BACKGROUND. During the COVID-19 pandemic, healthcare systems worldwide have implemented diverse health emergency strategies to address the unprecedented crisis. Following initial predominantly hospital-centred approaches, territorial health assistance emerged as a more effective response to the needs of the population. In low-middle-income countries, and particular in the so-called transitioning countries, where both the hospital network and the territorial primary care centres are weaker, adapting to this shift in strategy was particularly challenging, primarily due to the complexities of integrating pre-hospital and in-hospital Emergency Medical Services (EMSs).
This research aimed to evaluate the impact of changes in health strategies over time for managing the COVID-19 pandemic, specifically examining the roles played by both pre-hospital and in-hospital EMSs in a transitioning country.
METHOD. The country case study methodology was deemed the most fitting approach for this research. Albania was selected as a notable case study due to its continuous endeavours towards achieving national welfare aligned with European standards, especially in the healthcare sector, as it has been moving towards pre-adhesion to the European Union. Furthermore, the recent establishment of the modern National Emergency Centre 127 in 2018 represented a significant development and an extensible example in completing the healthcare emergency network by integrating pre-hospital and in-hospital EMSs.
RESULTS. The data indicated that at the onset of the COVID-19 pandemic in 2020, the initial response aligned with the national strategy, primarily was an hospital-centred approach in line with worldwide approach. Subsequently, as the pandemic progressed, a new health emergency strategy was implemented in 2021, shifting the focus towards reinforcing territorial health assistance. In this revised strategy, the responsibility for handling COVID-19 cases transitioned from the infectious disease departments of university hospitals to regional healthcare entities. The data illustrated that this transition allowed for the effective care of a higher number of patients with a more efficient utilization of resources.
CONCLUSION. The evolution of Albanian national health emergency strategies to struggle COVID-19 pandemic - that promoted the territorial response to COVID-19 in accordance with the emerging evidence - was not only implemented but also suggested and supported by EMSs system. The compresence of pre-hospital and in-hospitals EMSs permitted to provide an effective response both in hospitals and in the territory, overcoming the usual weaknesses in terms of coordination and integration of EMSs in transiting countries.
