Promoting a Culture of Prevention in Albania: the “Si Je?” Program

  • Tetine L. SentellEmail author
  • Alban Ylli
  • Catherine M. Pirkle
  • Gentiana Qirjako
  • Sonela Xinxo


Albania is a small country on the Balkan Peninsula that recently implemented an innovative primary healthcare program called “Si Je?” (How are you?) which allowed all Albanians aged 40–65 years to receive a free, yearly basic health examination at their local health center. Access to basic primary care is a critical component of a nationwide culture of prevention particularly for the non-communicable diseases that comprise 89% of total deaths in the country. Yet, as in many middle-income countries, a culture of prevention in Albania is often secondary to ensuring basic health infrastructure and healthcare access for those critically in need. Using the social-ecological model as our conceptual framework, this paper provides new insights into the culture of prevention in Albania by analyzing the need for, and implementation of, the Si Je? program using (1) findings from a critical literature review, (2) quantitative data from the database created from this program, and (3) qualitative data from key informant interviews from 15 health center directors. Positive developments towards a culture of prevention include the fact that the Si Je? program has been expanded to those 35–70 years, strengthened links between community and primary care, and participation among rural communities who traditionally have limited primary care access. Challenges include continued urgent health infrastructure needs, politicization of the Si Je? effort, limited participation by some groups (particularly urban men), and regional variations. Despite challenges, Albania appears to be building new infrastructure for a sustainable culture of prevention, particularly around chronic disease.


Albania Prevention Non-communicable diseases Health policy Primary care 



The authors would like to thank the 15 anonymous health center directors for being so generous with their time; Dr. Eduard Kakarriqi, Dr. Bajram Dedja, and Mr. Besjan Elezaj for the hypertension data analyses; and the Fulbright Specialist program for the invaluable support.


The Fulbright Specialist program supported the collaboration (7361; Sentell).

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was conducted in accordance with the principles of the Declaration of Helsinki and the research code of the Scientific Council of the Institute of Public Health (IPH), the body responsible for research ethics at the Albanian Institute of Public Health.

Informed Consent

Neither the qualitative nor the quantitative study data was considered human subjects research according to the IPH research code and formal informed consent was not obtained. Key informants were nevertheless informed of the study and provided verbal consent prior to the interview. All qualitative and quantitative study data were anonymized.

Supplementary material

11121_2018_967_MOESM1_ESM.doc (74 kb)
ESM 1 (DOC 74 kb)


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Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Office of Public Health StudiesUniversity of HawaiiHonoluluUSA
  2. 2.Sector of Research on Non-Communicable Disease Policies, Department of Epidemiology and Health SystemsInstitute of Public HealthTiranaAlbania
  3. 3.School of Public HealthUniversity of Medicine of TiranaTiranaAlbania
  4. 4.Department of Health PromotionInstitute of Public HealthTiranaAlbania

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