Health care facilities in the 1990s were substandard and much of their equipment obsolete. In 1992 Albania had 16 hospitals, with 14,000 beds. In 1996, hospital beds declined to 9,600. In 1993 there were almost 1,000 health centers staffed by primary care physicians and nurses and more than 2,300 walk-in clinics staffed by a nurses or midwifes. As of 1999, the total expenditure on health was estimated at 3.3% of GDP. In 1995, the ratio of hospital beds per 1,000 people stood at 3.2. In 1998, there were an estimated 1.3 physicians and 3.8 nurses per 1,000 people. There is a medical school in Tiranë (part of the Enver Hoxha University) and some Albanians receive medical training abroad. Tertiary care, available mostly in Tiranë, includes a teaching hospital, an obstetric and gynecological facility, a facility for treating respiratory diseases, and a military hospital. Albania's health care system was strained by the admission of as many as 500,000 Albanian refugees from Kosovo in the spring of 1999.
The general improvement of health conditions in the country is reflected in the lower mortality rate, down to an estimated 6.49 deaths per 1,000 in 2000, as compared with 17.8 per 1,000 in 1938. In 2000, average life expectancy was estimated at 74 years, compared to 38 years at the end of World War II. Albania's infant mortality rate, estimated at 20 per 1,000 live births in 2000, has also declined over the years since the high rate of 151 per 1,000 live births in 1960. There were 69,802 births in 1999 and the fertility rate in 1999 was 2.5 while the maternal mortality rate was 65 per 100,000 live births in 1993. In addition, in 1997, Albania had high immunization rates for children up to one year old: tuberculosis at 94%; diphtheria, pertussis, and tetanus, 99%; measles, 95%; and polio, 99.5%. In 1996, the incidence of tuberculosis was 23 in 100,000 people. In 1995 there were two reported cases of AIDS and seven cases in 1996. As of 2000 the number of people living with HIV/AIDS was estimated at less than 100. The leading causes of death are cardiovascular disease, trauma, cancer, and respiratory disease.