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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 10
Centre of Telemedicine reports to PS and not to the division of HIMS There are formal boards that report to the Minister that are not shown in the structure: Board for Professional Continual Education; Central Board of Residency; Board for Registration and Licensing; and Professional Ethical Board. The following positions are currently vacant and are not being actively recruited for (as at April 2009): Office for Health Policy Chief Information Department Several legal department positions Head of Division of Administrative Support Office for Hospital Institutions Office for HIV AIDs Given the budget, the MOH has selected the positions it can afford to fill that are a priority and is leaving others vacant. Established positions being recruited for as at April 2009 included key positions: Permanent Secretary, Director Department of Budget and Finance, Head of Division of Health Care; Head of Division of Private Practice; Capital Investments officer, and Information Officer. This indicates the degree of management change that this ministry is under-going. The table below sets out the current establishments in the budget. 3 Table 3 Staff levels, March 2009 Entity Positions in 2009 budget Minister’s office 8 Ministry of Health: departments, offices Central administration Sanitary Inspectorate Kosovo Pharmaceutical Inspectorate Health Inspectorate Health Care Commissioning Funded under MOH and reporting to PS but not MOH staff Hospitals National Institute Public Health Labour Medicine National Institute for Blood Transfusion Telemedicine centre Kosovo Agency for Medical Products Funded under MOH Department of Health Services but not MOH staff Primary health care Mental health services Division of care (?) Doctors in country Minority Health Mix of the above Other programs Hospital services Grand total 11 108 11 9 6 7 141 subtotal 5878 289 86 56 15 38 6362 subtotal 10 227 10 427 195 869 subtotal 13 5878 7393 The budget for 2009 set out in Appendix E is difficult to align with the organisational structure as the cost centres are at a more aggregated level. Unfortunately we were unable to get sufficiently detailed 3 We suggested to the MOH that it would be good to identify the established positions that are vacant and of those, the ones that will be recruited for and the ones that will not be filled, to get an accurate picture of the situation. This information was not readily available.
Page 1 and 2: Functional Review and Institutional
Page 3 and 4: Executive Summary 1. The process fo
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Page 7 and 8: 9. Once the structure is decided th
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Page 13 and 14: other functions it could work along
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Page 33 and 34: Issues raised by staff and others O
Page 35 and 36: The roles and functions of the boar
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Page 39 and 40: Appendices Vertical Functional Revi
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Page 43 and 44: split proposed in the World Bank re
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Appendix E: Number of Staff and Bud
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Agency for the control of health ca
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Appendix G Additional advice provid
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Improving the health status analysi
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3. Accountability. Incentives and s
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While there is clarity of central g
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50.2 Section 1.2 of the Law on Pubi
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[check if section 13 is OK or are t
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all of the directors as soon as pra
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Template for examining decision rig
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Name of agency Invest Give loans bu
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Name of agency Modify a license Can
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The issues raised at the start of t
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Figure 2: Integrated management cyc
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fees. The proposal could exclude th
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