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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
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