• Develop a model of care that addresses the major health concerns of the population to be served by the WWC.
• Develop health education materials targeting women, children and men and focusing on an array of disease prevention and health promotion topics.
• Implement training and retraining courses consistent with the new clinical practice guidelines and quality improvement programs adapted for use within the center.
• Host a Women's Health Conference covering a range of topics affecting the delivery of comprehensive services to women
• Elaborate a business plan that promotes sustainability of the WWC after AIHA funding.
• Collaborate with other relevant organizations, particularly SEATS and the Albanian Family Planning Association, to coordinate activities with those of the WWC.

• To increase cervical cancer screens in Tirana to 12,000 women by March 2004.
• To provide 3,750 colposcopic follow-up exams by September 2003.
• To extend the screening program with the enrollment of four more policlinics in Tirana by March 2004.
• To collect patient data and build a cervical cancer screening registry that will serve as an invaluable data resource for future analysis by January 2003.
• To ensure the laboratory is adequately staffed with two properly trained personnel to meet the screening program's needs by May 2003.
• To ensure all participating physicians are adequately trained in the proper technique for Pap smear collection and follow-up diagnosis by November 2002.
• To refine and promulgate professional and public education programs on women and cancer by March 2004.
• To develop strategies for sustainability of the program by November 2003.
• Disseminate public and professional education materials in Tirana by March 2004.

Capacity for Comprehensive Care

• Since the partnership’s inception, a model Women’s Wellness Center (WWC) was established in Tirana; the Center opened in September 2000 with a formal ribbon-cutting ceremony. The celebration drew over 100 dignitaries, health care professionals, community leaders, representatives of international organizations, and the media. Among the featured guests and speakers were the First Lady of Albania, the Albanian Prime Minister and his wife, the Minister of Health, the Ambassador, and the USAID Director. The WWC was later replicated with funding from the ministry of health and other sources. The WWC reported nearly 7,000 patient visits in 2001 and more than 9,000 in 2002.
• The US Department of Defense financially supported a classroom addition to the WWC facility.
• AIHA implemented a uniform data reporting form for WWCs mid-2002. This form collects information on various diagnostic tests that relate to an output indicator (# of diagnostic tests performed by category) that was designed to confirm that WWCs are providing screening and diagnostic services among the comprehensive services that WWCs are expected to provide.
• US and Albanian partners organized the first women’s health fair on the grounds of the WWC shortly after the Center’s opening in September 2000. The fair attracted over 80 women who participated in free blood pressure screenings and received health education materials.
• The partners organized four women’s health fairs that combined attracted over 400 women and men, and a women’s health conference for 100 health professionals from throughout Albania.
• The Tirana WWC continues to emphasize health promotion and disease prevention and reported that during the latter half of FY02, their health education courses drew over 3,000 participants.

• US partners provided training to their Albanian counterparts on patient-focused care, developing patient education classes, patient flow and scheduling, clinical practice guidelines, cancer screening, mental health needs, and health education for women, children and men.

• In order to further promote the implementation of women’s health CPGs, AIHA sponsored a WWC Quality Improvement/Dissemination Conference that was attended by the director of the Albania WWC.
• Over fifteen clinical practice guidelines were developed by the partners. These guidelines include issues such as nutrition/weight management, cervical cancer screening and disorders, domestic violence, UTI and vaginal infections, and ultrasound use in OB/GYN and were integrated directly into the patient care setting. As a corollary to the guidelines, the US team followed the obstetrical patient flow from prenatal care through labor, delivery and post partum care. This was done to emphasize the need to integrate obstetrical care and follow patients to assure continuity of care. The team also evaluated the critical aspects of patient education.

• Another key service WWCs are expected to provide relates to family planning. AIHA measures the use of contraceptive methods among women who wish to avoid pregnancy as one of its indicators. During the latter half of FY02, the Tirana WWC reported a total of 1,024 contraceptives selected by their clients.
• SEATS, a USAID-funded NGO, provided family planning materials and equipment in conjunction with the Albanian Family Planning Association.

• In June 2001, the Providence partners conducted an initial assessment to examine country capabilities for cytology laboratory expertise and pap screening needs.
• In November 2001, partners signed a Memorandum of Understanding for the new cervical cancer screening project.
• US and Albanian partners discussed all aspects of the cervical cancer screening program in the US and identified appropriate program transference to Albania. The Albanian partners observed lab operations in the US and worked with their counterparts to develop an operational model for the Maternity lab.
• Having secured funding from the Ministry of Health, partners worked to renovate a section of the University Hospital #1 into a modern, western-style cytology/pathology laboratory. Partners procured, received, and set-up lab equipment and formally inaugurated the lab in September. The inauguration marked the opening of the first cytology lab in Albania and was attended by approximately 50 physicians and nurses. Since opening in September, the new lab has read more than 1,000 Pap smears and conducted approximately 400 biopsies.
• US partners procured and shipped to the cytology/pathology lab several reagents and equipment for the LEEP system for treating cervical dysplasia, as well as a second microscope.
• The Pap smear collection protocol and establishment of a tumor registry was finalized by the partners. All protocols adhere to the Bethesda 2001 consensus document on Pap smear designation, diagnosis, and treatment.

• Three physicians received training in Pap smear collection at the Women’s Wellness Center #1 so that they can become trainers for physicians in other centers and polyclinics.
• Two Albanian cytologists received training in cytology screening and laboratory management. Upon completing their training, the two cytologists returned to Tirana to work in the new pathology/cytology lab reading slides.
• One OB/GYN physician received training on the LEEP system. Upon returning to Tirana, the physician will train others on the use of the equipment.

• Partners created a quality control policy focusing on the following areas: specimen identification, specimen rejection, specimen processing/staining, screening accuracy, re-screen of negative Pap smears, reporting accuracy and timeliness, assurance of staff competence, specimen adequacy, diagnostic categories, and follow-up policies.
• To ensure accuracy in the screening and diagnosis techniques of the laboratory staff, partners also created a quality assurance review. Every three months, 10 percent of all negative slides, 5 percent of all ASCUS, and 1 percent of all LSIL Pap smear slides will be sent to Providence, along with a copy of the original report for each patient slide submitted, to be re-screened by the US partners.
• The Tirana WWC began administering patient satisfaction surveys, which will be completed during the fourth quarter of FY03 for analysis.
• Partners built a cervical cancer screening registry at the cytology/pathology lab. Partners created a patient ID numbering system that will assign ID numbers to each patient being screened and treated though the cancer screening program. Partners also prepared Pap smear logs, colposcopy logs, and biopsy logs for the four Polyclinics participating in the screening program.

• A presentation on cervical cancer screening was conducted for 25 physicians from the two Maternity Hospitals in Tirana.
• Partners sponsored a workshop in Tirana on women’s reproductive health. The workshop focused primarily on cervical cancer screening in all its aspects, but it also included a review of risk factors, the prevalence and incidence of cervical cancer in the US and Albania, the Bethesda classification system, and treatment protocols. The workshop also reviewed STIs and other gynecological cancers. As part of the workshop, a clinical team from Providencedemonstrated the technique for Pap smear collection. Altogether, over 150 physicians, nurses, and representatives from several NGOs attended the workshop.
• The five-part lecture series on Pap smear collection that was offered to 15 OB/GYN physicians from all 10 Polyclinics in Tirana was completed. Some 64 physicians attended the didactic sessions, and four physicians participated in the one-week clinical training session that followed the lecture series. All attendees were certified to the competencies gained in each of the identified clinical, procedural, and administrative areas.
• Public awareness brochures and posters were developed and translated into Albanian.

• As of February 2003, the partnership has had a total of 21 exchanges involving 11 person trips to Providence and 39 to Tirana.