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Some issues raised by staff include:
Options
Problems in providing an adequate service supplying pharmaceuticals to the providers due
to the incompatibility of the Procurement Law with the special conditions in the drugs sector
such as urgent and changing demands, the need to be able to purchase at a price and
adjust the volume rather than purchase set volumes, and other issues. The MOH needs to
proposed changes to the Procurement Law.
The Kosovo Medicines Agency considers that it needs more independence. The reason the
agency is seeking more independence relates to difficulties experienced with the lack of
financing and other input flexibility, and how this impacts on services provided by this
agency. The agency advised that it is proposing a law to become an “independent agency”
under the Constitution (142). Independent agencies reporting to parliament should be
agencies that need to be far removed from government influence such as State Audit,
Courts, Auditor General, and the Ombudsman. These are parliament’s agencies not the
government’s agencies, whereas many of the agencies that exist now do not need full
independence from government. While this agency provides services to external users and
generates revenues about equal to its annual budget, this is not a reason in itself for
increased independence, given that it is exercising a monopoly service that is a core part of
the regulatory framework in the health sector (see Appendix G). A government-wide solution
to the situation with agencies could be addressed in a law for agencies.
The separation of the pharmacy inspectorate from the Kosovo Medicines Agency is causing
some practical problems as they need to work closely together.
Options for this department include:
Removing the divisions as this department is too small to justify these.
Consider the possibility of either including this department as a division of the Department of
Secondary and Tertiary Services or consider options to enlarge the department, however we
do not have sufficient information to make suggestions about options to improve the
arrangements for the pharmacy functions in all the entities (MOH, Kosovo Medicines Agency
and Pharmacy Inspectorate) and further work is required on this area. We are not aware of
the reason why the Pharmacy Inspectorate has been created and why it reports directly to
the Minister and without information on the problems that this structural change is intended
to address, we are not in a position to comment.
There is a proposal to enlarge the pharmacy department by bringing the warehousing and
distribution functions in the MOH rather than continuing the contract to the private sector for
these services. The comparative costs analysis for this proposal needs further development
to take account of the full costs to the government of this proposal including the costs of
owning the building and running the vehicles including depreciation, insurance, maintenance
etc., as well as the opportunity costs. The performance differences between an in house
service and a contracted service should also be considered, as sometimes it is possible to
get a higher quality service through using contracting techniques compared to an in house
service. If the decision is taken to enlarge the department by taking the warehousing and
distribution functions in house then this strengthens the case for keeping the Pharmacy
Department as a department and not making it a division in another department.
SECTION VIII: Public health services
Current situation and issues
The Division of Public Health has a head of the division with three areas: an Office of Mental Health
(0.5 staff); an Office for HIV AIDs (vacant) and programs for mother and child and TB (1 staff and
recruiting 1 assistant that UNICEF will fund). This is an unusual collection of services to associate
with public health. Public health policy, health education and promotion, and health status
monitoring are not well resourced in the MOH.
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