Health Sector Transparency and Establish a Cost Impact Assessment Mechanism (MK0128)

Promoting transparency in the implementation of health programs and establishing a costs impact assessment mechanism from these programs on end-users through citizens’ inclusion
Start and end date of the commitment: August 2018 – August 2020
Lead implementing agency
Ministry of health
Description of commitment
Status quo or problem addressed by the commitment
Establishing continuity in the publication of publicly available information on funds’ spending from the budget of the Ministry of Health for implementation of individual preventive and curative health care programs. Lack of a mechanism / methodology for measuring the citizens’ impact on the costs incurred through the implementation of the activities foreseen in the preventive and curative programs of the Ministry of Health. Hence, the planning of future activities and the alocation of the budget funds for these activities are not based on the real needs of the citizens
Main objective
The Ministry of Health will continuously publish the narrative-financial reports for the implementation of individual preventive and curative health care programs. Ministry of Health will develop, adopt and pilot a mechanism/methodology for impact measurement on citizens of the costs incurred by the preventive health care program: "Program for population protection from HIV/AIDS in the Republic of Macedonia".
Brief description of the commitment
Emancipation, Solidarity and Equality of Women (ESE), has prepared a standardized form of annual narrative financial reports for each of the preventive and curative budget programs for 2017 and is published on the Ministry's website. In the next period, the initiative for publishing annual reports for the implementation of program activities for each of the preventive and curative health protection programs will be continued. The established template report will mean unifying the narrative reporting parameters at a level of an institution, and it will cover data on what the institution has done and achieved with the costs incurred in the current year according to the objectives, the results and the activities foreseen by the program. It will also provide financial reporting and will cover data on how much funds are planned and spent at a level of activity and per budget program executor. These reports will be published by the institution on their websites during the first half of the current year for the previous year. The Ministry of Health will select at least one preventive or curative budget program in cooperation with the Association for Emancipation, Solidarity and Equality of Women (ESE), mechanisms / methodologies will be developed for impact measurement of costs on end users. Such a developed mechanism/methodology will be piloted on the identified pilot budget program (implementation of the assessment process and communication with end users will be carried out in cooperation by the ESE Association). To this end, the Association for Emancipation, Solidarity and Equality of Women (ESE) will develop and conduct a one-day training for presentation of the steps for assessing the impact of budget expenditures on public services’ end users. Additionally, this process will enable identification of the actual needs and priorities of the end users, which will further assist the institution in the planning process for future activities. Upon completion of the piloting period, the institution will include the results of the conducted assessment process in the budget planning and activities for the selected pilot program for 2021.
OGP challenge addressed by the commitment
- Public service improvement - More efficient public resources management
Additional information
Refference to Goal 16 "Peace, justice and strong institutions" Target 16.6: Develop effective, accountable and transparent institutions at all levels and Goal 3 "Good health and well-being" Target 3.8: To achieve universal health care including protection from financial risk, access to quality necessary health services and access to reliable, effective and quality as well as affordable basic drugs and vaccines for all.
The measures under this commitment contribute to the transparency and accountability of the utilization of funds and the delivery of services intended for preventive and curative health programs.
Milestone
3.3.1 Prepared and publicly available narrative-financial report for program and budget reporting for each of the curative and preventive programs from the budget of the Ministry of Health
3.3.2 Introduced methodology for impact measurement of costs on end-users for the preventive budget program: "Program for population protection of HIV/AIDS in the Republic of Macedonia". -Preparated Report with recommendations for the programs’ planning for the next budget year.
Contact information
Name of responsible person from implementing agency
M.A. Biljana Babushkovska
Title, Department
Head of internal audit unit
Phone and e-mail
biljana.babushkovska@zdravstvo.gov.mk phone: 02 3112 500 loc.114
Other actors involved
Association for Emancipation, Solidarity and Equality of Women (ESE) Darko Antikj, dantik@esem.org.mk

Theme III: Fiscal Transparency

3.3. Promoting transparency in the implementation of health programs and establishing a costs impact assessment mechanism from these programs on end-users through citizens’ inclusion

Language of the commitment as it appears in the action plan: [51]

“The Ministry of Health, in cooperation with the Association for Emancipation, Solidarity and Equality of Women (ESE), has prepared a standardized form of annual narrative financial reports for each of the preventive and curative budget programs for 2017 and is published on the Ministry's website. In the next period, the initiative for publishing annual reports for the implementation of program activities for each of the preventive and curative health protection programs will be continued. The established template report will mean unifying the narrative reporting parameters at a level of an institution, and it will cover data on what the institution has done and achieved with the costs incurred in the current year according to the objectives, the results and the activities foreseen by the program. It will also provide financial reporting and will cover data on how much funds are planned and spent at a level of activity and per budget program executor. These reports will be published by the institution on their websites during the first half of the current year for the previous year.

The Ministry of Health will select at least one preventive or curative budget program in cooperation with the Association for Emancipation, Solidarity and Equality of Women (ESE), mechanisms / methodologies will be developed for impact measurement of costs on end users. Such a developed mechanism/methodology will be piloted on the identified pilot budget program (implementation of the assessment process and communication with end users will be carried out in cooperation by the ESE Association). To this end, the Association for Emancipation, Solidarity and Equality of Women (ESE) will develop and conduct a one-day training for presentation of the steps for assessing the impact of budget expenditures on public services’ end users. Additionally, this process will enable identification of the actual needs and priorities of the end users, which will further assist the institution in the planning process for future activities. Upon completion of the piloting period, the institution will include the results of the conducted assessment process in the budget planning and activities for the selected pilot program for 2021.”

Milestones:

3.3.1 Prepared and publicly available narrative-financial report for program and budget reporting for each of the curative and preventive programs from the budget of the Ministry of Health

3.3.2 Introduced methodology for impact measurement of costs on end-users for the preventive budget program: "Program for population protection of HIV/AIDS in the Republic of Macedonia". -Preparated Report with recommendations for the programs’ planning for the next budget year.

Start Date: August 2018

End Date: August 2020

Context and Objectives

This commitment is the continuation of Commitments 5.2 and 5.7 from North Macedonia’s third action plan (2016-2018). These commitments respectively aimed to improve access to information on health programs (5.2) and to train Ministry of Health officials on the implementation of social accountability methodologies, and to select a preventive or curative program to pilot new social accountability methodologies (5.7). Although some progress was made with regard to the design of the pilot plan, the Ministry of Health did not conduct training on the implementation of social accountability methodology, nor did it provide the training for officials from the Ministry of Health. [52]

Under the current commitment, the Ministry of Health plans to continuously publish narrative-financial reports on preventive and curative programs and introduce a methodology for impact assessment of end users for the preventive budget program. Prior to the action plan, there was no publicly available information in North Macedonia on the program and budget implementation related to health programs financed by the Ministry of Health. According to a representative of the supporting CSO the Association for Emancipation, Solidarity and Equality of Women (ESE), the only way to receive information on the scope of realized activities and the amount of funds spent was to submit an official freedom of information request, which is often a lengthy process. [53] Although the adopted health programs are published on the Ministry of Health website and in the Official Gazette, the annual reports are not publicly available and contained general information without specifics. For example, the only publicly available information about the health programs was the total funds spent per health program presented in the Year End Report adopted by the Parliament six months after the end of the fiscal year.

This commitment calls for the continued publication of annual narrative-financial reports for each curative and preventive program using a standardized template developed in 2017 in collaboration with ESE. The narrative-financial reports will include data on how each institution utilized the funds they received from the Ministry of Health and the achievements under each of their health programs. These reports will be published by the institution on their websites during the first half of the current year for the previous year. According to an ESE representative, the narrative-financial reports will include more detail on the individual programs, such as the type of medicines procured, the quantity of medicines purchased, the funds spent to purchase the medicines, and how the medicines are distributed among the health institutions. [54]

The commitment also calls for the introduction of a methodology for impact measurement of the costs of preventive programs for end users, using the health program on HIV/AIDs protection as a pilot. Using this pilot program, ESE will conduct a one-day training for public health institutions and CSOs on best practices for applying the social impact methodologies across different public health-related contexts. The institution will then prepare a report including recommendations for the selected pilot program for 2021. According to the ESE representative, this training is scheduled to take place in January 2020.

The commitment is relevant to the OGP value of access to information as it aims to make information on the results of programs funded by the Ministry of Health available through the annual narrative-financial reports. Overall, the commitment’s activities represent important but minor steps towards greater transparency of health-related funding in terms of results achieved per program and their efficiency and cost-effectiveness. According to the ESE representative, the application of social accountability methodologies is important for learning whether health programs have delivered their expected results, so that corrective measures can be taken on time. However, the replicability of the results from the pilot program and the lessons learned on best practices from the one-day training will be easier to determine in the long-term. Furthermore, while the publication of the annual narrative-financial reports could improve transparency of health programs, this activity represents a continuation of ongoing work by ESE and the Ministry of Health that started prior to the action plan.

Next steps

The IRM recommends rolling out the pilot cost assessment in other areas of healthcare, and to form a working group including healthcare professionals, government policymakers, and NGOs. The working group could commission cost-benefit studies and make recommendations for further improvements, both in presentation of data (budget and actual expenditure) and adjustments to future budgets based on the cost/impact assessments. This could then help to better target health budgets to particular groups of citizens, particular curative and preventive programs, and geographical regions where needs are poorly met.

[51] The texts for all the commitments are an abridged version of the commitment texts. For the full commitment texts, see the Republic of North Macedonia 2018-2020 National Action Plan, https://www.opengovpartnership.org/wp-content/uploads/2018/09/Macedonia_Action-Plan_2018-2020_EN.pdf

[52] Macedonia End-of-Term Report, p 42-43, https://www.opengovpartnership.org/wp-content/uploads/2019/11/Macedonia_End-of-Term_Report_2016-2018_EN.pdf

[53] Darko Antik, Coordinator for budget monitoring and analysis, Association for Emancipation, Solidarity and Equality of Women, email correspondence with IRM, 6 December 2019.

[54] See (In Macedonian): http://zdravstvo.gov.mk/izveshtai/

Commitment 3.3 Transparency in health programs

Substantial:

The Ministry of Health published on its webpage the narrative-financial reports on its fulfillment of health programs for the years 2018, 2019, and 2020. However, of 24 reports published in 2020, five cannot be accessed because the links are missing. [50] All reports for the year 2019 are accessible, but one report for 2018 is not accessible. [51]

The ministry, in cooperation with the Association for Emancipation, Solidarity and Equality of Women (ESE), developed trainings on the impact of budgetary expenses on end users for representatives of the Institute for Public Health (responsible for implementing the Program for Protection of the Population from HIV). [52] However, despite the dates for the trainings being set, these activities were delayed due to COVID-19, and ESE aims to carry them forward to the next action plan. [53]