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