2005年-世界发展银行全球_Kyrgyz_Republic___Health_Sector_Fiduciary_Assessment_75页_1mb

Kyrgyz Republic Health Sector Fiduciary Assessment Summary

A. Introduction

The Manas Taalimi program, covering the period 2006–2010, is a health sector development initiative developed by the Ministry of Health (MOH) as a successor to the Manas I strategy. It aims to institutionalize reforms initiated under Manas I and strengthen the health system, particularly in resource targeting, structural improvements, policy formulation, and quality of care. The program includes activities to improve access, financial protection, efficiency, equity, transparency, and fiduciary performance in the Kyrgyz health sector.

The Health Sector Fiduciary Assessment (HSFA) was conducted to evaluate the financial management, procurement, and internal control arrangements of health sector institutions involved in the program. This assessment is not an audit and does not provide assurance on the use of funds, but rather serves to identify fiduciary risks and support capacity-building for the effective implementation of the program.

The HSFA is aligned with the Sector-Wide Approach (SWAp), which emphasizes policy coordination and integrated systems for managing financial and procurement processes. It is based on the Fiduciary Arrangements for Sectorwide Approaches (SWAps) guidelines issued by the World Bank.

B. Summary of Fiduciary Risks and Mitigation Measures

1. Country-Level Issues

• Budget Formulation: The process remains fragmented, with three parallel budgeting systems. Annual budgeting dominates over program-based budgeting.

  • Risk: The Manas Taalimi program may not align with the annual budget.
  • Mitigation: MOH and MHIF will focus on the Manas Taalimi program budget and reconcile it with the annual budget.
  • Capacity Building: MOH will continue the Medium-Term Budget Framework (MTBF) exercise to train staff and streamline the annual budget process using a program-based approach.

• Budget Execution: Budget execution is hindered by a lack of credibility and unpredictability in fund availability.

  • Risk: Insufficient funds may be available for program implementation.
  • Mitigation: MOH and MHIF will produce quarterly financial reports on program budget execution.
  • Capacity Building: The program initiated in 2004 to implement a modified accruals-based accounting system should be completed to consolidate expenditures and improve reporting.

• Accounting and Financial Reporting: While institutions prepare modified accrual-based financial statements, consolidated financial statements are only prepared on a cash basis.

  • Risk: Health sector expenditures may be under-reported, leading to potential misallocation of donor funds.
  • Mitigation: MOH will submit a draft Program Operational Manual for the Bank's review, and MHIF will submit test reports on expenditures for the State Guarantees and Outpatient Drug Benefit programs.
  • Capacity Building: The modified accruals-based system will be completed, improving transparency and reporting accuracy.

• External Audit: There are no explicit arrangements for the external audit of Manas Taalimi.

  • Risk: No independent third-party assurance on program expenditures.
  • Mitigation: Obtain agreement with the Chamber of Accounts (CoA) on external audit arrangements.
  • Capacity Building: Establish a twinning arrangement with an experienced audit institution to strengthen the CoA’s technical capacity and improve audit practices.

• Social Fund (SF): The SF transfers health insurance revenues to the Mandatory Health Insurance Fund (MHIF) monthly, but there is no independent verification of these transfers.

  • Risk: Resources intended for the health sector may not reach it, and budget comprehensiveness is lacking.
  • Mitigation: Ensure that annual budgets are fully executed and monitored for deviations.
  • Capacity Building: N/A

• Procurement Legislative and Regulatory Framework: The new Public Procurement Law adopted in 2004 lacks implementation regulations and model bidding documents.

  • Risk: Procurement practices may be misinterpreted or non-compliant with the current law.
  • Mitigation: MOH will lead in developing bidding documents based on SCPPMR model documents.
  • Capacity Building: Use the Program Operational Manual and SCPPMR training to improve procurement practices across the sector.

• Procurement Operations and Market Practices: The Public Procurement Bulletin does not provide full transparency in tender announcements.

  • Risk: Limited competition and transparency due to incomplete tender information.
  • Mitigation: Tenders and consultant selections will be advertised on MOH/MHIF websites and in the UN Development Business.
  • Capacity Building: Introduce online tender advertising with clear terms and results to promote transparency and ethical behavior.

• Procurement Planning: Annual planning does not allow for multi-year contracts and is not linked to program-based budgeting.

  • Risk: Disconnection between procurement planning and the need for long-term contracts.
  • Mitigation: MOH will adopt a rolling multi-year procurement plan linked to the Program of Work (POW).
  • Capacity Building: Train MOH/MHIF procurement staff in aligning procurement plans with program-based budgets.

• Procurement Organization and Staffing: Procurement units are not yet established in all institutions.

  • Risk: Lack of dedicated procurement teams may hinder efficient administration of increased workload.
  • Mitigation: MOH/MHIF will establish a procurement unit in the new organizational structure and ensure staff recruitment.
  • Capacity Building: Develop a trained procurement cadre using technical assistance, specialized training, and analysis of procurement audits.

2. Sector-Level Issues

• Flow of Resources: A revised resource flow schema has not been formally approved.

  • Risk: Implementation delays may occur due to lack of formal agreement.
  • Mitigation: Obtain formal approval from MOF and MOH for the revised schema.
  • Capacity Building: N/A

• On-Budget Pooling: Donors may provide funds for on-budget pooling, but the process is not yet formalized.

  • Risk: Funds may not reach the budget.
  • Mitigation: Require annual audit confirmation that on-budget pooling funds are received into the budget.
  • Capacity Building: N/A

• Donor Financing Agreement: Donors have not yet agreed on the modalities for transferring resources (either on-budget pooling or off-budget parallel financing).

  • Risk: Delays may occur if donors choose off-budget financing.
  • Mitigation: During implementation, government and donors will meet at Health Summits to agree on disbursements.
  • Capacity Building: N/A

• Accounting and Reporting: Accounting staff follow a mechanical process without critical analysis.

  • Risk: Management lacks the ability to assess the impact of health policies and reforms.
  • Mitigation: MOH will submit a draft Program Operational Manual for the Bank's review.
  • Capacity Building: Provide technical assistance to train staff in modern management accounting techniques.

C. Conclusions

The HSFA highlights several fiduciary risks in the Kyrgyz Republic’s health sector, including budget fragmentation, inadequate procurement systems, and weak external audit arrangements. These risks must be addressed to ensure the effective and transparent implementation of the Manas Taalimi program.

The assessment supports the World Bank’s fiduciary responsibilities by identifying institutional weaknesses and recommending actions to strengthen financial management and procurement systems. It also supports the development objective of Manas Taalimi by promoting common understanding among the government, the World Bank, and donors on fiduciary risks and capacity-building needs.

D. Key Recommendations

• Establish a procurement unit in MOH/MHIF and ensure staff recruitment.
• Develop and implement bidding documents based on SCPPMR model documents.
• Ensure annual budget reconciliation and quarterly reporting.
• Complete the modified accruals-based accounting system to improve reporting accuracy and transparency.
• Implement external audit arrangements and twinning programs to enhance audit capacity.
• Promote online tender advertising with transparent terms and results.
• Conduct training for procurement staff and management accounting using technical assistance and consultants.
• Finalize the resource flow schema and obtain formal approval from MOF and MOH.
• Ensure donor agreement on financing modalities and disbursement processes.

These measures aim to enhance the integrity and efficiency of the health sector’s financial and procurement systems, supporting the successful implementation of the Manas Taalimi program.