2014年-世界发展银行全球_Moldova_Health_Transformation_Project___Fiduciary_Systems_Assessment_Report_46页_620kb

MOLDOVA HEALTH TRANSFORMATION PROJECT (HTP) FIDUCIARY SYSTEMS ASSESSMENT SUMMARY

Core Content

The Moldova Health Transformation Project (HTP) is a Program for Results (PforR) operation with a technical assistance component, designed to improve the health system through better financial management, procurement, and governance. The fiduciary systems assessment, conducted in accordance with OP/BP 9.00, evaluates the adequacy of the systems and institutions in place to ensure the appropriate use of program funds and safeguarding of assets.

The assessment concludes that the overall fiduciary and governance framework is adequate to support the program and that the fiduciary risk is moderate. The financial management risk and procurement risk are also assessed as moderate. The key institutions involved are the Ministry of Health (MoH), National Center for Public Health (NCPH), and National Health Insurance Company (CNAM).

Main Viewpoints

• Budget Planning and Execution: The program's budget is realistic and prepared in line with relevant policies. It is part of the consolidated state budget, and the Ministry of Health (MoH) and other agencies have well-established budgeting and financial management systems. Parliament scrutinizes the budget law regularly, and the budget execution reports are timely and useful for decision-making.

• Accounting and Financial Reporting: The accounting systems of MoH, NCPH, and CNAM are adequate and meet the requirements for transparency and accountability. Financial reports are produced and disseminated for management and oversight purposes. The use of a modified accrual basis of accounting ensures that financial records are accurate and reliable.

• Treasury and Funds Flow: The Treasury Single Account (TSA) system, managed by the Ministry of Finance (MoF), is comprehensive and functions satisfactorily. The system ensures proper allocation and disbursement of funds. Arrears are low, and the country has consistently performed well in arrears monitoring.

• Internal Controls and Audit: The internal audit units of MoH and CNAM are well-performing and will include the HTP in their annual audit plans. The Court of Accounts (CoA), the independent external audit body, audits the health sector annually and issues clean audit opinions. Its reports are publicly available and follow INTOSAI standards.

• Procurement: Procurement is conducted under the Public Procurement Law (PPL), which emphasizes open competition. The PPL is periodically updated and aligns with EU standards. The Public Procurement Agency (PPA) oversees procurement activities, and all necessary documents are available online. The open bidding method is the default procurement approach, and electronic procurement systems are in place. However, the lack of Standard Bidding Documents for consulting services and contract monitoring mechanisms pose some risks. Multi-year contracts may also face challenges due to delayed fund allocation.

• Program Activities and Funding: The HTP supports 5 sub-programs out of 17 included in the Medium-Term Budget Framework (MTBF). These include:

  • Sub-program I: Health policy and management.
  • Sub-program XVII: National Tobacco Control Program.
  • Sub-program II: Administration of the Mandatory Health Insurance Fund (MHIF).
  • Sub-program V: Primary Care Services.
  • Sub-program IX: Inpatient Care.

  The main sources of funding are the state budget (59%) and MHIF (40%). The program's total estimated cost for 2014-2017 is US$1,964 million, with US$113.7 million allocated for the HTP.

Key Information

Program Expenditure Framework

• MHIF resources grew by an average of 9.7% over the past four years.
• MHIF expenses increased by 11.4% due to improved execution of planned activities.
• In 2012, the basic fund (used for current healthcare services) accounted for 95.6% of MHIF expenses.
• The development fund was used for modernizing public healthcare infrastructure and purchasing high-performance equipment.
• The prophylactic fund (for disease prevention) had a 44.4% utilization rate.
• Total program expenditures in 2012 were US$1,964 million, with US$113.7 million allocated to the HTP.

Estimated Program Expenditures

Key Fiduciary Risks and Mitigation Actions

• Risk 1: Delayed fund allocation for sub-programs such as Tobacco Control.

  • Mitigation: The MoF is committed to ensuring timely availability of funds, and the Bank will monitor the annual budgets and revisions.

• Risk 2: Lack of qualified staff for contract administration.

  • Mitigation: Capacity-building efforts will be needed to ensure effective contract management.

• Risk 3: Absence of a contract monitoring mechanism.

  • Mitigation: Strengthening internal controls and oversight will be essential.

• Risk 4: Implementation of multi-year contracts depends on future fund availability.

  • Mitigation: Close coordination between the Bank, MoF, MoH, NCPH, and CNAM will be required to ensure continuous funding.

• Risk 5: Lack of Standard Bidding Documents for consulting services.

  • Mitigation: The development of such documents is necessary for transparency and fair competition.

• Risk 6: Complaint review body is not independent.

  • Mitigation: Ensuring the independence of the review body is crucial for maintaining trust and accountability.

Conclusion

The HTP is well-positioned to achieve its objectives with a robust institutional framework and adequate financial systems. However, some risks related to funding availability, procurement procedures, and contract management need to be closely monitored and addressed to ensure the program's success. The Bank will play an active role in monitoring the program's budget and fiduciary processes, and the assessment will inform the Implementation Support Plan (ISP).