Alma Lahe’s motivation for health budget advocacy in Albania didn’t come from textbooks or policy papers. It came from years of watching family members struggle with medical issues. “Relatives of mine have had cancer and weren’t able to get proper services or medication,” she recalls.
They couldn’t access proper treatment because for years the country’s public health system was underfunded.
Alma currently works as a Project Manager at the civil society organization, Together for Life, which is focused on tracking government health spending and promoting patient rights. For three years running, they have produced comprehensive monitoring reports on health sector spending to shine a light on insufficient funding and advocate for better allocations for services for the most marginalized.
Health care budgets in the country steadily declined from 2021 to 2024. In 2024, public spending on health was just 2.9 percent of GDP – the lowest in the region – and 59 percent of health expenses were paid out of pocket by patients; a burden many could not afford. For advocates like Alma, this chronic underfunding highlighted the urgency of empowering civil society to access budget information to ensure health is prioritized.
Turning Data into Advocacy
Through IBP’s support, Together for Life received comprehensive training in budget analysis and advocacy, both at national and local levels. This helped them to assess whether budget promises matched what was delivered. Their analysis went beyond official allocations to track actual spending through procurement contracts, tenders and concessions.
By analyzing not just what the Ministry of Health promised in budget documents, but what they contracted and spent, Together for Life uncovered a disturbing pattern: services were often launched with fanfare but with zero dedicated funding, leaving marginalized groups stranded.
For instance, the government announced home healthcare services for people with disabilities in 2024 but allocated no budget line or resources to fund the service.
Together for Life turned this evidence into detailed monitoring reports and deployed them strategically. Their detailed analysis grabbed the attention of the parliamentary commission that oversees approval of the healthcare budget.
The parliamentary health commission became a key ally, inviting the group to present their findings when reviewing budget proposals. “We meet with this commission two or three times a year to discuss our reports and provide them with information and suggested measures to improve spending,” Alma said.
Alma also leverages strategic partnerships to gain information that can bolster their analysis. When the Ministry of Health doesn’t respond to information requests, (a common occurrence), Alma has developed a system where she collaborates with health and legal experts to escalate requests to the Independent Commissioner for Right to Information, using Albania’s freedom of information laws to force transparency. The commissioner follows up on the complaints and ensures the Ministry of Health complies with the law, Alma said. For example, after the Ministry of Health ignored a formal request for documentation on four healthcare contracts in January 2025, Together for Life successfully compelled compliance by filing a complaint with the Independent Commissioner for Right to Information. The Commissioner ruled the complaint justified and ordered the Ministry to release the data, which it did in early February. “This case demonstrates how the mechanism enabled access to information of significant public interest,” Alma added.
Building Alliances, Building Influence
Together for Life has also built broad coalitions—partnering with the Commissioner Against Discrimination, patient organizations, disability rights groups and other allies to drive change. Their work with International Budget Partnership (IBP) has also helped to expand their alliances.
Meeting counterparts from Kosovo, Serbia and across Albania at an IBP convening in 2024, Alma realized the importance of peer learning. “It was good to be part of the regional network that was in the same field to exchange experiences between us,” Alma said. When Kosovo partners needed help producing monitoring reports, for example, Together for Life was able to share with them a methodology they had refined over three years.
Most importantly, IBP’s work connected Together for Life for the first time with two other budget accountability civil society organizations in Albania, Partners Albania and the Institute for Public and Private Policies. “It’s the first time we met in person,” Alma said. “The process is much easier if we are working together and joining forces.”
When IBP facilitated Together for Life’s first meeting with the Albanian Ministry of Finance in 2025, it quickly opened new advocacy channels. “This is the first time we have taken part [in conversations] with the Ministry of Finance, and we are now actively working with the ministry,” Alma said.
Strategic Wins
Through evidence-based advocacy, coalition-building and persistent engagement, Together for Life has achieved several decisive victories.
The first major win came through the courts. After providing legal assistance for a child needing cochlear implants and partnering with the Commissioner Against Discrimination, cochlear implants for children with hearing problems are now part of the government budget.
In the 2026 budget, hospitals and community centers also received increased funding for mental health services.
And in April 2025, after Together for Life presented evidence to the Ministry of Health about children with Down Syndrome lacking dedicated health services, the ministry made a commitment to include these services in the next budget. In the 2026 budget, the allocation is there. “Now we have a dedicated budget for this category,” Alma said. “That’s successful advocacy.”
Most significantly, the planned budget for the health sector for 2026 has increased by €17.6 million compared to 2025. According to the Prime Minister, €15 million of this increase will be allocated to reimbursing cancer patients for medications. “It’s the right step, but we are here to monitor the spending of this new budget and how it impacts people with disabilities and especially cancer patients,” Alma said.
Another bright spot is that out-of-pocket health spending has dropped from 59 to 51 percent— progress that represents real relief for Albania’s people.
The Road Ahead
Together for Life continues pushing, organizing a major convening this February with the Ministry of Health, Ministry of Finance and members of parliament to continue to address still-unfunded home healthcare services and to encourage more public participation to improve the quality of services and management of public funds.
Proud of what has already been accomplished, Alma knows that there is still much work left to do.
“We hope that the health sector will be a government priority and that they will increase access to services for all of the population, but especially older people, people with disabilities and children,” Alma said. “We also hope that the ministry and the government will raise the health budget to be in line with Europe’s budget levels.”
Until then, Alma and Together for Life will continue to work to ensure that public finance and health institutions are more open and responsive to those they serve.
