Albania dispatch: bill requiring medical students to work in Albania after finishing their degrees faces constitutional challenge – JURIST

Emanuel Xhindi is a special correspondent for JURIST and a law student in the University of Tirana Faculty of Law in Tirana, Albania. 

Emigration measures in developing countries are almost always seen through a vague, public-interest lens, but their constitutionality may be dubious. In an effort to stop young doctors from leaving the country to work in the West, the Albanian government is pushing for a new law which would make it absolutely necessary for medical students in Tirana’s University of Medicine Albania to work in hospitals all over the country before being able to receive their degree. Depending on the year they’re in, medical students will have to work for a period of 2-5 years after finishing school, unless they agree to pay a much larger tuition fee, which hasn’t been specified in the draft legislation, but which will most likely be unaffordable for the average Albanian student.

The initiative has sparked public backlash from Albanian medical students, as well as other professionals and people who support their protests calling the legislation “communist” or “populist”. The government having been accused of unjustly infringing on medical students’ right to education, a case against the bill is now being reviewed by the Constitutional Court, and its implementation will be pending until a decision is taken. Prime Minister Edi Rama has addressed the issue: “The Albanian people don’t pay taxes so that doctors, who have received their education through a minimal tuition fee, supported by the same Albanian people’s taxes leave on their first day after graduation.”

Moreover, protesters have called for the resignation of Deputy Education Minister Albana Tole, who also stated that students who refuse to pay the new fees, in case they don’t want to work in the country after finishing university, should stop their studies.

Constitutionally, the prospects for the protesters don’t seem so bright. Being in a post-COVID-19 era, public interest seems to carry more and more weight, even in an international context, especially regarding the health sector. This policy, however, is quite unique: I haven’t seen any case in which taking a degree would be conditioned on completing several years in the workforce. Globally, similar measures would be a prerequisite to further specialization or even getting a proper license to work as a medic. India, however, is at least something of an exception, and the most similar precedent I have found. In 2012, the Indian Government adopted a compulsory rural service scheme known as Compulsory Rural Posting. In order to get their MBBA degree, after completing the 4.5 years of this program, students will have to work for a year in a rural posting. The decision was welcomed by the Supreme Court of India in 2019, emphasizing that the community’s interest in having quality medical care supersedes the individual doctors’ interest. Moreover, the Court encouraged the Government to adopt the same policy even for candidates who wish to pursue a Post-Graduation (PG) degree. The legitimacy of this policy in the Indian case, was also supported by the low-tuition fee argument, in comparison to the required costs carried by taxpayers’ money.

Albanian PM Edi Rama has essentially made the same case, stating that the tuition fees in the University of Medicine only amount to 1/16 of the real cost which is afforded by the state. This, in turn, supports another line of reasoning used by the Albanian government: since the people, through their taxes have been an essential factor to your education, you must return the favor. This general message takes a whole new specific meaning when talking about the health sector, and all it had to endure during the pandemic.

Furthermore, Albania has, on average, around 1.93 doctors per 1000 inhabitants, which is significantly lower than that of countries in the region (2.6 doctors per 1000 inhabitants) and in the OECD (3.6 doctors per 1000 inhabitants). This is quite a problematic state, as rural places in Albania are having quite a hard time providing decent health care.

In my opinion, the Court will most likely consider the bill as constitutional. Since it isn’t completely without precedent, the proportionality argument will most likely fall when confronted with the public interest case. If this happens, it will be a significant step in evaluating the constitutionality of emigration measures, especially when directed towards young people.

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