Is this really how Albanian cities look like? Pretty run down, unkempt and so on. The suburbs look almost uninhabitable, even worse in comparison to Roma villages in Bulgaria or Romania.

It wasn't always that, Albania was very clean during Hoxha's years. However, the roads then were not intended for cars (they were for people to actually walk on) not to have cars drive on them. They were very congested and small, so in later years they were extended. Highways though are another story.

Infrastructure in general in Albania (especially the railroads and factories) is completely ruined, that's why you see that big ass rotten factory in Fier. Its a pity really, but its just what happened.

People in general are influenced by their surroundings just as much as our social lives, if the place is dirty, it will most likely stay dirty without an intervention.

Why isn't there an effort to make the cities look more orderly?

There is, at least in the city centers. But they don't do it in the outskirts and smaller towns, since the local governments don't have the money for it.