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Some advantages of the proposed structure include: reduction in vacant positions that MOH does not intend to fill and cannot resource; joining the management role together for personnel and administration where one of these unfilled vacancies exists and thereby providing a management structure that is more affordable and has a more usual level of employees (current structure has division managers for very few employees); and creating the potential for more flexible use of resources by aggregating some functions and reducing the detailed designation of jobs. This is just one example of a possible reorganisation of these functions. It would need to be analysed in more depth. Suggestions need to be made for the level of staffing and these suggestions need to be considered by the MOH before a firm recommendation could be made. In the medium term the government may wish to consider using a back office function servicing many ministries for some of the services set out above. Department of Budget and Finance: This department has nine staff. The Director is being recruited, making a total of 10. It is organised into two divisions as set out in Appendix F. The Division of Budget has a manager and three staff. The Division of Finance has one manager and five staff positions, but we have been advised that the Assets Officer’s position has been moved to the Department of Administration. This function could be added to the “Administration Services” in the diagram above. The role of the Chief Financial Officer is carried out by the Director of the Department. We have been advised that the law requires this position to report to the PS. In interviews with staff from this department the following issues were raised. Some possible changes are noted. Process issues Very detailed sign off, documentation and other processing requirements for making payments (eg, five signatures for payments) with opportunities to streamline these. If this is done, it would require changes to regulations for all ministries. The Government may wish to consider reviewing the major business processes that are common across ministries and look for ways to improve their efficiency, including options for shared back office functions. Budgeting issues Problems with a lack of alignment between capital and recurrent budgeting and planning, including a position dealing with donor capital being located under the Department of Strategic Management and poor communications between that position and the Department of Budget and Finance. This contributes to a lack of quality in capital planning along with other issues such as the approach to capital planning being reactive and not sufficiently forward looking. There are problems with commissioning buildings without considering recurrent costs. The wider issue of a lack of alignment between capital and recurrent budgeting needs to be addressed through the planning and budgeting process, but the issue with the structural separation could be addressed by locating the capital investment role with the finance and budgeting functions. At a minimum, there should be clear requirements for this donor coordination and donor related capital planning functions to exchange information freely with the budget and finance functions. MOH manages some capital for agencies reporting to it which some staff think could be better managed by the agency, so decision making is better aligned to the actual capital requirements of the agency and to improve the clarity of roles and accountabilities. There are issues with capital planning and management in agencies identified in the 2007 report from the Office of the Auditor General that would need to be considered in making any changes to roles and responsibilities for capital planning. 5 5 The Office of the Auditor General’s report for 2007 identified issues with a lack of financial statements, procurement, capital being purchased and not used, service issues in regulating medicines, and unauthorised purchases. The MOH rejected many of these findings and the OAG did not accept many of the reasons put forward by MOH. 14
The whole-of-government budget process is not yet mature and there are issues like the MOH’s strategic plan coming after the MTEF and some significant changes between the MTEF and the annual budget, with decisions being made to allocate funds for capital without a lot of analysis backing this up. The strategic planning process and its links to operational plans could be strengthened. The Health Sector Strategy is being developed and has many good points but could be improved by linking it to the MTEF. The Health Sector Strategy is intended to be used to communicate the gap in funding to donors and to support requests for donor funding. Ideally donor funding could be better predicted and included as part of the MTEF planning and there could be more focus on improving the outputs for the funds forecasted. Separation of budgeting and finance Some lack of coordination between budget and finance divisions and divisions being too small to stand alone, with a possibility of combining these functions. Some of the issues above require improvements in internal processes. These have not been examined closely enough to make recommendations. Some initial ideas about changes that could be made to the arrangements of functions include options to: Join the finance and budget functions with administration services to form one department. There are many consequences that would need to be worked through in assessing this possibility. Some obvious advantages include: reducing the number of corporate service reports to the PS and making space on the senior management team for key services (discussed later); reducing the payroll costs for senior management; and providing opportunities for the director of corporate services to streamline functions and maximise the use of resources in this larger department. A disadvantage may include possibly overloading the role of the director, particularly if that person has to fulfil the role of the chief financial officer. Move the donor capital investment role to this department. Move the certifying officer to this department (would require a change in the law to implement this fully as they report to the PS under the Public Finance Law) provided any issues with conflicts of interest can be managed. The testing and full formulation of these options and other options to improve the structure, roles, systems and processes in this department would require working in detail with the MOH. Procurement This department has one director reporting to the PS and six staff in two divisions, as shown in Appendix F. At some periods during the year the Director has frequent daily contact with the PS. It is unusual for a corporate service like this to report directly to the PS and to have frequent contact. There are considerable problems identified in the OAG report relating to procurement. Many staff commented on issues with capital and drugs procurement, including problems relating to the unsuitability of legal provisions for dealing with the purchasing of these items. This review does not extend to reviewing procurement law and procedural issues, but it appears to be a key issue that the MOH needs to focus on. Presumably if the legal issues with the procurement situation were resolved then the need to interact so frequently with the PS would reduce and the function would become routine. An option could be considered to place this function under a corporate services function, with other functions discussed above. 15
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
Page 9 and 10: SECTION I: Legal, policy and medium
Page 11 and 12: Centre of Telemedicine reports to P
Page 13: other functions it could work along
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Page 21 and 22: Structural problems with excessive
Page 23 and 24: One option for the organisation of
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Page 31 and 32: Health information is part of the D
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
Page 41 and 42: Valdet Hashani, Primary Health Care
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Page 49 and 50: Provides for a grant for minimum st
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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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