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public finance distinction and if it is not well understood and used in Kosovo then it would be important to clarify exactly how it will be used so the roles of the Minister of Finance and Minister of Health are very clear and not confused.] 50.7 In addition to the powers and requirements in section 7 the shareholding ministers shall be entitled to remove any or all members of the Board of Directors at an earlier date than two years if one or both of the ministers are of the view that performance failures have occurred that relate to the exercise of the governance role of the Board of Directors. 50.8 The POE Policy and Monitoring Unit shall focus on the ownership interests [define this] and shall coordinate its monitoring with the Ministry of Health. The Ministry of Health shall have principal responsibility for monitoring the service performance of Health Sector Public Enterprises and shall have a joint responsibility with the POE Policy and Monitoring Unit to monitor the ownership interests. The POE Policy and Monitoring Unit and the Ministry of Health shall proactively exchange information and analysis to ensure that the monitoring is effective and efficient. [this expression of the roles and responsibilities of these two entities could be more deeply defined to ensure clarity and how they will cooperate] 50.9 The Ministry of Health shall have the power to exercise its roles assigned by law and the restrictions in section 7.6 shall not apply to the proper exercise of such powers. [make sure that the Ministry of Health has the power to fulfil its regulatory role and also the purchase interest] 50.10 Section 7.7 shall not entitle Health Sector Public Enterprises or the POE Policy and Monitoring Unit to withhold information that should be in the public domain according to law or a decision of the Minister of Health or Minister of Finance. 50.11 The reporting required by section 8 shall be included in the periodic and annual reports of the Health Sector Public Enterprises which shall comply with the requirements pursuant to the Health Law. [the reporting requirements need to cover the service performance which is not adequately covered in the Public Enterprise law] 50.12 Section 9 shall not apply to Health Sector Public Enterprises. The government and municipalities shall not sell shares, use shares for security, or otherwise deal in the shares of Health Sector Public Enterprises as prohibited by section 41 of the Law on Public Enterprises except that the government may amalgamate enterprises, close enterprises and otherwise reorganise them. 50.13 Section 10.1 shall not apply to Health Sector Public Enterprises. 50.14 Section 12.1 shall not apply to Health Sector Public Enterprises. The Health Sector Public Enterprise shall provide services in an effective, economical and efficient way in compliance with its obligations and shall ensure that it maintains and develops capability in a financially sustainable way. The Health Sector Public Enterprise shall provide services in accordance with its statement of forecast service performance in the business plan, any service agreements with the Ministry of Health and other entities, and its other legal obligations. If the Ministry of Health and the Health Sector Public Enterprise are unable to reach agreement then the Ministry of Health shall have the power to impose the service agreement by serving a notice under this section setting out the terms of the service agreement. Without affecting the status of this service agreement, the Health Sector Public Enterprise shall be entitled to prepare an analysis of the issues with the service agreement imposed under this section and proposals for variations to the service agreement for consideration by the shareholding ministers who shall have the power to jointly require variations to the agreement. [this provides for service agreements which are a key step towards clarifying what is provided for the funds used and will be a basis for the future contracting with the Health Insurance Fund and other purchasers if the health sector evolves in that direction. It can be a very useful tool for driving performance improvements and can be designed to be very simple in the beginning to match capabilities and become more sophisticated over time. The last resort power to impose the agreement is necessary as the government needs this method to close down negotiations that become unproductive and difficult to resolve as can happen in the early years of specifying and pricing or costing services] 36
[check if section 13 is OK or are there laws that are unsuitable for Health Sector Public Enterprises?] [section 14 it would be good to apply modern accounting standards to Health Sector Public Enterprises but check how long it might take before they could comply as it requires staff with accounting skills] 50.15 Section 15.2 shall be modified so that the appointment of the Recommendation Committee shall be undertaken jointly by the permanent secretaries of the Ministry of Health and the Ministry of Finance with the Permanent Secretary of the Minister of Health being entitled to appoint four members and the Permanent Secretary of the Ministry of Finance being entitled to appoint three members. Section 15.11 shall be modified so that the Minister of Health has the power to appoint an acting chairperson. [check other provisions of section 15 to test how suitable they are to apply to health Sector Public Enterprises] [modify section 16 to provide for Health Sector Public Enterprises that are jointly owned by central government and municipalities] [check section 17 to see if it will work for the Health Sector Public Enterprises- will there be enough people with these requirements to fill all the board positions?- need to at least make the following change] 50.16 Section 17 (3) b shall be modified to add one more specification for a director that they may qualify under (i), (ii) or (iii) has experience in the health sector [the other requirements are about commercial expertise so it would be useful to permit board members that have health sector expertise] 50.17 Section 18 shall be modified so that the Board of Directors shall have the power to remove a CEO for any material failure of organisational or personal employment performance or breach of organisational or personal employment obligations without the limitation of the two year period. [Modify section 20 to cover Health Sector Public Enterprise owned by central and local government] [section 21.1 looks unfair as it permits termination of an employment contract without cause] 50.18 Section 29 shall be modified to include a requirement to report to the Ministry of Health on service performance in the form and on the dates specified by the Ministry of Health. [MOH could specify the reporting requirements for the statement of service performance in the business plan, the service agreement and any other reporting requirements. It would be good to consolidate these reporting requirements into simple templates that can be filled in electronically on commonly available software like excel] 50.19 Section 30.1 shall be modified to require the approval of the Minister of Health and the Minister of Finance of the business plan. The Minister of Health in consultation with the Minister of Finance shall have the power to direct changes to the business plan should the Board of Directors not agree with the Minister of Health‟s request to change the business plan. All directions from the Minister of Health to change the Business Plan shall be made in writing and provided to the Kosovo National Assembly for information. [this is important as Health Sector Public Enterprises are not simply commercial entities and the Minister of Health needs to have a role in approving the business plan as it will relate to the provision of essential public health services. Need to have the transparency about directions. This draft gives the main power to the Minister of Health to give directions after consulting with Minister of Finance. Need to draft a provision to cover the rights to direct changes to the business plans of the entities that local government partly own.] Section 30 (1) a shall be modified to include a requirement that from a date to be specified by the Minister of Finance the requirement for financial targets will be replaced by a requirement to provide the following information in the form specified by the Ministry of Finance: [see an example below- this can be adapted to suit Kosovo] 37
- Page 23 and 24: One option for the organisation of
- Page 25 and 26: Some issues raised by staff include
- Page 27 and 28: main providers of services funded b
- Page 29 and 30: Policy and planning unit A variatio
- Page 31 and 32: Health information is part of the D
- Page 33 and 34: Issues raised by staff and others O
- 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
- Page 49 and 50: Provides for a grant for minimum st
- Page 51 and 52: V. Fourth goal - Functionalize, reo
- Page 53 and 54: Health information Develop effectiv
- Page 55 and 56: Two projects on Health and Environm
- Page 57 and 58: local government in relation to the
- Page 59 and 60: Hospital prepares its own budget an
- Page 61 and 62: Appendix E: Number of Staff and Bud
- Page 63 and 64: Agency for the control of health ca
- Page 65 and 66: Appendix G Additional advice provid
- Page 67 and 68: Improving the health status analysi
- Page 69 and 70: 3. Accountability. Incentives and s
- Page 71 and 72: While there is clarity of central g
- Page 73: 50.2 Section 1.2 of the Law on Pubi
- Page 77 and 78: all of the directors as soon as pra
- Page 79 and 80: Template for examining decision rig
- Page 81 and 82: Name of agency Invest Give loans bu
- Page 83 and 84: Name of agency Modify a license Can
- Page 85 and 86: The issues raised at the start of t
- Page 87 and 88: Figure 2: Integrated management cyc
- Page 89: fees. The proposal could exclude th
public finance distinction and if it is not well understood and used in Kosovo then it would be important<br />
to clarify exactly how it will be used so the roles of the Minister of Finance and Minister of Health are<br />
very clear and not confused.]<br />
50.7 In addition to the powers and requirements in section 7 the shareholding ministers shall be<br />
entitled to remove any or all members of the Board of Directors at an earlier date than two years if<br />
one or both of the ministers are of the view that performance failures have occurred that relate to the<br />
exercise of the governance role of the Board of Directors.<br />
50.8 The POE Policy and Monitoring Unit shall focus on the ownership interests [define this] and shall<br />
coordinate its monitoring with the Ministry of Health. The Ministry of Health shall have principal<br />
responsibility for monitoring the service performance of Health Sector Public Enterprises and shall<br />
have a joint responsibility with the POE Policy and Monitoring Unit to monitor the ownership interests.<br />
The POE Policy and Monitoring Unit and the Ministry of Health shall proactively exchange information<br />
and analysis to ensure that the monitoring is effective and efficient. [this expression of the roles and<br />
responsibilities of these two entities could be more deeply defined to ensure clarity and how they will<br />
cooperate]<br />
50.9 The Ministry of Health shall have the power to exercise its roles assigned by law and the<br />
restrictions in section 7.6 shall not apply to the proper exercise of such powers. [make sure that the<br />
Ministry of Health has the power to fulfil its regulatory role and also the purchase interest]<br />
50.10 Section 7.7 shall not entitle Health Sector Public Enterprises or the POE Policy and Monitoring<br />
Unit to withhold information that should be in the public domain according to law or a decision of the<br />
Minister of Health or Minister of Finance.<br />
50.11 The reporting required by section 8 shall be included in the periodic and annual reports of the<br />
Health Sector Public Enterprises which shall comply with the requirements pursuant to the Health<br />
Law. [the reporting requirements need to cover the service performance which is not adequately<br />
covered in the Public Enterprise law]<br />
50.12 Section 9 shall not apply to Health Sector Public Enterprises. The government and<br />
municipalities shall not sell shares, use shares for security, or otherwise deal in the shares of Health<br />
Sector Public Enterprises as prohibited by section 41 of the Law on Public Enterprises except that the<br />
government may amalgamate enterprises, close enterprises and otherwise reorganise them.<br />
50.13 Section 10.1 shall not apply to Health Sector Public Enterprises.<br />
50.14 Section 12.1 shall not apply to Health Sector Public Enterprises. The Health Sector Public<br />
Enterprise shall provide services in an effective, economical and efficient way in compliance with its<br />
obligations and shall ensure that it maintains and develops capability in a financially sustainable way.<br />
The Health Sector Public Enterprise shall provide services in accordance with its statement of<br />
forecast service performance in the business plan, any service agreements with the Ministry of Health<br />
and other entities, and its other legal obligations. If the Ministry of Health and the Health Sector<br />
Public Enterprise are unable to reach agreement then the Ministry of Health shall have the power to<br />
impose the service agreement by serving a notice under this section setting out the terms of the<br />
service agreement. Without affecting the status of this service agreement, the Health Sector Public<br />
Enterprise shall be entitled to prepare an analysis of the issues with the service agreement imposed<br />
under this section and proposals for variations to the service agreement for consideration by the<br />
shareholding ministers who shall have the power to jointly require variations to the agreement. [this<br />
provides for service agreements which are a key step towards clarifying what is provided for the funds<br />
used and will be a basis for the future contracting with the Health Insurance Fund and other<br />
purchasers if the health sector evolves in that direction. It can be a very useful tool for driving<br />
performance improvements and can be designed to be very simple in the beginning to match<br />
capabilities and become more sophisticated over time. The last resort power to impose the<br />
agreement is necessary as the government needs this method to close down negotiations that<br />
become unproductive and difficult to resolve as can happen in the early years of specifying and<br />
pricing or costing services]<br />
36
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