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One option for the organisation of a Department of Secondary and Tertiary Services has been set
out below. It is only one of many possible options and needs to be discussed and tested with the
MOH. The primary health, public health and mental health services are dealt with later in this report.
Policy & planning unit
(also support to
funding/purchasing
function)
Detailed policy and planning related to secondary and tertiary services could be carried out by this
Department. Note that the policy and planning role in the Department of Strategic Management is a
facilitation role that helps departments like this one feed into ministry-wide policy, planning and
budgeting processes. The services provided by the Office for Treatment Abroad could be included in
the Policy and Planning Unit or the HCCA.
The monitoring role would include monitoring hospitals. This would involve routine monitoring of the
performance reports, as distinct from the inspection functions if the Health Inspectorate. The idea of
having monitoring units requires more work to assess whether there is sufficient capability able to be
attracted the individual units or whether fewer units are more realistic, although note that the skills to
do policy analysis are similar to the skills used in routine monitoring.
Options agencies
Department of secondary and
tertiary services
Staff members in the MOH and hospitals have commented that the current arrangements of the
MOH having detailed decision making roles with regard to the agencies including the hospitals is not
an efficient and effective way to deliver services. The problems noted above in relation to budgets
are examples of the issues affecting performance. The creation of a robust governance and
accountability framework for the agencies including the hospitals could include the following:
A suitable legal framework that covers all essential components of an agency law, tailored to
the situation in Kosovo. While the Health Law 2004 has many useful provisions it does not
provide a full accountability framework for an agency. If an agency law is not likely any time
soon then amend the Health Law. Chapter VIII of this law could be expanded. Appendix G
has some suggested draft provisions.
Governance arrangements with a separation of governance and management roles, boards
with members with governance skills, good governance practices in the part of the board
including management of conflicts of interest. The Health Law provides for a supervisory
board but hospitals do not tend to have these boards. The suggested provisions for
revisions to the Health Law in Appendix G include the application of the provisions about the
board of directors from the Public Enterprise Law with some modification. That law has many
provisions designed to minimise conflicts of interest and to ensure that the boards can be set
up well to carry out their functions.
Clarity of roles and responsibilities between governance boards, management, MOH
officials, and others. The Health Law 2004 could be expanded to do this as suggested in
Appendix G.
Good ex ante accountability document covering forecast finances and forecast service
performance. The Health Law has high level requirements for the Annual Plan but there are
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Monitoring unit