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9. Once the structure is decided the staffing should be considered. There is little point in
restructuring if the people with the right skills and capabilities are not placed in the jobs and if
non performers remain. Job descriptions with the person specifications need to be
developed for all positions in the MOH, followed by a placement process that is designed to
ensure that appointments are made on merit and that people with the right skills are
appointed to the positions. This might involve confirming some people in roles similar to
ones they have now, moving them, replacing them, recruiting new staff and making some
redundancies. The legal implications and costs of this part of the restructuring need to be
considered and the legal rights of the employees complied with. A special law relating to the
MOH restructuring may be required if there are provisions in the law that prevent an effective
approach to the restructuring.
10. There are back office functions that may be able to be aggregated and delivered for
many government entities. There are also functions that could be considered for
contracting out to national and international providers, such as testing pharmaceuticals,
some tertiary health services, medical training, etc. Further work on the Institutional
Development Plan could consider this.
Beginning in the coming year and extending over the medium term
Changes to agency arrangements: hospitals, inspectorates, other agencies, boards
11. Consider increasing the ability of hospitals and other agencies to manage resources
alongside introducing incentives for performance (such as improving the alignment of
the budget to outputs) and adequate controls. 2 The draft changes to the Health Law in
appendix G provide a potential framework for doing this, but considerable work would need
to be undertaken to implement these changes. Other agencies including the National
Institute for Public Health, Centre for Telemedicine, and the Kosovo Medicines Agency could
also be brought within this governance and accountability framework as appropriate. This
framework includes forecast financial statements, forecasts statements of service
performance, reporting against these forecasts, and service agreements/contracts with
reporting against these, monitoring and external audit of service performance. In addition the
MOH could offer to be a pilot for aspects of performance based budgeting involving the
hospitals as a way to develop, test and prove ways to improve performance and thereby
gain the credibility to seek increased flexibilities in the management of resources.
12. Consider options for improving the arrangements for licensing and inspectorates.
This report has not covered these areas in detail but raises some issues and options,
including the possibility of combining the functions of some licensing boards.
13. Continually monitor progress with the reforms and make adjustments when
necessary. Ensure that the changes are managed in a way that the MOH can deliver on
critical accountabilities and can manage risks to its performance.
2 The term “agency” is used in a broad sense in this report to cover institutions that are not the MOH or its departments
and offices. It includes hospitals, NIPH, KMA, and others.
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