4. Impact of COVID-19 in Albania

Material well-being and social protection

The short- and medium-term impacts of the lockdown could increase the vulnerability of the most disadvantaged and risk compounding socio-economic divides. The unemployment rate, which was at historic low before the crisis at 11.2% in the last quarter of 2019 (INSTAT, 2020[12]), is likely to rise. The current crisis may have a disproportionate effect on those who live in poverty and do not have adequate social security. Close to 40% of households are severely materially deprived (Figure 5.1), and 23.4% of the population was at risk of poverty in 2018.

Informality is a major contributor to individual income risk. Informal employment accounts for about 61% of total employment, and the current crisis may highlight informal workers’ vulnerability as their incomes decrease. It could widen the economy’s inequality gap and push many people into poverty. Moreover, the many informal workers who cannot afford social distancing are more vulnerable to the pandemic (Gerdin and Kolev, 2020[17]).

A drop in remittances may lead to reduced household consumption and generate significant social strains for many people. A significant share of Albanian households depend on remittances, which accounted for 9.6% of GDP in 2019 and were higher than FDI inflows (7.9% of GDP). Potential further decline in remittances due to migrant workers’ loss of employment and wages would be the sharpest in recent history (World Bank, 2020[15]). Given that about 1.4 million Albanians live abroad, the impact might be significant (Government of the Republic of Albania, 2017[18]).

Albania’s social protection budget is very modest, and targeting is ineffective, limiting its scope to reach those most in need. Albania spent 9.4% of GDP on social protection in 2016, much lower than the European average of 28% (see the People section in Chapter 5). Spending on social assistance in particular needs to be ramped up, as social transfers, excluding pensions, reduced risk-of-poverty rates by fewer than three percentage points in 2018 and will be an insufficient safety net for the most needy during the pandemic (INSTAT, 2019[19]). As much as 32% of the population lacks sufficient social support.

Health and non-material well-being

Albania’s population is young, but there are persistent health risks. Close to one-third of adults in Albania smoke daily, and 21.7% are classified as obese, both of which are risk factors associated with higher COVID-19 mortality rates. The Albanian healthcare sector suffers from inefficiency and inequity. These vulnerabilities may be further exposed during the COVID-19 crisis. Albania spent 5.2% of GDP on health expenditure in 2018, less than the majority of comparable economies (World Bank, 2020[15]). Although health coverage has improved moderately compared to a decade ago, over 60% of adults aged 15 to 49 (64% of men and 62% of women) reported having no health insurance in 2018 (INSTAT, 2019[20]; INSTAT/Institute of Public Health/ICF, 2018[21]). The government has made COVID-19-related care available to all residents and waived out-of-pocket payments for such treatments (COVID-19 Health System Response Monitor, 2020[22]). The lack of equipment and staff is an issue. With 1.2 doctors per 1 000 inhabitants – a decline of 14% compared to 2000 – Albania has the lowest number of doctors per capita in the region and is well below the OECD and European figures (see the People section in Chapter 5). In the context of COVID-19, the government ordered the reactivation of retired healthcare staff, mobilisation of workers from various medical fields, engagement of medical students and residents, and additional financial incentives for health workers involved in the pandemic response (Order No. 174 and Order No. 175 of the Minister of Health and Social Protection of 15 March 2020). However, no specific measures are being taken to provide psychosocial or other occupational health support for health workers (COVID-19 Health System Response Monitor, 2020[22]).

Other, non-material, aspects of well-being are affected by the crisis. Living conditions at home, where most people are asked to stay during the crisis, are less than ideal for some: 43.3% of households in Albania lack high-speed Internet, making teleworking and home-schooling difficult. Quality of life is also about people’s relationships, which can provide a vital lifeline during crises and social distancing. Yet, one-third of Albanians say that they do not have relatives or friends they can count on for help in times of need. Even before the pandemic, life satisfaction was much lower in Albania than in the average OECD economy. The considerable risks of social isolation and loneliness need to be addressed by policy measures for both physical and mental health, for instance regular check-ins by social services, civil society and volunteers, and promotion of digital technologies that connect people with each other and with public services. In this regard, the World Health Organization is supporting the establishment of a platform for psychosocial and mental health support via a network of community mental health providers. There are also initiatives to home-deliver medicines for older patients with chronic conditions (COVID-19 Health System Response Monitor, 2020[22]).

Women are particularly exposed to the collateral effects of COVID-19. As in other regional economies, loss of employment and lockdown conditions in Albania are likely to have led to increased gender-based violence (Bami, 2020[23]; OECD, 2020[24]). Indeed, reports by civil society organisations (CSOs) and observers indicate that vulnerable groups have been particularly affected by the COVID-19 crisis, especially in remote areas. The government adopted a number of measures to mitigate the effects of the pandemic and lockdown and to ensure outreach to vulnerable people and groups at risk. The effectiveness of actions will depend in part on strengthened collaboration among the central government, local government units and civil society (European Commission, 2020[25]). Prevailing gender norms that normalise violence against women were a concern before the crisis: 30% of women considered a husband justified in hitting or beating his wife for trivial reasons, such as burning food, going out without telling him or refusing sex, compared to 8%, on average, in OECD economies. Women are affected in other ways too. They make up the majority of the healthcare workforce, exposing them to greater risk of infection. At the same time, women are shouldering much of the burden at home, given school closures and longstanding gender inequalities in unpaid work (see the People section in Chapter 5).