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many areas not covered in order for this to be a suitable accountability document- such as
timing of plan, reporting on plan, external audit of report on plan, etc. Suggestions are made
in Appendix G to expand the specifications for the annual plan and the annual report.
Ex post formal annual reporting of financial and service performance with external audit and
external monitoring, including by MOF of the government’s “ownership” interests related to
the maintenance of the agency’s capability using the POE Policy and Monitoring Unit.
Service agreement with MOH covering detail of services to be provided and funds to be
provided, designed to incentivise good performance. The Health Law can provide for this as
per Appendix G.
Regular reporting on service agreement to MOH, eg, quarterly and a full annual report. The
Health Law can provide for this.
Monitoring of performance by MOH including comparative performance reports to encourage
better performance. The Health Law could define MOH’s role in relation to these agencies.
Readily accessible information on performance for service users, monitors, and others. The
Health Law can provide for this.
Adequate internal controls to support greater flexibilities to manage resources.
Increased flexibilities to manage resources need to be balanced with increased accountability for
performance. The framework outlined above has the basic components required to achieve this, if
implemented well. The barriers to performance need to be addressed such as the very detailed
budget execution method implemented by the MOF. This detailed approach to budget execution is
not appropriate for an agency that has an adequate governance and accountability framework and
internal financial management capabilities. Hospitals would need to develop these capabilities and
the framework for governance and accountability would need to work well.
Policy work on designing an accountability framework for agencies must take account of the situation
in Kosovo, including the level of capability and the risks that need to be managed. It is unrealistic to
expect to be able to rapidly develop a robust governance and accountability framework and to have
all processes relating to this operating very well, given the constraints in Kosovo. A transition path
could be developed with incremental changes that involve the adequate management of risks.
Problems can be expected in moving to an agency model, but this should not justify maintaining the
status quo which is characterised by some notable problems.
Managers in hospitals and other agencies could be trained in management and in future, selected
according to suitable criteria. If they are set up with more flexibility to manage resources, then the
management role becomes more challenging.
MOH could have a funding, purchasing and monitoring role instead of a direct procurement role and
other direct roles in relation to hospitals and agencies, if hospitals and agencies have robust
accountability frameworks. Agencies could report to the PS or Minister for high level matters like
agreement on key strategic and accountability issues. With regard to the provision of services,
reporting and monitoring, the agencies could report to the appropriate part of the MOH and in the
case of the hospitals, this could be to the Department of Secondary and Tertiary Services. The MOH
would need to develop its capabilities to effectively exercise its roles.
SECTION VII: Pharmaceuticals
Current situation and issues
The Department of Pharmacy has two divisions: one for monitoring and one for supply. There is a
director, one person in each division and two assistants serving both divisions (five in total). See
Appendix F.
The Kosovo Medicines Agency regulates drugs and other medical products. It is an agency of
around 38 staff, reporting to the Minister.
There is a separate Pharmacy Inspectorate that used to be part of the Kosovo Medicines Agency,
but has recently been set up as an inspectorate reporting to the Minister. It has a staff of six being a
director, an assistant and four inspectors.
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