WITH DEFICIENCES OF VIEW
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The operation "Modernization of the health sector in the Republic of Moldova" was initiated with the aim of reducing the key risks related to non-communicable diseases, increasing the efficiency of health services offered to the population, reducing disability and incapacity for work, as well as improving health indicators in the Republic of Moldova.
In this context, the Court of Accounts of the Republic of Moldova examined today, July 28, the results of the audit of the financial reports of the Operation "Modernization of the health sector in the Republic of Moldova" completed on December 31, 2021.
The financing agreement was signed in 2014 and provides for the granting of a loan in the amount of 20 million Special Drawing Rights (SDR), equivalent to 30.8 million US dollars. The financing of the Program is granted in the form of budget support, and the amount is disbursed based on the achievement of the indicators established between the World Bank, the Ministry of Health and the National Medical Insurance Company (NMIC).
The audit was initiated and carried out at the request of the Ministry of Health and the World Bank, according to the conditions stipulated in the Financing Agreement between the Republic of Moldova and the International Development Association.
According to the findings of the Court of Accounts, the financial statements of the World Bank’s Project provide, in all material respects, a fair and true picture, according to the specific financial reporting requirements of the World Bank and the budgetary system, being issued an unqualified.
According to the Financing Agreement, the project was to be completed within 5 years, with the end date being March 2019. According to the Memorandum from October 2018, in order to ensure the achievement of all the indicators related to the disbursement, as well as the full absorption of the credit means, the extension of the deadline by 21 months, until December 31, 2020, was accepted. Later, the World Bank, at the request of the Ministry of Finance, extended the terms of implementation of the Agreement until December 31, 2021.
Therefore, in 2021, for the implementation of the Program, 5 indicators were to be reached and disbursed as follows:
- I indicator: all imported cigarettes and domestic products, sold on the market, are in accordance with the regulation on the labeling of tobacco products;
- II indicator: increase in the number of people with cardiovascular diseases who benefit from compensated drugs for treatment;
- III indicator: designing and piloting performance-based incentives for all hospitals in the country;
- IV indicator: consolidation of departmental hospitals under the administration of the Ministry of Health;
- Indicator V: Integrating lessons learned into population behavior change communication campaigns and assessing vaccine readiness.
The audit shows that, although the World Bank’s Project was extended in 2021, in order to validate/disburse five planned indicators, it is found that in the reference year one indicator was disbursed, and the others were not achieved or validated, which is why no financial means were granted, the implementation period being extended to 2022.
As a result, all cigarette packs contain health risk warnings and partially cover the pack surface. The validation of this indicator was carried out at the end of October 2020. The audit mentions that the disbursement of the amount of 323.5 thousand SDR to the budget of the Ministry of Health, Labor and Social Protection (MHLSP) was made in February 2021.
Regarding the indicator "Increasing the percentage of people with cardiovascular diseases who benefit from compensated drugs for treatment" it was found that the number of beneficiaries of compensated drugs increased by 9.26 percentage points. In the context, it is certified that the indicator was partially validated at a level of 92%, and the disbursement of financial means in the amount of 2.9 million SDR amounted to 2.7 million SDR within the NMIC’s budget.
The indicator "Design and piloting of the performance-based incentive scheme for all hospitals", attests that 485 thousand SDR were disbursed for the revision of the payment-for-performance scheme in May 2022. At the same time, for the piloting of the revised methodology within at least 7 hospitals, financial means in the same amount were provided. Thus, the results of the piloting are to be issued by August 2022. In this sense, financial means were provided for the CHCIF budget in 2022, in the amount of 23.3 million lei.
Regarding the indicator with reference to "Consolidation of departmental hospitals under the authority of MHLSP", it is certified that the Central Railway Clinical Hospital and the Clinical Hospital of the Ministry of Health were merged. Therefore, the indicator was partially achieved, which provides for the establishment of joint management within 3 hospitals in Chisinau and for which 404 thousand SDR were disbursed in advance.
With reference to the indicator that refers to the "Integration of lessons learned in the communication campaigns regarding the change of the population's behavior and the evaluation of the degree of preparation for the vaccine" the audit denotes that this indicator was validated and disbursed in May 2022.
Finally, the Court of Accounts reiterated some of the recommendations from the previous year's audit report, aimed at improving the achievement of the mentioned indicators and adding value to the audited aspects.
