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At this stage we do not have enough information on the intentions for the MOH’s role in the future. If it is going to be increased, then there is an option to lift mental health to a level of reporting to the PS and set it up as a department, like other service areas with policy, planning and monitoring functions. The Department could have a policy and planning unit which could also be responsible for the agreement with mental health centres and other providers on the services they will provide for the funding they receive from the central government. At the early stages the agreements may be very general, but as information improved, the agreements could specify minimum levels of service access and quality. This reflects some elements of a purchaser/provider split, but the centres are still directly accountable administratively to the MOH and not separate legal and budget entities. Policy and planning unit Department of Mental Health Mental health services unit Another option is for the Health Care Commissioning Agency to undertake the purchasing/funding role. Further analysis would be required to form a view on the most suitable option. If the role of the MOH is going to remain small in the medium term, then mental health could be a unit in one of the other service department, such as the Primary Health Department, given that the bulk of this service is at the primary care level. Its current location with public health appears unusual as its main synergies would be with primary care services and to a lesser extent, with the secondary and tertiary services. SECTION XI: Health information, internal audit, licensing, inspection, special offices and committees Health information current situation, issues and options Many reports have documented issues with health information and many people we interviewed mentioned health information as a critical issue. It is one of the five priorities of the MOH in its draft Strategic Plan and in the MTEF, although it does not appear to be well resourced in the proposed medium term budget (see appendix D). The WHO consultant helping the MOH with the Health Information Strategy is recommending that a formal national “HIS Assessment” be prepared as a step towards a national HIS strategy that can be implemented. 7 Stakeholders are being involved in this work which includes identifying the data needed for management, disease control and response, strategic decision-making and policy development. This will involve determining what data should be collected, at which levels of the system and by whom. 7 Rudi Samoszynski, International Consultant, advice from his communications with stakeholders 15 March 2009. 30 Monitoring unit
Health information is part of the Department of Strategic Management but is not resourced. The NIPH collects patient information data from hospitals using a mix of transmission methods including paper based records. We have been advised that some records are not up to date and incomplete. We have not made recommendations on health information given that there is an in-depth study of this underway. Internal audit current situation, issues and options The Office of Internal Audit currently reports to the PS according to the organisation chart, but it also reports to the Minister. It has a director and two staff members. The Director advised that based on the law, internal audit should be reporting to an Internal Audit Committee made up of ministerial appointees, including some from outside the MOH. The Office of Internal Audit sends its reports to the MOF’s internal auditor. The issues raised included: the need to establish the Internal Audit Committee; lack of clear definition over to whom the internal audit function in the University Clinical Hospital reports, issues with lack of role clarity between the finance, pharmacy and procurement departments; no licensing of auditors although this is planned; and low salaries making it hard to attract and retain staff. The forthcoming FRIDOM review of public financial management arrangements notes the need to set up the internal audit committees in all ministries. If this was done for the MOH it would be more in line with good practice and would reduce the overload of reports on the PS. Standards, licensing and registration functions: current situation, issues and options Standard setting, licensing and registration functions are carried out for various activities, professionals and products as summarised below. It involves five different entities. Standard setting and licensing health facilities The Division of Private Practice in the Department of Health Services has a director and two staff members involved in private practice regulation, licensing, monitoring, and accreditation, for around 1000 private practices including hospitals, private polyclinics, and laboratories. Their work mainly focuses on licensing, monitoring of institutions, developing the law, and creating a database. They are not involved in enforcement. Standards are based on an administrative instruction issued in 2007 for day-care hospitals, ambulatory services and inpatient hospitals (special and general), and polyclinics. The Commission for Licenses is a ministerial committee appointed to assess technical and professional activities that run across the MOH. It contributes to the licensing process by considering problems with unlicensed hospitals including assessing facilities, and the adequacy of staffing, space, equipment and other matters. This would appear to be a core MOH function that could be carried out by staff, but the commission may be a way to solve staffing shortages and other issues. The Office for Quality of Health Services in the Department of Strategic Management mainly works on health quality standards and the strategy for improving the quality of health services for the private and public health facilities. The scope of the work is supposed to include developing guidelines, protocols, monitoring, evaluation, working with coordinators for quality for primary, secondary and tertiary care and the main family medicine centres and while this is done in part, it is constrained by the size of this office (1 person). Licensing medical products including drugs The Kosovo Medicines Agency licences pharmacies, licenses drug warehouses, issues import licenses for medical products, lists authorised medical products, tests drugs, and licenses pharmacies. 31
Page 1 and 2: Functional Review and Institutional
Page 3 and 4: Executive Summary 1. The process fo
Page 5 and 6: 5. There are many constraints on ma
Page 7 and 8: 9. Once the structure is decided th
Page 9 and 10: SECTION I: Legal, policy and medium
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Page 13 and 14: other functions it could work along
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Page 21 and 22: Structural problems with excessive
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Page 35 and 36: The roles and functions of the boar
Page 37 and 38: Some countries have combined health
Page 39 and 40: Appendices Vertical Functional Revi
Page 41 and 42: Valdet Hashani, Primary Health Care
Page 43 and 44: split proposed in the World Bank re
Page 45 and 46: 56.2. Implementation of the health
Page 47 and 48: This law regulates tobacco products
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Name of agency Invest Give loans bu
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Name of agency Modify a license Can
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The issues raised at the start of t
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Figure 2: Integrated management cyc
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fees. The proposal could exclude th
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