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Lack of information
Lack of primary health care information available to the MOH.
There is a pilot to develop performance based payments in primary health care for 5% of the
grants and while efforts are being made to do the ground work now through the Health Care
Commissioning Agency, this is challenging given the problems with the lack of data and
quality issues with population data, registration data, health status data and patient activity
data. Rolling out this pilot to all regions before solving core information and other problems
was noted as a concern. A stronger policy and planning function in primary health in the
MOH may have been able to better prepare the sector for the movement to performance
based payment
Fragmented monitoring
With regard to monitoring, the Office of Primary Health Care is not expected to have a role in
the performance based payments to municipalities. Municipalities are expected to send data
to the NIPH; the Health Inspectorate will access this and monitor; the Health Care
Commissioning Agency will do ad hoc monitoring; and the Office for Quality of Health
Services will also be involved. Municipalities will do some self assessment of performance
and monitoring. This is a very fragmented approach to monitoring.
Problems in funding approach
There are issues with the approach to funding primary health care as set out in the World
Bank report on financing noted below, indicating the need for policy work at the MOH level. 6
Options
The decentralisation of primary health care does not mean that the MOH should not have a strong
policy, planning and monitoring role. The options for strengthening this include considering creating
a Department of Primary Health with these functions.
6 World Bank, “Kosovo Health Financing Reform Study”, 2008, page 105.
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