WITH DEFICIENCES OF VIEW
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The motivation of staff to provide healthcare to patients with COVID-19 was accompanied by deficiencies and irregularities.
The Court of Accounts of the Republic of Moldova, on February 17, examined the Compliance Audit Report on the implementation of measures to motivate and financially support the staff involved in the prevention, detection and treatment of COVID-19 infection and the measures of surveillance and monitoring of persons in quarantine.
The purpose of the audit was to assess compliance with the use of financial resources allocated to motivate and support the staff involved in the prevention, detection and treatment of COVID-19 infection and the implementation of epidemiological surveillance measures in the years 2020-2021.
To address the health challenges posed by the pandemic, the Parliament, the Government, the central public authorities have adopted a number of systemic measures, including the motivation and financial support of staff involved in the prevention, detection and treatment of COVID-19 infection, which determined the allocation of significant public financial resources.
For these purposes, during the years 2020-2021, considerable financial resources have been allocated, as follows:
- over 708 million lei for motivating the staff involved in achieving the professional performance indicator “Providing medical care to patients with COVID-19;
- about 7.5 million lei for granting compensation salary increases for performing work in conditions of increased health risk;
- over 331 million lei for the granting the single indemnity of 16 thousand lei;
- 7 million lei for the payment of the single indemnity of 100 thousand lei.
The audit area was established, based on the attributions and responsibilities of the entities, the quantitative significance of the public funds allocated to stimulate the staff involved in the prevention, control and treatment of COVID-19 infection, and included 39 public entities.
With regard to the complex process of stimulating the medical staff involved in the direct provision of health care services to citizens infected with COVID-19, it is noted that according to the criteria it includes 3 main stages:
- the appointment of the personnel involved, by order of the manager;
- performance evaluation with proposals for incentives;
- granting supplements by order of the leader.
For these purposes, in May 2020, the Ministry of Health (MoH) approved the size of the salary supplements of the staff involved in providing medical care to patients with COVID-19, establishing the personal responsibility of the heads of medical institutions.
Managers of some medical institutions did not fully ensure the orderly appointment of staff directly involved in the treatment of patients infected with COVID-19, which led to inadequate reporting, solicitation and allocation of funds from the Compulsory Health Insurance Funds in the amount of 12,8 million lei.
Likewise, the audit established that, out of 8 public hospital and pre-hospital medical institutions audited, the district hospitals from Floresti, Cahul, Anenii Noi and Orhei did not update the orders for appointing the staff involved.
The process of evaluating the indicator of professional performance and the increase of compensation for work in conditions of increased health risk, in some institutions was non-transparent, which allowed the irregular granting of financial means in the amount of 21.6 million lei.
The audit established that the assessment of professional performance within the audited entities was of a general nature. At the same time, it was found that the hospitals in Straseni and Floresti districts, for the audited period, did not evaluate and did not record in the minutes of the evaluation commissions, the professional performance indicators for providing medical care to patients with COVID-19, thus being admitted irregular expenses in the amount of 6.5 million lei.
At the same time, the district hospitals from Anenii Noi and Orhei evaluated the performances of the employees involved in the treatment of patients with COVID-19, but did not evaluate some employees who benefited from salary supplements for providing medical care, in the amount of 115 thousand lei.
The Cahul district hospital, although in April 2020 evaluated the performance of employees involved in the treatment of patients with COVID-19, between May 2020 and May 2021 did not ensure the evaluation of employees involved in this process. Thus, during this period, the professional performance indicator was paid without its evaluation in the amount of 15 million lei.
The National Agency for Public Health (NAPH), established and paid a monthly increase in compensation for the work performed in conditions of increased risk for health in the amount of 2.8 million lei, and the Ministry of Internal Affairs (MIA) in the amount of 4,7 million lei, in the absence of internal regulations for evaluating the contribution and professionalism of each employee.
In this context, it is revealed that, from the evaluated data, monthly, the leaders of NAPH’s subdivisions, according to the approach, requested the granting of the salary increase, indicating the percentage amount for each individual employee, thus requesting the granting of 956 salary increases, being approved by NAPH - 837 of bonuses. Respectively, in 119 cases they were not approved, and in 8 cases the salary increase was approved without being requested by the heads of the subdivisions. At the same time, in 216 cases, the National Agency for Public Health decreased the size of the salary increase, compared to the one requested by the heads of the subdivisions, and in other 33 cases it increased the size of the increase, compared to the requested one.
These circumstances indicate the need for internal regulation of the evaluation process, which would ensure transparency, fairness and proper documentation of the use of public funds.
The compliance audit of the staff motivation process for the provision of hospital care to patients infected with COVID-19, identified within 2 institutions fraud and misappropriation of funds in the amount of about 562 thousand lei, determined by insufficient internal control actions, such as and the regulatory documentation of the calculation and payment of public funds.
Concerning the objective regarding the granting of the unique allowances of 16 thousand lei, it is noted that public financial means in the amount of over 331 million lei have been allocated, out of which: 284 million lei for the employees of public medical institutions, 42 million lei for the employees of other budgetary authorities/institutions and 4 million lei for the employees of the medical subdivisions of the Ministry of Internal Affairs, the Ministry of Defense and the National Administration of Penitentiaries.
The central public authorities (CPA) requested and received allowances of 16 thousand lei for non-medical staff, amounting to 26.8 million lei.
At the same time, it is found that some authorities or institutions have requested and received allowances in the amount of up to 15.7 million lei, while other public institutions have not requested and have not been granted such payments.
It is also noted that the local public authorities (LPA) have requested and received allowances of 16 thousand lei for non-medical staff in the amount of over 15 million lei. At the same time, it is found that some LPAs requested and received allowances in the amount of up to 2.8 million lei, while others did not request and did not benefit from such payments, such as the district councils of Calarasi, Donduseni, Hincesti and Ocnita.
During 2020, over 2,600 allowances were paid to non-medical employees within the CPAs and LPAs, amounting to over 42 million lei, which is 13% of their total.
At the same time, between February and December 2021, due to the lack of financial resources, 4694 allowances were not paid for eligible medical staff directly involved in the prevention, control and treatment of COVID-19 infection, which became infected in 2020.
With reference to the objective of monitoring quarantined or self-isolating persons, it is noted that this process was carried out by the Ministry of Internal Affairs, together with the Ministry of Health, based on their specific responsibilities.
The performance of the monitoring activities by the MIA subdivisions of the persons, in self-isolation regime, was affected by the insufficiency of the data held about them, which led to a low level of verification of compliance with the requirements of these regimes.
In conclusion, the audit shows that although the public authorities have established and regulated the necessary measures and activities, for which public means of stimulating and financial support of the employees involved in the process of treating the infected persons as well as those involved have been identified and mobilized in the monitoring of people in self-isolation or quarantine, they were accompanied by ambiguities, and the people in charge of some of the institutions involved admitted non-compliance. These situations were caused by the lack of experience in managing the pandemic situation, the insufficiency of the regulations in force, the gaps in the internal managerial control system within some medical institutions, the improper execution of duties, lack of interconnection of information systems and staff overload.
