Analysis of the Results Obtained in Field Research at the National Level to Implement the Program (MK0084)

Analysis of the results obtained in field research at the national level to implement the program

XII. Anti-Corruption: Health and General Budgets

Commitment 3.8: Transparent Health Budget

Commitment Text: 3.8. Publishing information about […] health budgets, with particular focus on the budgetary and financial implementation of preventive programs of the Ministry of Health, obtained through a procedure of access to public information http://www.esem.org.mk.   

Commitment 5.1: Open Budget Initiative 

Commitment Text: 5.1. Implementation of the Open Budget Initiative.

Commitment 7.5: Analysis of Women’s Health Program   

Commitment Text: 7.5. Analysis […] to implement the program [for the early detection and prevention of disease of the reproductive organs in women].

Commitment 7.6: Awareness-Raising on Women’s Health Program

Commitment Text: 7.6. Informing women on the rights and the services available to them with the Programme [for women’s health through an information campaign…].

Responsible institution(s): Ministry of Finance; Ministry of Health

Supporting institution(s): Association for Emancipation, Solidarity and Equality of Women of Macedonia

Start Date: 1/1/2014   End Date: 31/12/2016

Commitment aim

This cluster of commitments was designed to promote budget transparency, with a particular focus on health budgets.

Status

Midterm

Commitment 3.8: Limited

Commitment 5.1: Limited

Commitment 7.5: Substantial

Commitment 7.6: Limited

Commitment 3.8 endorses civil society efforts to request and release information received (if access is provided) from the Ministry of Health (MoH). According to the IRM midterm report, inclusion of this measure in the OGP action plan allowed the proactive release of some data; however, a substantial amount of information is still unavailable, even though formal requests have been filed.

The ministry reported that it had contracted a service provider to lay out and print the Citizens’ Budget, and that it had received a first draft. Civil society, meanwhile, complained that the Citizens’ Budget had to be published together with the government’s budget to be meaningful, and that the delay, already incurred, made the measure ineffective. The IRM review found that the 2014 balance sheet data were not very useful, with no explanation of the different variables. Hence, it was difficult to compare.

Commitments 7.5 and 7.6 refer to the independent monitoring of health programs and their services, including raising awareness and budget allocations. The self-assessment did not contain any information on the progress of this measure. However, the Association for Emancipation, Solidarity and Equality of Women of Republic of Macedonia reported that significant progress had been made in improving cooperation with the Ministry of Health under the previous two commitments.^{[Note 101: Darko Antic, Association for Emancipation, Solidarity and Equality of Women of Macedonia, Written Submission to IRM.]}

For more information, please see the 2014-2016 IRM midterm report.

End of term

Commitment 3.8: Limited

Commitment 5.1: Not started

Commitment 7.5: Complete

Commitment 7.6: Limited

The government’s self-assessment reported that the Ministry of Health created a new web platform to publish information stemming from commitment 3.8. However, the IRM researcher could not find the website, and the Ministry did not provide a link. The Association for Emancipation, Solidarity and Equality of Women of Republic of Macedonia confirmed that the website was unavailable, that the ministry developed reports on only five of the 20 programs, and that it partially developed reporting forms on only three. The ministry did not report on 12 of the programs.^{[Note 102: ESEM, Shadow Report on the Implementation of the OGP Action Plan 2014-2016, (Skopje: ESEM, 2016), available at: http://bit.ly/2dUryWV [in Macedonian].]} None of the reports are available publicly.

The IRM researcher found no evidence that the Citizens’ Budget was produced for either 2015 or 2016.^{[Note 103: International Budget Project, Open Budget Initiative 2015: Macedonia, available at: http://bit.ly/2cQHvvM.]} The last available budget was produced by civil society in 2013,^{[Note 104: Marjan Nikolov, Citizens Budget for 2013, (Skopje: CEA, 2013), available at: http://bit.ly/2dwLaBD [in Macedonian].]} while a new citizens’ final account (for 2014) was based on the released data.^{[Note 105: Nikica Mojsoska Blazevska, Citizens’ Final Account for 2014, (Skopje: MCIC, 2016), available at: http://bit.ly/2dsyrKZ [in Macedonian].]} Overall, the government provided little budget information, and the mid-year review, Citizens’ Budget, and pre-budget statement were not available. The Macedonian Center for International Cooperation lobbied for the release of budget information, but the institutions’ unwillingness to release data meant these activities remained incomplete.^{[Note 106: IRM interview with Marija Sazdevski, MCIC.]}

Commitment 7.5 was completed, and the analysis of the women’s health program was published in September 2016.^{[Note 107: ESEM, Report from the Monitoring and Analysis of the Program or the Early Detection and Prevention of Disease of the Reproductive Organs in Women, (Skopje: ESEM, 2016), available at: http://bit.ly/2cZrDaH [in Macedonian].]} This was an initiative by a non-profit association that could have been implemented without OGP. The recommendations of the analysis could have been followed up by the government, since the report was published at the end of the OGP cycle, but they had no effect on the government within the period covered by this report.

The government provided no information on commitment 7.6. Activities to raise awareness were conducted independently as stand-alone initiatives by non-profit organisations,^{[Note 108: See, for example, the work of the National Roma Centrum at: http://bit.ly/2dEdxJD or ESEM at: http://www.esem.org.mk. ]} and did not have any added value from inclusion in the OGP action plan.

Did it open government?

Access to Information: Marginal

Civic Participation: Marginal

Public Accountability: Did not change

This cluster of commitments was designed to improve fiscal transparency overall, and more specifically, in the health sector. Before the country adopted the second action plan, there was little fiscal transparency. The promise of an Open Budget and Citizens Budget^{[Note 109: A clear and simple summary specifically developed for the public that should be widely distributed with the annual budget. For more information, please see the International Budget Project, The Power of making It Simple: Governments Guide to Citizens’ Budget, available at: http://bit.ly/1Y2d34o. ]} could have had a transformative impact, but the IRM researcher found only limited implementation, mostly by civil society.

Progress on this cluster only marginally improved access to information, mainly through information gathered and analysed by civil society.^{[Note 110: http://www.fiskalnatransparentnost.org.mk/.]} Several initiatives collected and published the income and expenditures of all municipalities.^{[Note 111: http://sledigiparite.mk/.]} They also published all data collected from direct public procurement contracts as well as budget expenses, including all contracts since 2011 which were worth over 1 million euro.^{[Note 112: http://opendata.mk/. ]} Analysis of this data showed that half the value of all contracts made by all 83 municipalities is allocated to 34 companies, while the remaining half is split among 1.323 companies. In the last three years, 39 million euro were contracted under urgency procedures, and an additional 35 million euro with contract amendments. In both cases, there was no transparency or competition. The released data were compiled by civil society via regular, often lengthy, access to information procedures, or by observing public procurement processes.  

These commitments provided a framework for meetings and cooperation between civil society and the Ministry of Health. Civil society organisations, through OGP working groups, met three times with representatives of the ministry, which strengthened their relations. While this contributed to building trust, civic participation improved only marginally. Both the government’s end-term assessment and civil society^{[Note 113: IRM interview with Darko Antic, Association for Emancipation, Solidarity and Equality of Women of Macedonia.]} noted that cooperation between the two involved only the sharing of information. 

Finally, publishing the Citizens’ Budget (commitment 5.1) and analyzing the women’s health program (commitment 7.5) could have potentially increased public accountability, but did not. First, the Citizens’ Budget was not produced. The EC noted that budget transparency is not ensured in Macedonia, because clear, comprehensive, timely, and reliable budgetary and statistical information is not available publicly.^{[Note 114: EC, Annual Progress Report for 2016, 11.]} Second, the analysis of the women’s health program included only one program, the results of which were not utilised by the government. The findings of the analysis point to the need for serious measures. According to the survey, 56% of women and girls over the age of 14 do not have a primary gynecologist, hence, are not accessing any government-sponsored preventive programs. Furthermore, there is no access to a primary gynecologist in 35 municipalities, and access is limited to a small number of gynecologists in the other 29 municipalities.^{[Note 115: Ibid., footnote 7.]} Therefore, it is clear that these two commitments did not change government practice, since no public facing element was established for citizens to request further action in health provision in the country. 

Carried forward?

The new action plan specifically targets fiscal transparency in all sectors. A new commitment (5.1) pledges to introduce the open budget practice, while other commitments (5.2 and 5.7) specifically target health budget transparency, as a nod to the commitments in this cluster. The government has vowed to publish data on budget spending for all 20 programs, develop framework and publish reports on implementation of one preventive and one curative program, and raise awareness among citizens.