The Minister Rama Is Looking For

By Albatros Rexhaj

When I asked Edi Rama why Klodiana Spahiu, the answer came in three words: humble, professional, loyal.

The more I think about the answer, the less they seem like three random qualities. They seem like the description of the minister Rama is looking for at this stage of his government. And Health is perhaps the best place to see whether he has found her.

Spahiu comes with an advantage that cannot be bought with seminars. She knows the hospital from the inside. She was a doctor in the ward, she directed the Durrës hospital for a period and she knows what happens between a decision taken in the ministry and the patient waiting in the corridor.

That distance is one of the old diseases of our healthcare. On paper you have the doctor; in the hospital you don’t find them. In the inventory you have the equipment; when you need it, they tell you it’s broken and send you across the street to the private sector. The budget paid for the medicine; the patient leaves the hospital with the prescription in hand to buy it outside. Investment, contract, reform, statistics, everything exists, only the service is missing. The Health Minister is not measured by what the state says it has built. She is measured by what the citizen finds when something hurts.

That is why the word ‘humble’ here is not character decoration. For this word I was not content with the prime minister’s assessment; I asked up and down people who know her from the hospital and from Parliament, and the answer was almost everywhere the same: yes, she is a woman with her feet on the ground. In healthcare that quality is a way of working. The humble minister does not believe the system works because the report that reached her desk says it works. She goes, sits in the hospital, talks to the doctor, the nurse and the patient, and asks why there are queues, why the equipment stands idle, why the medicine is missing, why someone from Kukës or Gjirokastër must come to Tirana for something they should get near home. Not for the photograph.

Professionalism has equally practical meaning. Spahiu is a doctor. No one needs to explain to her what a delayed examination means, a missing specialist or a department that functions only on paper. She has seen the other side of the counter, and this makes it harder for the system to deceive her.

But the word that interests me most is the third one.

Not that I want to philosophize about political loyalty. Rama has the right to choose ministers he trusts; every prime minister does it. The question is what that trust produces.

Rama is trying to bring into governance an idea he has called BESA and a way of working he has called Loyal Presence. At its core it is simple: the citizen should not face a state that talks to itself, but someone who listens, someone who answers and someone who does not let go of the problem until it gets a solution.

I believe Rama when he says this time he is serious. Not out of any special faith in the word of prime ministers. He simply doesn’t need this maneuver. He has power. He has no opposition before him to take it. BESA is not needed for him to survive even one more month in office. This does not prove his sincerity; a leader with secure power can do both communication and legacy. But it is the main reason I am inclined to believe him, and why I think the initiative comes from another question: now that he has power again, what will he do with it? Not how to win the next elections, but how to make the administration he leads behave differently with the citizen.

If so, Klodiana Spahiu is not simply the new Health Minister. She is one of the first tests of whether that reflection can become a way of governing. And in healthcare the test is brutally concrete, because the patient does not ask for a construction permit or an administrative answer. They are afraid, they are in pain, maybe they have a sick child in their arms, and the organizational chart is of no use to them.

Loyal Presence in Healthcare is not Spahiu appearing every week in a hospital. It is the hospital that works when she is in Tirana: the doctor on shift, the laboratory with reagents, the equipment that doesn’t send you to the private sector the moment you need it, the medicine found where the state says it bought it, and a director who answers when something fails. That is her test: how much of the difference between healthcare on paper and the healthcare the patient finds will she manage to close.

It will not be easy. Healthcare is a minefield and the mines have owners. I don’t know these only from reports. I go in and out of hospitals for years, I wait in corridors, I listen to people and I see how the system works when there are no cameras. From those corridors a conviction has long been formed in me: pharma functions as a parallel budget, with financial relations reaching up to the doctor; import prices are inflated because depots make the market; public money is paid for services the patient does not receive; and private owners have more influence over an appointment than a private interest should have over a public system.

Albania needs pharmaceutical companies, it needs private hospitals, it needs the private sector. But the public healthcare system has only one reason to exist, the patient, and when someone else’s interest starts determining what service they receive, the minister must know how to say no.

Here we will understand whether Rama has read Spahiu correctly. He has not chosen a figure from outside the system who must learn where the doors are. He has chosen a doctor who knows the hospital, a politician with her own weight and a person for whom he himself says he has trust. Now it is her turn. Humility will serve her to hear the things subordinates don’t like telling the minister. The profession will serve her to understand when they are giving her an explanation and when they are selling her a justification. The rest is simpler: a problem that is only forwarded is not a solved problem.

The big condition remains. BESA and Loyal Presence cannot become one of those Albanian oddities that last three days. The first enthusiasm is the easy part: ministers go out into the field, MPs listen, phones open, cameras record. The test begins when this is no longer news. After six months, after a year, when the director has understood that the wave is not passing, when the minister knows it is not enough to say ‘I forwarded it’, when the citizen starts demanding answers not because the prime minister just announced an initiative, but because that is how the state works.

If Rama is serious, and I believe he is, he must protect this standard even from his own people. Especially from his own people. Not by dismissing a minister every time an appliance breaks or a director errs; that would be theater. But when a minister abandons the spirit, when the office becomes again more important than the field and the report more important than reality, when the citizen turns again into an annoyance and not the reason for the work, there is nothing more to discuss. Whoever deviates from this standard, leaves. No political negotiations, no months of justifications, no automatic protection that power gives its own people.

Klodiana Spahiu must know this, and with her every other minister. Only then does ‘loyal’ carry weight: not to the chair, not to the minister, not even to the prime minister, but to what the government has undertaken to give the citizen.

The citizen doesn’t care how many meetings the minister held, how many reforms she presented or how many kilometers she traveled. They will want to know whether, when something hurts, the state is there. If Klodiana Spahiu achieves this, Rama has found the minister he is looking for. If the obstacle is the system, Rama must give her the power to break it. If the obstacle becomes the minister herself, he must look for another one.

BESA and Loyal Presence will not be judged by how they began. They will be judged by something much simpler: whether, this time, they don’t end after three days.