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terms the two outer years may be decreases after taking account of inflation. As these figures are not broken down by central and local government levels, it is not possible to estimate the changes relating to the budget of the MOH. Table 2 MTEF for Health Note that the annual budget provided by the MOH has a total sum of 66,282,033 euros for 2009 which is below the 67,081,628 euros indicated in the MOH‟s medium term budget figures. In summary, over the medium term the MOH can expect a flat or declining government budget. The effect of donor contributions also needs to be considered and a full MTEF projection prepared that takes these into account. At this stage we have not been able to locate a full projection that takes account of all sources of funding. EC policy As part of the consideration of how to improve the MOH, the EC policy requirements need to be taken into account. The Government‟s 2008 Action Plan on the Implementation of the European Partnership includes the following activities that relate to the MOH: 5 5 Health related requirements are assigned to other ministries in relation to environmental matters, safety at work, and other areas, e.g., MAFRD is responsible for the requirement to adopt the law on food and the consequent implementing legislation, and establish the relevant agency to implement and enforce the law. MLSW is primarily responsible for strengthening cooperation with mental health centres. 16
Two projects on Health and Environment: 1) modernization of monitoring equipment for the Institute for public health, and 2) the review of regulations on standards for the quality of the drinking water Improvement of Health Care Information Systems Continued assessment of health care services provided to all communities, and publishes quarterly reports Continued financial and technical support for health care institutions providing services to minority communities and minority-inhabited municipalities Continued provision of health care services through mobile teams in minority settlements and to returnees, through District Health Authorities and Municipal Health Departments Review complaints and undertake legal and disciplinary measures against ethical, professional and legal violations, in cases of failure to provide health care services to all communities Ensure health care policies and programs respond to gender differences and health needs of women (with PMO) Work on a sector-wide approach (SWAp) is expected to begin soon with EC support. This will involve: 1. Understanding the strategy and subsectors, mapping donors and interests 2. Understanding the legal framework in the health sector considering what other ministries do 3. Health information system and strategy. 4. Assess the management capacities in MOH and municipalities including the gaps in the municipalities‟ ability to fulfil their role in primary health in terms of staff, skills, buildings, etc. 5. Awareness campaign on public health issues. This work has overlaps with this review of the ministry and it would be good to ensure that the SWAp work can take advantage of the work from this project. Extent of the strategic management challenges It is important to consider the extent of the strategic management challenges facing the MOH as this has implications for its structure and functions. The MoH is dealing with major policy and planning challenges in financing, information, health insurance, purchaser/provider split and other areas, as set out in appendix D. Financing An area of major reform that has been considered in recent work is how to improve the financing of health services. The current arrangements are set out below: 17
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Two projects on Health and Environment: 1) modernization of monitoring equipment for the<br />
Institute for public health, and 2) the review of regulations on standards for the quality of the<br />
drinking water<br />
Improvement of Health Care Information Systems<br />
Continued assessment of health care services provided to all communities, and publishes quarterly<br />
reports<br />
Continued financial and technical support for health care institutions providing services to minority<br />
communities and minority-inhabited municipalities<br />
Continued provision of health care services through mobile teams in minority settlements and to<br />
returnees, through District Health Authorities and Municipal Health Departments<br />
Review complaints and undertake legal and disciplinary measures against ethical, professional and<br />
legal violations, in cases of failure to provide health care services to all communities<br />
Ensure health care policies and programs respond to gender differences and health needs of<br />
women (with PMO)<br />
Work on a sector-wide approach (SWAp) is expected to begin soon with EC support. This will involve: 1.<br />
Understanding the strategy and subsectors, mapping donors and interests 2. Understanding the legal<br />
framework in the health sector considering what other ministries do 3. Health information system and<br />
strategy. 4. Assess the management capacities in MOH and municipalities including the gaps in the<br />
municipalities‟ ability to fulfil their role in primary health in terms of staff, skills, buildings, etc. 5. Awareness<br />
campaign on public health issues. This work has overlaps with this review of the ministry and it would be<br />
good to ensure that the SWAp work can take advantage of the work from this project.<br />
Extent of the strategic management challenges<br />
It is important to consider the extent of the strategic management challenges facing the MOH as this has<br />
implications for its structure and functions. The MoH is dealing with major policy and planning challenges in<br />
financing, information, health insurance, purchaser/provider split and other areas, as set out in appendix D.<br />
Financing<br />
An area of major reform that has been considered in recent work is how to improve the financing of health<br />
services. The current arrangements are set out below:<br />
17