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Final Consultancy Report on Design of the Affordable Quality Healthcare Project of Kosovo on Behalf of Swiss Development Corporation

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Final Consultancy Report on Design of the Affordable Quality Healthcare Project of Kosovo on Behalf of Swiss Development Corporation Final Consultancy Report on Design of the Affordable Quality Healthcare Project of Kosovo on behalf of Swiss Development Corporation 19 May 2014 Consultant Team: P. Campbell (Team Leader) T. Gotsadze J. Costa L. Cela M. Berisha 1 Table of Contents 1. Acknowledgements ..................................................................................................... 5 2. Acronyms .................................................................................................................... 5 3. Executive summary ..................................................................................................... 6 3.1. Suggested Vision/Goals .................................................................................................. 6 3.2. Suggested Objectives ..................................................................................................... 7 Component A: Provider Focus- Providers enabled to meet the needs of Patients ............... 7 Component B: Management Focus- Managers enabled to support the Providers ................ 7 Component C: Population Focus- Population know/make known their needs ...................... 7 4. Background ................................................................................................................. 8 4.1. Historical Context ........................................................................................................... 8 4.2. Socio-Economic context ................................................................................................. 8 4.3. Health System ................................................................................................................ 9 Historical Overview ................................................................................................................ 9 Structure ................................................................................................................................ 9 4.4. Health System Strategy ................................................................................................ 10 4.5. International Support ................................................................................................... 10 4.6. Population Health Status and Utilization of Health Services ........................................ 11 5. Purpose of the consultancy and methodology ......................................................... 13 6. Current Situation ....................................................................................................... 13 6.1. Health Service Organization ......................................................................................... 13 6.2. Health Financing and Spending .................................................................................... 15 6.3. Human Resources ........................................................................................................ 16 6.4. Medical Equipment, Medicines and Supplies ............................................................... 17 6.5. Utilization of services ................................................................................................... 18 6.6. Management of Health Facilities ................................................................................. 19 6.7. Special Issues ................................................................................................................ 20 7. Swiss Government Role in Health Development ...................................................... 23 7.1. Rationale ...................................................................................................................... 23 7.2. Relevance and Coherence with Strategic Framework .................................................. 23 7.3. Involvement of Switzerland in Kosovo Health Sector .................................................. 24 8. Options for Interventions .......................................................................................... 25 8.1. Strategy for Change ...................................................................................................... 25 8.2. Suggested Project Vision .............................................................................................. 27 8.3. Suggested Project Objectives and Intervention Strategies .......................................... 27 Component A: Provider Focus - Providers enabled to meet the needs of Patients ............ 28 Component B: Management Focus - Managers enabled to support the Providers ............. 37 Component C: Population Focus: Population know/make known their needs .................... 43 9. Stakeholders and Potential Partnerships .................................................................. 47 9.1. Key Stakeholders (see also Annex 3) ............................................................................ 47 9.1.1. Ministry of Health .................................................................................................... 47 9.1.2. MoH-Related Agencies ............................................................................................. 49 9.1.2.1. Health Funding Agency (HFA) ............................................................................... 49 9.1.2.2. Health Inspectorate .............................................................................................. 49 9.1.2.3. National Institute of Public Health of Kosovo ...................................................... 50 9.1.2.4. Kosovo Agency for Medical Products and Equipment (KMA)............................... 50 9.1.2.5. Hospital and University Clinical Service in Kosovo (HUCSK) ................................ 51 9.1.2.6. Chambers/Professional Bodies............................................................................. 52 2 9.2. Local Governments, Municipalities .............................................................................. 54 9.2.1. Kosovo Health Project (KPH)- using loan funds from the World Bank ..................... 55 9.2.2. Health Support Programme (LuxDev) ...................................................................... 56 9.3. SDC-Supported Organisations ...................................................................................... 57 9.3.1. Association of Kosovo Municipalities (AKM) ............................................................ 57 9.3.2. Private Sector Development Programme ................................................................. 58 9.3.3. DEMOS -Local Governance Project .......................................................................... 59 9.3.4. Kosana NGO .................................................................................................................. 60 9.3.5. Community Psychiatry/Clinical Psychology project .................................................. 60 9.3.6. P4H ........................................................................................................................... 61 9.4. UN Agencies ................................................................................................................. 61 9.4.1. WHO, UNFPA, UNICEF .............................................................................................. 61 10. Organisation, Management & Administration .......................................................... 63 10.1. Overall Approach ..................................................................................................... 63 10.2. Pilot Sites (PHC level and Hospitals) ......................................................................... 63 10.3. Selection of Pilot Regions/Municipalities ................................................................. 65 10.4. AQH Project Management ....................................................................................... 68 11. Resources .................................................................................................................. 69 11.1. Staffing/Technical Skills ............................................................................................ 69 11.2. Preliminary Estimation of AQH Project Costs over 4 Years ...................................... 70 12. Risk Assessment ........................................................................................................ 71 12.1. Government Elections .............................................................................................. 71 12.2. Budgetary funding .................................................................................................... 71 12.3. Capitation-Related PHC Budget Allocations ............................................................. 71 12.4. Municipal-Level Transparency.................................................................................. 72 12.5. Private Sector ........................................................................................................... 72 12.6. Performance Based Capitation implementation ...................................................... 72 13. Open Issues ............................................................................................................... 73 13.1. Establishment of HUCSK and reorganization of SHC and THC .................................. 73 13.2. Private Health Sector Conflict with the Public Sector .............................................. 73 13.3. Accuracy of Capitation Calculations ......................................................................... 74 13.4. Management/Epidemiology
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