THE PEOPLE
The population increased by about 71 percent from 1950 to 1969 and in
1970 was increasing at a rate that would double the number of
inhabitants in approximately twenty-six years. The median age, about
nineteen years, was increasing slowly. The abundance of rural population
and the increasing tempo of industrial development provided potential
for rapid urban growth, but government controls and a scarcity of
housing tended to restrict population movements.
Persons of Albanian ethnic origin constituted about 97 percent of the
2.1 million population in early 1970. Of ancient Illyrian descent, they
have maintained their homogeneity despite many invasions and centuries
of foreign occupation. The Communist regime, in its effort to develop
social and cultural solidarity, attempted to reduce consciousness of the
differences between the major subgroups, the Gegs in the north and the
Tosks in the south. Some progress has been made, but a continuing
struggle is being carried out against customs and beliefs that are
considered remnants of the past and detract from the achievement of
Communist objectives (see ch. 5, Social System).
The Albanian language is a derivative of the tongues that were spoken by
the ancient Illyrians and Thracians. For many centuries its continuity
was maintained by only verbal means. A standardized alphabet was not
developed until the twentieth century. Since World War II considerable
progress has been made in making the Tosk dialect the standard written
language. In the late 1960s there were still some variations in
spelling.
The pattern of settlement was predominantly one of widely dispersed
villages; approximately two-thirds of the people lived in communities
with less than 1,000 population. Only twelve cities had more than 10,000
population in 1969. The quadrangular area formed by the cities of
Durres, Tirana, Elbasan, and Fier, all of which are linked by rail and
roads, was experiencing the most rapid growth in the 1960s.
There was a very slight improvement in living standards from 1950 to
1970. Despite modest growth in the economy, the per capita gross
national product (GNP) in 1967 was the lowest in Europe, an estimated
United States equivalent of $320. The average citizen's welfare in the
allocation of resources for food, consumers' goods, and housing was
sacrificed to the development of industry and the program to achieve
eventual self-sufficiency in agriculture. Reduction of disease and
improved health were the most important gains countrywide. Also, by 1970
electricity had been extended to over two-thirds of all villages.
Consistently high levels of population growth placed severe strains on
available supplies of food, consumers' goods, housing, and services.
POPULATION
The total population in January 1970 was an increase of approximately
500,000 over the 1960 official census total of 1,626,315. The
distribution by age groups in 1970 was: under fifteen years of age, 42
percent; fifteen to thirty-nine years, 37 percent; forty to sixty-four
years, 16 percent; and sixty-five years and over, 5 percent. With almost
60 percent of its inhabitants under forty years of age and a median age
of approximately nineteen years, the population was extremely youthful,
and indications were that it would remain so into the 1970s. The
proportion of persons in the dependent age groups, under fifteen and
over sixty-four years, to the working age group, fifteen to sixty-four
years, was 887 to 1,000.
The overall ratio of males to females, 106 to 100, was the highest among
the Communist countries of East Europe. The preponderance of men was
greatest at ages below forty; in the age group above sixty-four there
were only 77 men to 100 women. The higher ratio of men for the total
population was attributed in part to the high infant mortality rate
among female infants, caused by neglect and the deference accorded to
male progeny. Losses in World War II, an estimated 28,800 persons, or
2.48 percent of the population, had little influence on the ratio of
males to females and the population structure.
In keeping with the traditional pattern of a highly dispersed
population, the country remains predominantly rural. About two-thirds
live in villages and in the countryside. Urban population increased from
about one-fifth to one-third of the total during the 1950-70 period and
would have increased to a greater extent had the government not taken
measures, beginning in the mid-1960s, to build up agriculture and to
restrict city growth. During the drive to reduce the number of people
involved in administration and to increase production forces in the
mid-1960s, thousands of persons living in the city, including some from
the bureaucracy and the Party, were sent to the country.
Housing in the cities was greatly overcrowded, and the allocation of new
dwellings built by state funds and controlled by the government provided
further restrictions on city growth. Indications were that the expansion
of industry would continue to require urban growth but that the rate of
growth would be controlled. The largest cities and their populations in
1967 were: Tirana, 170,603; Durres, 80,066; Vlore, 57,745; Korce,
53,563; and Shkoder, 49,095.
The birth rate declined only slightly from 1950 to 1970 and in 1968 was
35.5 per 1,000 population (see table 3). Fertility continued at a high
level, and there were no apparent influences that tended to reduce the
prevailing rate of births. No information was published concerning the
effects, if any, on the birth rate of women's employment outside the
home, abortions, contraceptives, or other restraints on population
growth.
The expansion of medical services and improvement in the standard of
health during the 1950s and 1960s resulted in a marked decline in the
mortality rate, from 14 per 1,000 in 1950 to 8 per 1,000 in 1968. The
age structure of the population, with a preponderance in the lower age
brackets, provided the potential for a continuing low mortality rate.
A concomitant of the reduced death rate was an increase in life
expectancy. Data from domestic sources indicated that the average life
expectancy at birth increased from 53.5 years in 1950 to 66.1 years in
1965.
Because of the highly restrictive policies of the Communist regime,
migration into and out of the country had a negligible influence on the
size and composition of the population. Internal migration was
controlled by requiring approval for persons to move from one location
to another. Specific data on the scale and character of population
movements were not available.
The pattern of sustained high birth rates and declining death rates
resulted in high rates of natural increase. Total population increased
by 71 percent from 1950 to 1969, whereas the average increase for all
other East European Communist countries, excluding the Soviet Union, was
18 percent. The growth rate for 1970 was estimated at 2.7 percent.
Government and Party leaders, voicing the need for greater numbers of
people for the building of socialism, supported a continuing high level
of population growth. They were undeterred, in the face of persistent
shortages of food and the requirement for foreign assistance, in their
encouragement of a sustained high birth rate and the payment of an
allowance for each child.
_Table 3. Albanian Vital Statistics for Selected Years, 1950-68 (per
thousand population)_
Year Birth Death Natural increase
1950 38.5 14.0 24.5
1960 43.3 10.4 32.9
1968 35.5 8.0 27.5
Source: Adapted from U.S. Department of
Commerce, Office of Technical Services,
Joint Publications Research Service
(Washington), "Protection of Mother and
Child Health, the High Expression of
Socialist Humanism, Realized by the Party
During the 25 Years of People's Power," by
Vera Ngjela et al., in Shendetesia
Popullore (People's Health), Tirana, 1969
(JPRS: 50,302, _Translations on Eastern
Europe, Political Sociological, and
Military Affairs_, Nos. 204, 1970).
ETHNIC GROUPS
Persons of non-Albanian ethnic origin--Greeks, Vlachs, Bulgars, Serbs,
and Gypsies--constitute only about 3 percent of the population. Among
the Albanians, the natural dividing line between the Gegs and the Tosks
is the Shkumbin River, but there is some spillover on both sides.
Numerically, the Gegs predominate, making up slightly over one-half of
the Albanians within the country (see ch. 2, Historical Setting).
Despite successive foreign invasions and centuries of occupation, a
distinctive ethnic identity was preserved. Mountains and the lack of
communication routes provided isolation and opportunity to evade
intruders. Nevertheless, the imprints of foreign influences were
considerable. Additions and modifications to the language were made from
the Latin, Greek, Slavic, and Turkish contacts. Lacking an organized
religion as part of their Illyrian heritage, Albanians embraced the
Muslim, Orthodox, and Roman Catholic faiths brought to them by their
conquerors (see ch. 5, Social System).
Individual Albanians distinguished themselves in the service of the
Roman and Turkish empires and were noted for their ability as soldiers.
It was not until the nineteenth century when they began to seek
autonomy that their history was recorded in writing. Kinship and tribal
affiliations, a common spoken language, and folk customs served to
provide continuity and common identity through the many centuries of
relative obscurity.
There are marked differences in the physical appearance of the typical
Geg and the typical Tosk, but until World War II the greatest contrast
was in their social systems. The Geg and Tosk dialects differ, and there
are also variations within subgroups. Some progress was made under the
Zog regime in bringing the clans, whose authority prevailed particularly
in the north, under government control and in eliminating blood feuds
(see ch. 5, Social System).
After the Communists emerged victorious they imposed controls, the
objective of which was to eliminate clan rule entirely; they waged a
continuing struggle against customs and attitudes that, they believed,
detracted from the growth of socialism. Blood feuds were brought to an
end. Party and government leaders, in their effort to develop national
social and cultural solidarity in a Communist society, publicly tended
to ignore ethnic differences.
In practice, Enver Hoxha, the Party leader, who came from the south and
received the bulk of his support during World War II from that area,
frequently gave preference to persons and customs of Tosk origin. In the
late 1960s Party and government leaders continued to devote considerable
effort to the suppression of customs and rituals that, they declared,
were vestiges of the patriarchal, bourgeois, and religious systems of
the past. On one occasion in 1968 the Party announced that because of
its influence 450 infant betrothals were annulled and 1,000 girls
renounced ancient customs, including the taboo against females leaving
their village (see ch. 5, Social System).
The Gegs, because of their greater isolation in the mountainous areas of
the north, held on to their tribal organization and customs more
tenaciously than the Tosks. As late as the 1920s approximately 20
percent of male deaths in some areas of northern Albania were attributed
to blood feuds.
Under the unwritten tribal codes, which included the regulation of
feuds, any blow, as well as many offenses committed against women,
called for blood. Permitting a girl who had been betrothed in infancy to
marry another, for example, could cause a blood feud. The _besa_ (pledge
to keep one's word as a solemn obligation) was used under various
conditions and included pledges to postpone quarrels. A person who
killed a fellow tribesman was commonly punished by his neighbors, who
customarily burned his house and destroyed his property. As fugitives
from their own communities, such persons were given assistance wherever
they applied.
A man who failed to carry out prescribed vengeance against a member of
another tribe or that individual's relatives was subjected to
intolerable ridicule. Insult was considered one of the highest forms of
dishonor, and the upholding of one's honor was a first requirement for a
Geg. On the other hand, if the individual carried out the required act
of vengeance, he was in turn subject to extinction by the victim's
relatives. Women were excluded from the feud and, when escorted by a
male, he too was considered inviolable. In other respects, women's
position in society generally was one of deprivation and subjugation
(see ch. 5, Social System).
The isolation from influences beyond his community and the constant
struggle with nature tended to make the Geg an ascetic. Traditionally,
his closest bonds were those of kinship, as a member of a clan.
Obstinate and proud, the Geg proved himself, under the leadership of his
compatriots, a ruthless and cruel fighter. Visitors from outside the
clan were generally suspect, but every traveler was by custom accorded
hospitality.
Less isolated by rugged terrain and with greater, although limited,
contact with foreign cultures, the Tosk generally was more outspoken and
imaginative than the Geg. Contacts with invaders and foreign occupiers
had influence and, before 1939, some Tosks had traveled to foreign
countries to earn sufficient funds to buy land or to obtain an
education. The clan or tribal system, which by the nineteenth century
was far less deeply rooted and extensive in the south than in the north,
began to disappear after independence was achieved in 1912.
Of the minority ethnic groups, persons of Greek descent are the most
numerous. Estimates based on World War II and earlier data indicate that
they compose approximately 2 percent of the population. They are most
numerous in the southwestern coastal area of Dhermi and Himare and the
region extending southward to the Greek border from Gjirokaster. They
have adopted Albanian folkways and dress. Although their first language
is Greek, they speak Albanian as well.
Persons of Vlach, Bulgar, Serb, and Gypsy origin make up about 1 percent
of the population. The Vlachs in Albania have lost much of their
homogeneity and adopted the ways of their Tosk neighbors. The typical
Vlach is akin to the modern Romanian. Both are descendants of Romanized
Dacians or Thracians of the pre-Christian era.
Under Communist rule the Vlachs, mostly herdsmen, have been incorporated
into the collectivized economy. Previously, they grazed their flocks in
the mountains in the summer and then returned to the valleys in the
winter. They are most numerous in the Pindus Mountains and in the Fier,
Korce, and Vlore areas. Persons of Bulgar origin live mostly in the
border area near Lake Prespa; a few persons of Serb derivation live in
the Shkoder area; and Gypsies are scattered in various places.
There are large numbers of persons of Albanian origin living outside the
country. Estimates based on Yugoslav data indicated the total number in
Yugoslavia in 1970 was approximately 1 million, of which about 70
percent were in Kosovo. Data is generally lacking on the exact number in
other areas, and estimates vary widely. There may be as many as 250,000
in Italy and Sicily, 350,000 in Greece, and 80,000 in the United States.
They are found also in Bulgaria, Egypt, Romania, and Turkey. The degree
to which persons living outside the country have retained Albanian
customs and language varies. Indications are that they have retained
their clannishness to a considerable degree.
LANGUAGES
Albanian, of Indo-European origin, is the only surviving language of the
early Thraco-Illyrian group and is spoken by all or nearly all
inhabitants. Some of the minority ethnic groups also speak the tongue of
the country from which their families originated.
Modern Albanian is derived from the ancient Illyrian and Thracian, but
many outside influences are evident. Additions and modifications,
beginning in the pre-Christian era, were made as a result of foreign
contacts. Most important of these were the Latin and Italian influences
during the centuries of Roman domination and trade with the Venetian
merchants and, later, in the nineteenth and twentieth centuries.
Contributions also were made by the Greeks, Turks, and Slavs. The first
written documents in Albanian did not appear until the fifteenth
century; therefore it is difficult to trace the development of the
language during the earlier period.
The repressive policies of the Ottoman rulers over a period of 450
years, beginning in the fifteenth century, further retarded language
development. Written Albanian was forbidden, and only the Turkish or
Greek languages could be used in schools. Emigre Albanians, particularly
those in Italy after 1848, helped keep the written language alive. Until
the nineteenth century continuity of the language in Turkish-dominated
areas was provided largely by verbal communication, including ballads
and folk tales (see ch. 7, Communications and Cultural Development).
By the early twentieth century more than a dozen different alphabets had
developed. Some were predominantly either Latin, Greek, or Turko-Arabic.
Many were a mixture of several forms. It was not until 1908 that a
standardized orthography was adopted. The Latin-based alphabet of
thirty-six letters, approved at that time by a linguistic congress at
Monastir, was made official by a government directive in 1924 and
continued in use in 1970.
Letters are written as they are pronounced. There have been variations
in the spelling of many words because of dialectical differences, and
they still persist despite the government's efforts to develop a uniform
language. A dictionary was published by the Institute of Sciences in
Tirana in 1954, and it indicated that the spelling of some words varied.
During the 1960s the Linguistics and History Institute, which was part
of the State University of Tirana, carried on studies relating to
language origins and morphology, but no lexicon was known to have
appeared as of early 1970 to standardize spelling or supersede the 1954
dictionary.
The two principal Albanian dialects are Geg, spoken by about two-thirds
of the people, including those in the Kosovo region of Yugoslavia, and
Tosk, by the remaining third. There are subvarieties of both dialects.
Despite the considerable variations that developed in the many isolated
communities, Albanians are able to communicate easily with each other.
Efforts were made by the government during the 1920s and 1930s to
establish the dialect of the Elbasan area, which was a mixture of Geg
and Tosk, as the standard and official language; but the local dialects
persisted, and writers and even officials continued to use the dialect
of their association. After the Communists, most of whose leaders had
come from southern Albania, acceded to power, the Tosk dialect became
the official language of the country. In 1952 the Albanian Writers'
Union, a Party-controlled organization, took action to make Tosk the
only dialect to be used in publications.
SETTLEMENT PATTERNS
Some two-thirds of the people live in rural areas in a widely dispersed
pattern of small villages. The urban population, according to 1969 data,
lived in forty cities with 1,000 to 10,000 inhabitants and twelve cities
with over 10,000 dwellers; of the latter group, six had 10,000 to 30,000
inhabitants; two had 30,000 to 50,000; three had 50,000 to 100,000; and
one, Tirana, was approaching 200,000.
The heaviest concentrations of settlement in the late 1960s were in the
districts of Tirana with a density of 528 persons per square mile,
Durres with 469, Fier with 323, and Lushnje with 298. The area
surrounding Korce and the area immediately around, and to the south of,
Shkoder were among the most thickly settled even though the
administrative districts of Korce and Shkoder were not heavily populated
when considered in their entirety (see ch. 3, Physical Environment).
Several factors contributed to the pattern of settlement. Large expanses
of mountains and generally rugged terrain made the building of land
transportation routes difficult. Poor soil and lack of water during part
of the year did not provide support to large concentrations of people.
Mineral and other resources were generally not readily accessible or
were difficult to exploit (see ch. 3, Physical Environment).
Coastal cities generally have a small hinterland, and their influence
does not extend beyond their borders. The port of Durres, with road and
rail links to Tirana, Elbasan, and Fier, is an exception. During the
1960s the area generally bounded by these cities experienced the
greatest growth of industry and population of any region. Vlore, a port
and naval center, increased almost fourfold between 1945 and 1967, but
it lacks links with inland areas.
Tirana, the capital and largest city, increased from about 60,000
inhabitants in 1945 to 170,000 in 1967, largely because of the expansion
of industry and a growing bureaucracy. It is located on the inner margin
of the coastal plain and is surrounded by an area of the better soils of
Albania. The streets in the central area of the city, where government
buildings are clustered, are wide and attractive; many parts of the city
are much like the rural villages. Tirana has become the most
industrialized city and continues to be a collecting and distributing
point for agricultural products of the area.
Centers for inland mountain valley or upland basin communities are
Berat, Elbasan, and Korce. They, like most cities, have changed little
in appearance and retain much of the flavor of nineteenth-century
agricultural life.
The typical mountain village, of 70 to 100 homesteads, is located on an
isolated slope among rocks and thin scrub-like vegetation. Only
footpaths link it by land with the outside world. During the summer
there is a drought period which requires that water use be limited to
drinking. Houses are clustered in the south, whereas in the northern
mountains they tend to be dispersed. Fields and pastures are located
some distance from the village. Water must be carried from a common
source, usually a spring. Mountain villages frequently are located at
1,300 to 1,600 feet above sea level. This is generally the line of
contact between the underlying impervious serpentine rock and layer of
limestone and the point where spring water comes to the surface.
At lower levels the villages are laid out around the collective or state
farms or enterprises, many of which were previously estates or
patriarchal settlements. Here the houses are more substantial, and the
fields or other place of work are near the village. Water is carried
from a common source. Open sewers run down the streets of some villages,
but this condition is gradually changing. Electric power has been
extended to about 70 percent of all villages, but other facilities and
amenities, except medical services, have been little improved since the
end of World War II.
LIVING CONDITIONS
The standard of living in 1970 was very low, and life was difficult for
the masses despite very modest improvements in living conditions during
the 1950s and 1960s. The standard of living was the lowest in Europe and
was improving at a slow pace because priority was given to industry, to
increasing the means of production, and to developing eventual
self-sufficiency in food production, especially of cereal foods. The
most widely felt improvements were in health services and in use of
electricity, which resulted from expanding the electrical network to
many villages.
Plans for the late 1960s and 1970 called for 23 to 25 percent of the
state budget to be spent on social and cultural sectors. In 1967, when
total planned budget spending was 3.6 billion leks (5 leks equal
US$1--see Glossary), the sum for social and cultural sectors was 837
million leks, of which 189 million were for health, 167 million for
social insurance, 143 million for assistance to mothers and children,
and 338 million for education and culture.
The government maintained that it was improving living conditions by
increasing food supplies and commodities and by construction of public
facilities and structures. In February 1970 the chairman of the State
Planning Commission reported that 1,200 dining rooms, 1,140 bakeries,
1,850 public baths and laundries, and 187 water mains had been built and
that electricity had been supplied to 1,096 additional villages in 1968
and 1969, leaving only 663 without electricity. Although these additions
added to the amenities of life, the rapid growth of population caused
heavy strain on the very limited total resources available.
Medical authorities asserted that many diseases and afflictions that had
taken heavy tolls of life and tended to debilitate large segments of the
population before 1950 had been greatly reduced or eliminated. These
successes were primarily attributable to large-scale inoculation
programs, elimination or reduction in the number of disease-spreading
pests, and expansion of health services. Malnutrition, unsatisfactory
sanitary-hygienic conditions, and indifference to medical aid in some
areas posed problems for further improvements.
The Communist regime, posing as the protector of the masses, credited
itself with a revolutionary transformation in the health standards of
the country. Data on health and disease from other than Albanian sources
were not available. Statistics released by the Ministry of Health
indicated substantial improvements during the 1960s. Responsibility for
shortcomings and inadequacies relating to health care was attributed to
backwardness on the part of the people or to the lack of resources.
Failures on the part of the Party or government were not mentioned.
There were widespread epidemics of measles in 1948 and 1949 and 1954 and
1955, of Asiatic influenza in 1957, of typhoid in 1945 and 1950, and of
poliomyelitis in 1953. Health officials stated that there were no
epidemics during the 1960s.
Malaria was one of the most prevalent diseases before 1950. Health
authorities, assisted by the Rockefeller Foundation beginning in the
1920s, made considerable progress in eliminating mosquitoes and reducing
the incidence of malaria before World War II. The campaign was continued
by the Italians during their occupation. The ravages of war greatly
increased the spread of malaria from 1945 to 1947; according to
Communist reports, 60 to 70 percent of the population were afflicted in
those years, in comparison with 16.5 percent in 1938.
The United Nations Relief and Rehabilitation Administration provided
food, medicine, and antimalarial assistance in 1945 and 1946, and the
Communist regime followed up with a concerted effort against the
disease, which reduced the percentage of persons afflicted to
approximately 7 percent in the early 1950s. Health officials declared in
1970 that malaria had been eradicated by 1967, and no cases had been
recorded after that date.
Health authorities reported that measles had been eliminated by 1970
through a program of mass vaccinations. The last major epidemic, that
of 1954-55, afflicted almost 14 percent of the population. The incidence
among children under three years of age was 60 percent, and 1,712
children under age fifteen died.
A broad program against tuberculosis was begun in the 1960s that
included general prophylactic measures and vaccine injections. Health
officials planned completion of vaccinations countrywide in 1970. It was
estimated that almost 15 percent of the population had tuberculosis in
the mid-1950s. Officials reported that the incidence of this disease had
dropped to less than 0.2 percent in 1968.
The Health Ministry reported progress in combating many other diseases.
Syphilis, once prevalent, was eliminated. A broad program of serologic
examinations involving over 2.3 million persons between 1947 and 1968
was utilized to detect venereal disease and was instrumental in reducing
the rate of syphilis infection from 3.14 percent in 1949 to 0.02 percent
in 1968. Incidence rates per 1,000 population of other illnesses
decreased from 1955 to 1968 as follows: abdominal typhoid, from 5.2 to
2.4; dysentery, from 87.7 to 14.5; diphtheria, from 2.3 to 0.5;
poliomyelitis, from 0.4 to 0.1; brucellosis, from 2.4 to 0.8; and
arthritis, from 2.2 to 0.8. Trachoma was eliminated, and no cases of
rabies were reported in the 1967-69 period. Deaths per 100,000
population from contagious diseases, including influenza, decreased from
220 in 1950 to 43 in 1968. Data on the number of deaths from heart
ailments, cancer, and other causes were not published.
Although progress was made in reducing mortality among children up to
one year of age--from 121.2 per 1,000 live births in 1950 to 75.2 in
1968--the rate remained unusually high. Failure to obtain timely medical
assistance was given as the primary cause of death by health
authorities. Malnutrition, shortages of professional medical personnel,
and insufficient health facilities were also contributing factors. The
rate for cities in 1968 was 65.4 as compared with 78.0 in rural areas.
Some areas in the mountains of the north ran as high as 136.9 during the
1963-67 period. About three-fourths of all infant deaths occurred during
the first six months after birth. In 1960 only 34 percent of infant
deaths were diagnosed; by 1967 the percentage had increased to 65.
Medical aid by a physician or midwife was provided for about 99 percent
of births in cities; in rural areas approximately 61 percent of births
were with medical assistance.
There were indications that some segments of the population, those in
remote and most poverty-stricken areas, were in poor health. A 1968-69
study of 1,580 children up to three years of age in thirteen northern
localities, reported by the Ministry of Health, showed that 60 percent
suffered from neuromuscular disorders in various degrees and that 47
percent suffered from rickets. The principal causes for these
abnormalities, according to the official study, were malnutrition and
unsatisfactory hygienic-sanitary conditions.
Health and medical organizations from national to local levels were
under the Ministry of Health. In the 1960s the departments of the
ministry were: epidemiology, pharmaceuticals, sanitary inspectorate,
medical prophylactic institutions, personnel, administration, finance,
and planning. Data for 1968 reported by the minister of health listed
facilities countrywide as: 196 hospitals and other facilities with beds;
11,922 beds for medical use; 1,108 first aid stations and polyclinics;
and 36 dispensaries and tuberculosis centers. The average annual
increase in hospital beds from 1950 to 1968 was 323; in 1968 there was 1
bed for every 169 inhabitants.
The total number of persons employed in health and medicine increased
from 9,881 in 1960 to 14,370 in 1967. The numbers of professional and
semiskilled workers in 1969 were: physicians, 1,396; stomatologists
(mouth specialists), 183; pharmacists, 262; medical aides, 725; dental
assistants, 139; pharmacist assistants, 334; midwives, 1,091; nurses,
4,100; and laboratory technicians, 737. Dentists were not listed as a
separate category. The average number of inhabitants per doctor in the
districts was approximately 2,000; however, in two districts the average
was over 3,000, and in one, less than 1,000. All medical personnel were
in government employ, and no private medical practice existed.
The expansion of medical services after World War II was made possible
to a large extent by accelerated training programs. A school for
training medical assistants was begun in 1948 and, starting in the early
1950s, the Red Cross conducted courses for semiskilled medical workers.
A medical college for training professional personnel was established in
1952; in 1957 it became the Faculty of Medicine of the State University
of Tirana, and the first doctors were graduated that year. During the
1950s most physicians were trained in the Soviet Union. In the late
1960s the number of persons undergoing training as midwives was
increased, and the goal was to have at least one midwife in every
village by June 1971.
The use of mobile medical teams and equipment played a major role in
expanding and improving medical care in rural areas. Laboratory, X-ray,
and other services once available only in the largest cities were
established in the district and sometimes at lower levels. The regime,
in its effort to build up agriculture in the mid-1960s, set as an
objective the improvement of living conditions in the countryside and
the elimination of the differential between city and country. Medical
assistance to rural areas continued to increase in the late 1960s, but
in late 1969 the minister of health stated that the differences between
the center and the districts and between the cities and the villages
were very pronounced. He directed that action be taken to lessen the gap
but added that differences would continue to exist.
Nutrition
Food supply--perennially a problem because of poor soil, primitive
methods of cultivation, and lack of readily accessible resources--did
not keep pace with population growth. For the late 1960s calorie intake
per capita per day probably did not exceed 2,100 to 2,200, while the
estimate for the mid-1950s was 2,200 to 2,300. The diet lacked protein
and other protective elements. An estimated 80 percent or more of food
intake was carbohydrates. Fruits and green vegetables were in short
supply, and meats were a real scarcity. Little progress had been made in
increasing livestock herds during the period of Communist rule, and
credits to procure adequate supplies of protective foods from sources
outside the country were not available (see ch. 8, Economic System).
The diet generally depicted scarcity and, in the mountain and rural
areas, was simple and routine. Dishes, high in starch content, made from
corn, wheat, rice, and potatoes were basic. Yogurt, cheese, and prepared
dry beans were among the most commonly found other foods. Green
vegetables and fruits appeared seasonally in limited quantities.
While some progress has been made in improving sources of drinking
water, the vast majority of rural families, and some in the smaller
cities, must rely on unprotected sources. Central sewage systems are
found in only the largest cities.
Housing
Living quarters became increasingly overcrowded as population expanded
at consistently high rates. Party First Secretary Enver Hoxha stated in
December 1967 that the entire country, especially urban areas, was
experiencing a housing crisis. Reports on housing construction indicated
that the situation further deteriorated in the late 1960s because of the
necessity to divert resources to even higher priorities, to the building
of industry and procurement of food and clothing. War and natural
catastrophes added to the burden. In World War II some 35,000 dwellings
were destroyed. Earthquakes in November and December of 1967 demolished
3,500 homes. In April 1969, when 6,500 buildings were damaged or
destroyed by earthquakes, additional thousands of homes had to be
replaced or repaired.
Hoxha stated in late 1969 that 185,000 flats and houses had been built
since World War II. The average annual rate of construction, as
indicated by incomplete reports for the 1960s, was 6,000 private
dwellings and 3,000 state-owned and cooperative apartment units. Total
requirements were not stated, but with annual population growth at
approximately 40,000 to 50,000 persons, and considering reports relating
to crowded conditions, the critical condition was unresolved. Hoxha
stated in late 1967 that the housing situation had reached the point
where in some instances five persons were living in one room.
Most rural houses are of one or two rooms, with a hearth, and are of
simple construction. They are small and sparsely furnished. Many are
made of natural rock or stones. Urban houses and apartments are usually
small and lack central heating. Kitchen and toilet facilities in
apartments must be shared by three or four families.
Social Insurance
The social insurance program is administered by state organizations and
covers medical care, compensation for incapacities, old-age pensions,
family allowances, and rest and recreation. Social insurance was
introduced in 1947. Several modifications were made later to the basic
program. The law of 1953 provided a program closely resembling that of
the Soviet Union, and for a number of years, following the Soviet
example, trade unions administered a large number of social insurance
activities. In 1965 the state assumed the administration of all phases
except those for rest and recreation facilities.
The social insurance program, as provided for in the Council of
Ministers decision of September 13, 1966, and effective January 1, 1967,
included benefits for workers, employees, and others. Peasants in the
collectives were not included in this law, but similar welfare benefits
were provided from funds established by their organizations. The 1966
law continued the policy announced in 1964 that free medical care was
provided to everyone. Drugs, such as penicillin and antibiotics, and
vitamins prescribed during outpatient treatment had to be paid for by
the user. Funds for social insurance payments came from the state
budget. Contributions were paid by state institutions and enterprises
that were in the role of employers.
Workers who became incapacitated and had over ten years of work credit
received payments at the rate of 85 percent of the average wage for the
last month worked; persons with less than ten years' service received 70
percent, except that temporary or seasonal workers were given less. When
disability resulted directly from work, pay was given at the rate of 95
percent for most trades and 100 percent for persons working in mines.
Compensation was less when incapacity resulted from an accident
unrelated to work. Payments under these circumstances depended on age
and years of work credit. Veterans who served in the Army of National
Liberation before May 1944 and some of the Party elite were allowed an
extra 10 percent when incapacitated (see ch. 2, Historical Setting).
Pregnant women were given eighty-four days' leave under normal
circumstances and 95 percent of their monthly wage if they had worked
over five years. They received 75 percent if they had worked less than
five years. Workers could remain at home for limited periods to care for
the sick and receive 60 percent of their pay. When children under seven
years of age were ill, the worker was permitted up to ten days' leave
during a three-month period. A subsidy, a one-time payment, of 280 leks
was provided for each child. Upon the death of a family head or his
spouse, 300 leks were provided for funeral expenses.
Old-age pensions were based on age and years of work. Payments were
computed at the rate of 70 percent of the worker's average monthly wage.
The minimum pension was 350 leks, and the maximum was 900 leks per
month; two exceptions were veterans of the Army of National Liberation
who served before May 1944 and Party leaders, who were awarded an
additional 10 percent. Women who reared six or more children to the age
of eight were permitted to retire at age 50 when they completed fifteen
years of work, instead of the usual requirement of twenty years.
Wages and Prices
The limited data available indicated that in early 1966 factory and
manual workers received 400 to 800 leks in wages per month. Skilled
workers were paid 400 to 1,500 leks, and senior officials received up to
1,500 leks per month. After the reduction in the size of the bureaucracy
was announced in late 1966, the maximum for officials was reduced to
1,200.
Prices in leks per pound for foodstuffs in 1966 were approximately as
follows: bread, 1 to 2, depending on type; flour, 2 to 2.5; sugar, 4.5;
beans, 3 to 4.5; beef, 6.5; and lamb, 8.5. Prices for other
commodities, in leks, were as follows: a man's suit, 400 to 1,300; a
pair of men's shoes, 120 to 200; radio, 500 to 2,400; and a bicycle, 800
to 1,300.
During the late 1960s the consumer continued to feel the squeeze of the
drive for greater economic self-sufficiency and the priority given to
the building of means of production. Despite announcements of greater
benefits to the worker, the average citizen in early 1970 continued to
pay approximately 90 percent of his income for food and shelter. Basic
commodities and foodstuffs were in short supply, and waiting in line at
distribution points was required to obtain the most commonly used items.
Manufactured items were generally of poor quality. Automobiles were
owned by the government only, and bicycles, a status symbol, were
available to only a few.