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charge on assets to make ministries recognise the true cost of using a government owned
building so they are motivated to make better decisions about whether to use a government
building, or lease one, or in the case of the Department of Pharmacy, whether to contract out
the service. The adviser working on the study intends to refine it to more fully take account of
the full costs.
Inefficiencies in processing decisions and payments were identified which would require
improvements to government-wide requirements. There is a very legalistic culture with
many formal instructions which can create management inefficiencies.
There is a lack of a robust governance and accountability framework for agencies including
hospitals and other institutions, such as an agency law. This would need to be addressed as
part of resolving some of the problems with the hospitals and other agencies. Some
suggestions have been made in Appendix G to modify the Law on Public Enterprises to suit
health agencies.
The level of funding for the health sector in the MTEF appears to be flat or falling and low
compared to what might be expected as a percentage of the budget and GDP, particularly
going forward. It is difficult to implement changes such as improving health information
without significant investments.
There is also an issue with rigidities in the budget appropriations and practices which are
common in countries focused on fiscal control, but a path of progression from this situation
should be set out so the performance issues related to inefficiencies caused by the budget
practices can be addressed.
Unless these barriers are dealt with, it will be very difficult to improve on the MOH’s structure and
operations as the current arrangements are a rational response to the MOH’s situation. The
changes suggested in this report favour a flatter structure with more generic roles, fewer divisions
and offices and specialised positions, and consequently fewer people reporting to the PS and fewer
people with high level job titles. This could affect their pay, status, and willingness to make changes,
unless these barriers to a flatter structure are removed.
SECTION III: Overview of structure
Organisational structure and staff numbers
According to the structure approved by the Office of the Prime Minister in 2007, the MOH consists of
six departments, two inspectorates, seven offices/officers and a health care commission agency, set
out in Appendix F. The following institutions report to the PS:
Regional hospitals (8)
Kosovo University Clinic Hospital
Kosovo Dentistry Clinic
National Institute Public Health
Institute of Labour Medicine
National Institute for Blood Transfusion
The approved structure shows one agency reporting to the Minister: the Kosovo Agency for Medical
Products. MOH staff members have advised that the following changes have been made to the
approved structure as at April 2009:
New Pharmacy Inspectorate reporting to the Minister (formerly part of the Kosovo Medicines
Agency)
Executive Assistant and one other assistant reporting to the PS
Health Inspectorate reports to Minister not the PS
Sanitary Inspectorate will move to a new Food Safety Agency reporting to the Prime
Minister’s Office
Legal Office has been changed into a department due to an administrative instruction from
the PMO
Information Office has been changed into a department due to an administrative instruction
from the PMO
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