World Bank study on Kosovo reveals how tackling NCDs can save lives and propel Kosovo’s economy 


Since declaring independence in 2008, the Republic of Kosovo has seen important human capital and economic growth, outperforming its neighbors over the past decade. Yet these improvements risk being set back due to the high noncommunicable disease burden. A study published in June 2023, led by the World Bank and supported by Access Accelerated, described the impact NCDs have on the Kosovar population. In 2019, NCDs represented the cause of death of around 80% of all fatalities in the country.


“This study is one of the first comprehensive pieces of evidence on NCDs in Kosovo,” says Ha Thi Hong Nguyen, Senior Health Economist at the World Bank, who co-led the study. “Its aim is to strengthen the health system, build resilience, and prepare Kosovo against the rising burden of NCDs.”


Kosovo has a population of 1.8 million and boasts a unique demographic with more than 50% of its population under 25 years old, making it the youngest society in Europe and providing a distinctive scenario to foster healthy lives for a growing economy. However, the study found that even young adults are being diagnosed with NCDs. The authors reported that, in 2019, just over 20% of deaths among Kosovars aged between 20 and 29 years were due to NCDs. The burden of NCDs in Kosovo is fueled by preventable risk factors, such as smoking (particularly among men), unhealthy diets, and physical inactivity.


Efforts to address NCDs in Kosovo are compromised by a lack of awareness, underutilization of primary healthcare services, and fragmented health systems. Chronic conditions like hypertension and diabetes often go undiagnosed or uncontrolled, and screening programs for the most common types of cancer are severely limited due to lack of infrastructure. For example, in 2016, there were only four hospitals with mammograms and around 25,000 women were screened for breast cancer – representing less than 10% of eligible women. The study also found that NCD care is not reaching populations equally: the Roma, Ashkali, and Egyptian communities, as well as rural populations, are less able to access the care they need.


The authors reported that the challenges facing Kosovo in the management of NCDs are driven by a limited number of standardized clinical protocols, uncoordinated referral mechanisms, and information systems from hospitals and primary care clinics working in silos. Healthcare services are free to Kosovars, but the study shows there remains a reliance on out-of-pocket payments to pay for pharmaceuticals that could hinder people from accessing the care they need.


At a policy level, Kosovo has committed to international regulations on tobacco, alcohol and the environment. The country has adopted the recommendations from the World Health Organization and implemented excise taxes and restrictions to accessing tobacco and alcohol. However, the policies can still be improved to reach international standards. Kosovo has also been actively implementing policies to reduce air pollution and has adopted the European Commission’s thresholds for harmful particles (i.e., PM2.5).


Based on the study findings, a series of interventions have been proposed to address the burden of NCDs. The recommendations include implementing rigorous national antismoking campaigns and digital data registries to extending cancer screening programs, developing a plan to attract and retain healthcare professionals, and advancing health financing reforms to protect Kosovars from catastrophic expenses due to healthcare. By taking prompt, evidence-based action, Kosovo can now reshape its future, protecting its human capital from the devastating impact of NCDs and ensuring sustainable economic growth for generations to come.