goods. In practice, a security filter that served as an additional control over the quality of medicines was removed.
“It is a problem where the gap between the quality of medicines and the patients who seek treatment is widening,” says expert Pecnikaj. At the same time, the concept of direct price negotiation with pharmaceutical companies was also removed and the composition of the Medicines Price Commission was changed, excluding some independent representatives such as the Order of Pharmacists and patient organizations.
This has concentrated decision-making more in the administration and reduced professional and citizen control over drug prices and selection. But experts warn that this requires a very strong control system to guarantee patient safety.
"If we talk about the quality of medicines, it's scary to say. We know that we don't have the right quality of medicines," says expert Ilir Pecnikaj. Problems in the medicine control system have even more serious consequences when it comes to children.
A State Police operation, carried out by order of the Tirana Prosecutor's Office, uncovered drug smuggling, a large part of which were pediatric oncology drugs.
"The biggest tragedy is that a large part of the smuggled drugs were for children with cancer," says expert Pecnikaj. In the first episode of the show "Vetting", on February 8, 2024, the alarm would be raised about the lack of drugs in oncopediatrics or, in other words, drugs for children with tumor diseases, specifically for "Actinomycin D".
In the documentary, "Vetting" would raise questions about the authorization, which the Supreme State Audit Office would confirm in its latest report published in 2025. It was found that the drug Actinomycin D did not have a contract or marketing authorization and that measures were not taken to ensure its regular supply, making it impossible to treat patients at the Mother Teresa University Hospital Center normally.
The report even criticizes the Ministry of Health and the Mandatory Health Insurance Fund for the 4 lengthy authorization procedures and the lack of contracts with importers, which indicates a lack of planning. For the audit period, Actinomycin D was obtained through donation (24 vials from a hospital in Israel), which according to the audit does not guarantee full security for the storage and effect of the drug, especially since no clear record of receipt and entry into the inventory has been recorded.
From the verification of the cards for the period 2020-2024, it turns out that 12 children needed this drug according to medical protocols. Of these, four did not receive the treatment at all, five provided the drug themselves, one was treated abroad and in two cases an alternative therapy was used. "To carry out a real control of drugs, it starts from registration by performing a physical check and its documentary control, to its traceability. Is this done today? It is not done," said pharmaceutical expert Pecnikaj.
The report emphasizes that although after January 20, 2020, there was no stock of this medication in the hospital and in some cases it was used after being found privately or through donations.
The Medicines Agency under suspicion of influence and favoritism
One of the most important institutions in the health sector is the National Agency for Medicines and Medical Devices, which is responsible for the analysis, control and tracking of medicines on the Albanian market.
But the audit and official reports have revealed shortcomings in the functioning of this institution. "Pharmacovigilance must follow every drug. A drug may be of very high quality at the manufacturer, but transportation, temperature or humidity can lose its quality", says expert Pecnikaj. According to official documents, in 2022, deficiencies were found in public health safety, including the lack of annual programs for drug analysis and the lack of inspections of medical equipment in hospitals and laboratories. 5 According to expert Dasho, these problems need analysis from the way health institutions are run today. "Trying to centralize planning at the ministry creates confusion, where some medications are missing and others expire", said Dr. Erion Dasho.
According to the audit, the Ministry of Health and the Medicines Agency have failed to guarantee a fully reliable system for the safety of medicines. The report of the Supreme State Audit criticizes the weakness of the pharmacovigilance system, i.e. the monitoring of the side effects of medicines.
“This is the role of pharmacovigilance, from the manufacturer to the patient,” says Pecnikaj. Another identified problem is related to the list of reimbursable drugs. Of the hundreds of drugs that appear as the first alternative on the list, many of them were not imported during 2023. In some cases, drugs that appear on the list are not registered according to legal requirements.
This means that on paper they exist as an alternative for patients, but in practice they are not found on the market. Audits have also identified discrepancies in import authorizations and a lack of cooperation between the Medicines Agency and Customs, which increases the risk of medicines entering the market without full verification. Meanwhile, public documents show that the Medicines Agency has made payments for a tender to improve the medicines and equipment system worth around 134 million lek. According to data from the “Spending.al” platform, this contract was signed in 2022.
In this case, questions arise about previous business connections since Sokol Sinani, who was a partner with Ilir Beqaj at the company “Intech +” until August 2013 and in 2017 bought the shares of the company DATA LOG (formerly DATA-LOGIC), which later turned out to be active. The question that arises is how companies with low activity or periods of inactivity managed to benefit from public contracts with large values. 6 “Some of the concessions have ended in SPAK and it is not for nothing that we also have a former minister accused of these contracts”, says expert Dasho.
Oncologist exposes healthcare concessions
Coping with the disease of the century for patients with tumor diseases is not only related to drugs and their quality, but also to tests.
A person receiving chemotherapy should undergo tests as monitoring assesses their health status and how treatment will continue.
"Now we have a problem with the tests, they don't do the tests for us, go to the director in Durrës, we have nothing to do, I went to the Ministry twice, they say we don't have money," says Nazmiu about the laboratory analysis concession. A patient from the Oncology Department, who fights for his life every day, exposes with facts the alarm raised by doctors, the laboratory analysis does not provide. It is not the first time that the laboratory analysis concession raises concerns. Currently, all 4 health concessions are under investigation by SPAK, where the sterilization investigations have ended with former minister Ilir Beqaj accused of "theft by abuse of office" and "structured criminal group".
In fact, if we were to analyze all the problems that the Albanian healthcare system has, they are related to the funds that go to concession contracts that do not provide service. "The ministry together with the government have the funds, this (prime minister) goes and inaugurates a dog hospital at a time when we are dying on the highway, this is our state, which does not ask about us at all," said Nazmi Picirri.
Outraged, he expresses his disappointment not only with the state, but also with the fact that even the services that the state has undertaken to provide are not being provided as per the laboratory concession. "We have had problems with the tests, we are unable to go out in the sun. They say go to the family doctor, go get a document there, go to the hospital, which is completely false. They know we are sick. Go do those tests for us! Don't bring us up and down the streets," declares patient Nazmiu.
According to him, both concessions have problems, both the laboratories and the Check-up. "We have a lot of problems with the analyses, it's not the fault of the director here in Durrës, everyone from the Prime Minister to the Ministry of Health has responsibilities," says Nazmiu, seeking support from institutions. The concession for laboratory services in university, regional and municipal hospitals in Albania was won by the company "Laboratory Networks shpk".
The company has several partners, including the Albanian company “Labopharma”, as well as foreign companies such as “AB Laboratory Solutions” from the Netherlands and “Exalab” from France. The procedure for this concession began in 2016, while the contract was signed in 2019 with a 10-year term. This contract is under investigation by SPAK, like other contracts.
In total, the 4 healthcare concession contracts are expected to cost Albanians 41.95 billion lek or 420 million euros by the end of 2026.
FSDKSH, part of the failure of the healthcare system
From 2015 to 2025, the Mandatory Health Insurance Fund has changed 10 directors amid scandals that have engulfed the institution. The last director of this institution, Spartak Zekja, has been placed under investigation by the Tirana Prosecutor's Office, while his place has been taken by Arti Papajani.
From official reports, FSDKSH continues to have numerous problems with payments to concessions, electronic prescriptions and updating of reimbursable drugs. The audit has mainly reviewed the year 2024, also analyzing developments in 2023 and previous periods when necessary for comparison.
The report highlights that in 2023, for the Basic Medical Check-up concession, 876 million lek were paid for 475 thousand planned checks, while 467 thousand checks were actually carried out.
"All of these contracts have problems, some with necessity, but also where they work well," said expert Dasho.
Although the number of checks increased in 2023 compared to 2022, chronic diseases, reimbursed prescriptions and hospitalizations also increased, which according to the audit shows that the real effect of this measure has not been visible in reducing morbidity. The contract for this concession was signed in January 2015 and is based on a fixed annual payment for 475 thousand checks, regardless of actual performance. For 2024, the audit has revealed weaknesses in the monitoring of concession contracts.
In the case of Check-up, FSDKSH makes payments based mainly on statistical data and without administering complete documentation on the fulfillment of contractual obligations. There is also a lack of documentation of effective internal control systems and mechanisms for reporting problems.
In the laboratory concession for 2024, 4,6 million examinations were performed at a total cost of 1,89 billion lek, which constitutes 102.6% of the planned budget ceiling.
"I have called the 4 concession contracts, I have called them theft and putting my hands in the pockets of patients," said Dr. Dasho.
This indicates budget overruns. For health packages, the audit shows that from 2020 to 2024, a full review of the content and prices for most packages, except for dialysis and fistula, was not carried out. No one has properly followed up on these contracts, the reports are not accurate, and there are suspicions of manipulation of the numbers to get more money.
Patients have been left behind because services have been clustered with several private companies, some tests are delayed or not done at all, and people are forced to go to private clinics themselves, paying out of pocket. This has increased costs for families and worsened the health of some people due to delays.
"I've had check-ups 100 times, nothing, those tests come out as if I'm iron, what Vilma Nushi has," says patient Nazmiu. The Check-Up concession, like other concessions, has received payments for unfinished tests, while a patient from the Oncology department was discharged with very good health parameters.
The “Check-Up” concession was signed in 2015 by the Minister of Health Ilir Beqaj for the basic medical check-up of citizens from 40 to 65 years old. The contract was won by “3P Life Logistic”, associated with businesswoman Vilma Nushi and has a 10-year term. According to the agreement, the concessionaire carries out the medical check-ups and is paid by the state through the Mandatory Health Care Insurance Fund. About 475 thousand check-ups are planned each year.
This concession has often been the subject of criticism, as payments have been made according to the number of planned checks and not always according to the checks that have actually been carried out. However, the Mandatory Health Insurance Fund has financial and administrative responsibilities of great importance also in the Oncology drug sector.
Shortages of tumor drugs, a problem that has been recurring for years
Since 2020, cancer patients have faced serious problems as hospitals have not provided them with medicines. Patient Nazmi Picirri says that one of the main medicines is often in short supply.
"The vial, yes the vial is the main thing we had to find in the country, I bought them for 4 months, they were left at home for a month", says patient Picirri. In total, there are 49 cases where the drugs were brought late, often without any document to justify the reason for the delay. These drugs are not ordinary medicines, but cytostatic drugs and target therapy, which are used for cancer patients. Treatment with them is done in regular cycles and any interruption directly affects the course of the disease. However, the delays have been repeated from year to year. Instead of being treated as isolated cases, they appear as an ongoing problem.
"Do you know what disease this is? Don't let anyone know this disease! This is a cancerous disease. We know that we have some, but you as a state do the impossible, have Kosovo take them to Turkey," says Nazmiu, suggesting that an alternative be found for treating the disease. The contracts between the hospital, the fund and the importers provide for penalties when the drugs are not supplied on time.
The total value of the penalties calculated for the delays amounts to around 49 million lekë. But these penalties have not been collected. So, the importers have delayed the supply while the health institutions have not implemented the punitive measures foreseen in the contract. The analysis results that a considerable part of the antitumor drugs authorized for marketing have not been imported for long periods. There are drugs that, although they are registered and approved, have not entered the Albanian market for months or years. There are drugs that have no therapeutic alternative. One of them is Daratumumab, which is used for multiple myeloma.
In such cases, the lack of a drug is not just a delay, but the only possible interruption of treatment. Deficiencies have been found in the complete recording and documentation of drug entries and exits in the inventory. There is no unified mechanism to signal in real time the lack of a drug and activate emergency measures for replacement.
In some cases, certain drugs have been provided through donations, not through regular supply contracts. According to expert Pecnikaj, in Albania the deadlines for reimbursement are very long, expressing concern about their lack. “What is most painful is the situation with drugs for Oncology.
In the European Union, it takes from 3 to 24 months to be included in the reimbursement list. Do you know how long this is in Albania? Over 10 years,” said expert Pecnikaj. The data shows that delays and shortages are not episodic. They appear in 2021, in 2022, in 2023 and in 2024.
So we do not have a random problem, but a pattern that continues. When a problem recurs for four consecutive years, it is no longer accidental. Oncological treatment is not flexible and cannot be postponed according to supply availability. Each cycle has a certain time. Any interruption affects the effectiveness of the therapy.
The report does not provide data on individual clinical consequences, but the fact that cycles have been postponed or interrupted due to the lack of drugs indicates a real risk to patients. According to pharmaceutical expert Ilir Pecnikaj, a therapy to cure a patient in the European community is 50 thousand euros and this is not much for our country.
"We must now make those comparisons with what is missing from our pockets... We are fighting this whole war for the Llogara Tunnel, where they said 50 million euros were stolen. Here are 1000 cured patients," says expert Pecnikaj.
On July 17, 2024, the Economy and Finance Committee, chaired by Socialist Party MP Eduart Shalsi, pledged that a solution would be provided to this problem in the report to this Committee by the Supreme State Audit. “Vetting” made a request for comment to the Albanian Parliament on the reasons why measures have not been taken by the Parliament regarding the problems at the Oncology Department, but until the publication of this material there was no reaction.
