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TABLE OF CONTENTS EXECUTIVE SUMMARY ...................................................................................................................... 3 INTRODUCTION .................................................................................................................................. 8 SECTION I: LEGAL, POLICY AND MEDIUM TERM PLANNING FRAMEWORK ............................. 9 SECTION II: BARRIERS TO CHANGE ............................................................................................... 9 SECTION III: OVERVIEW OF STRUCTURE ..................................................................................... 10 SECTION IV: CORPORATE FUNCTIONS ........................................................................................ 12 SECTION V: STRATEGIC MANAGEMENT ...................................................................................... 16 SECTION VI SECONDARY AND TERTIARY SERVICES ................................................................ 19 SECTION VII: PHARMACEUTICALS ................................................................................................ 24 SECTION VIII: PUBLIC HEALTH SERVICES ................................................................................... 25 SECTION IX: PRIMARY HEALTH SERVICES .................................................................................. 27 SECTION X: MENTAL HEALTH SERVICES .................................................................................... 29 SECTION XI: HEALTH INFORMATION, INTERNAL AUDIT, LICENSING, INSPECTION, SPECIAL OFFICES AND COMMITTEES........................................................................................................... 30 SECTION XII: EXAMPLES FROM OTHER COUNTRIES ................................................................. 35 SECTION XIII: NEW STRUCTURE AND CURRENT STRUCTURE ................................................. 37 2
Executive Summary 1. The process for this review involved working with MOH and others to indentify issues and opportunities for improvement, followed by feedback from the Minister of Health and his advisers. This report considers the current services of the MOH, the organisational arrangements including the structure and related matters, the challenges the ministry has, the constraints on making changes, and options for improvements. 2. The Minister of Health has advised that there is political will to make improvements to the structure and functioning of the Ministry of Health and its related institutions. This has been demonstrated in recent improvements in the tender selection processes; management and supply of drugs; the publication of the status of licensing for private health facilities; the formation and empowerment of the Pharmacy Inspectorate; other changes to improve health services; and the guidance provided by the Minister of Health on the areas to focus on in order to improve the performance of the Ministry of Health and related institutions. The following areas were considered in more depth during the revision of the draft report and are discussed in Appendix G of this report: The implementation of the reforms in particular what can be undertaken in the coming months and what will require more time. The timing for changes are set out later in this executive summary and discussed in more depth in the Appendix G. Note that an Institutional Development Plan is intended to follow this report which can be incorporated as appropriate in the Ministry of Health’s strategic plan, operational plan and budget proposal for the forthcoming MTEF and annual budget. It could also be the basis for a proposal to be put to the government for approval of the changes to the MOH as this report is not in a suitable format for that purpose. Appendix G has advice on implementation. Developing purchasing/funding function in MOH. Further advice is provided in Appendix G on strengthening the purchasing/funding function in the MOH, including developing capability to specify, cost, price, contract for services, and undertake related work. This work could be developed by the MOH and applied to service providers including municipalities, hospitals, the NIPH, private providers and others. This offers the potential for the MOH to improve services through using incentive based contracts that are clear about performance expectations, have resources aligned to expected performance and are designed to encourage particular behaviours. It takes time for public service providers and for government officials involved in funding/purchasing to develop skills, information and mature behaviours. The sooner they start this work, the sooner the benefits will result from it. Arrangements for hospitals. Further advice on strengthening the governance and accountability arrangements for hospitals to improve performance is provided in Appendix G in the form of draft revisions to the Health Law, following discussions with the Working Group on the Health Law. The suggested arrangements include setting up hospitals as Health Sector Public Enterprises with an adapted set of governance and accountability arrangements from those applying to Public Sector Enterprises. The adaptations reflect the broader requirements on health sector public enterprises from enterprises that have the main function of maximising shareholder value. If implemented well, the suggested arrangements could strengthen the strategic roles of the Minister of Health and Ministry of Health and reduce the need for intensive operational involvement. There are many safeguards proposed to permit interventions when necessary, but the focus is on assigning appropriate roles to ministers, boards and management, and using tools to ensure there are incentives for performance including an annual business plan and periodic formal reporting with full external auditing. There are provisions to reduce conflicts of interest and to help ensure that board members have appropriate skills to provide good governance. Issues with Kosovo Medicines Agency’s proposal for more independence. The inappropriateness of this Agency being constituted as an independent agency similar to constitutional agencies is discussed in Appendix G in the context of the governance and accountability framework for institutions in the health sector. Options for addressing inefficiencies caused by the MOF role in policy and budget formulation and execution arrangements. This includes considering the issues with 3
Page 1: Functional Review and Institutional
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Page 13 and 14: other functions it could work along
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Page 39 and 40: Appendices Vertical Functional Revi
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Health information Develop effectiv
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Two projects on Health and Environm
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local government in relation to the
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Hospital prepares its own budget an
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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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