M.A.G.I.S and the devastation of the Albanian Neonatal Hearing Screening Program

Neonatal Hearing Screening program in Albania, started on 2004 as a pilot project in one of the two maternity hospitals in Tirana, thanks to a dedication of a group of Albanian specialists, who aimed to bring in Albania the best experience in the field.  The first stage of the project was covered by a grant of Oticon Foundation, Denmark & Soros Foundation, Albania.  This pilot project investigated the feasibility of such a program in the Albanian conditions. 
On 2006, after the completion of the pilot stage, it was concluded that such a project, with its own modifications was not only feasible, but also necessary.  This point was the start of the program itself, which covered both maternity hospitals and had several objectives:

and was recognized by the Albanian Ministry of Health.

This program was supported all along, by the Know How of the Audiology Department, University of Ferrara, Italy and was supported financially thanks to small grants of Oticon Foundation, USAID Albania, GlaxoSmithKline Albania, AMC Albania and Sulkaj pharmaceutics Albania.  While Albania is listed as one of the poorest countries in the area, where novel technologies reach the country very late, the establishment of such a program was a great success and at the meantime, required an immense work to keep on going.  During a 4 year period the staff has completed over 5000 screening tests; posters and leaflets were prepared and delivered to the families with sufficient and detailed information regarding the screening protocol and the follow up; TV programs reinforced the importance of the early intervention for the future development of the children; questionnaires with parents addressed the maternal anxiety caused by screening programs and so on.       
The work done is presented in the program website; www. albscreening.com and in diverse scientific papers and presentations.  Two multi-sectorial conferences, with international representation, organized respectively on 2002 and 2007, intended not only the analyses of the work done, but also bringing together the ENTs, pediatricians, social workers and speech therapists in one chain, where the service offered to the babies with hearing loss and their families, was integral. The organization of a round table like these, was considered a success on its own, because the Albanian health system suffers sometimes by the lack of cooperation between different specialties.
At the end of 2008, MAGIS, an Italian NGO, has signed with the Albanian Ministry of Health, an agreement for “starting for the first time in Albania a 3 years screening project” in the same sites where the actual program is running.  Certainly, in a country where the ministers and the main admin staff are changed every 9 months, things like this are to be expected, but never justified.
The Italian project intends to screen babies in 4 sites for three years and then offer free of charge fitting to the babies who result with hearing loss. The personnel will be trained for screening issues in Italy, hearing aid devices will be purchased in Italy and fitting will be done by Italian audiologists, who will come to Tirana and so on.  It is obvious that such a project is written by ‘experts’ who either do not know the Albanian reality or rather prefer to ignore it for their own reasons.  In Albania there is already a hearing screening, diagnostication and fitting expertise.  Nurses who have been screening for 2 years now in the NICUs of Tirana, have enough experience not only to screen and deal with babies and parents, but also they are quite capable to train more personnel if necessary.  ABR is part of the hearing status diagnosis work up since 2003, though offered only in Tirana; hearing aid companies have their representatives in Albania and fitting is done according to international standards in various fitting centers in Tirana and other cities of Albania.  The only weak point is lack of speech therapists although in theory MAGIS have trained several during another project of theirs, a couple of years ago. 
Given the above, it is a not a surprise either, that the recent project has not included the opinion, expertise or involvement of the ENT department, University Hospital Center (TUHC) and is situated (ABR included) only in the NICUs environment, ie outside TUHC.  This, in its own, is a novel model, because this kind of programs are generally coordinated by audiologists or ENTs.  It is also obvious that, if the internal resources would be used, the cost of the services offered would be much lower……………but if so, than the majority of funds would be used for Albanians and in Albania and not spent for the Italian staff or the staff mobility and so on.  
To summarize, an Italian NGO allowed by the Albanian government, destroys the existing program, which is a result of a gigantic work of several people and a structure which uses and coordinates the purely Albanian resources.
The biggest question naturally posed here is:  now that the existing program, with its successes and failures, is shut down, what will happened with neonatal hearing screening in Albania, after funding used by MAGIS will travel from Italy to Albania and then finish …?    The only answer is that the Ministry of Health administration will be again changed, and MAGIS may sign more agreements of the sort.
But Who will be blamed for the extinction of the Albanian hearing screening program?