Kuwait : Complete Profile - What is GIS - World Health Organization

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO
coordination with the Authority of Financial Affairs. Authority of Financial Affairs
inspects and settles the accounts on monthly basis. It must be provided with bank
statements, statements of all financial resources, and receipts. At the end of the fiscal
year, the Authority of Financial Affairs performs an audit of the financial statements
and expenditures.
Kuwait’s experience with decentralization is mixed. According to the MOH, the new
health region system has allowed better planning, management and more efficient use
of resources, which resulted in more efficient delivery of health services. However, there
are serious concerns about its impact due to the limited powers delegated to health
areas. The authority delegated to manage health work force in the regions is variable.
The Directors of health areas have the authority to transfer staff (within the region),
approve leaves, conduct performance evaluation, reward well-performing staff, nominate
for continuing education and approvals of termination and renewal of contracts; they can
not recruit, penalize or dismiss the staff. They do not have the authority to be flexible
with salaries to attract qualified staff, especially nurses. For promotions and raise in
salaries, the area director sends his nominations to the Administrative Affairs authority in
MOH for approval, in accordance with rules and regulations.
Health regions develop annual plans and send their requirements regarding staff and
other resources to the MOH, however the funds and human resources received are often
not based on the needs. Packages of health services and standards of care are defined
by the MOH in consultation with the regions. Decisions about construction of new
hospitals and facilities are also combined. Continuing education and health information
system is highly centralized. There is duplication of efforts in data collection and
compilation and limited capacity at regional level to analyze and use data collected from
hospitals and health facilities. Strengthening of health information system and capacity
development in the area of strategic and operational planning in the regions will be
essential for the success of decentralization.
Fiscally, the system remains highly centralized and health areas rely almost entirely on
government financing. There are restrictions on use of revenue generated through user
fee, donations and other approved sources. Budgets are prepared by the health areas,
mostly on incremental basis and submitted to the MOH. Once approved an instalment of
funds is deposited in the designated local bank at the beginning of the fiscal year, which
is balanced out throughout the year. Authority of Financial Affairs in MOH inspects and
settles the accounts on monthly basis. According to the regional director, budget is
allocated for all regions and they are not aware of the amount allocated to their region.
Each time they need funds, regions have to give justifications. There is no flexibility
between line items without the approval of the MOH. Regional directors have the powers
to disburse up to KD 5000 ?? in accordance with the approved budget. They are required
to make payment of more than 100 KD through cheques and any donations received by
the area must be notified to the Authority of Financial Affairs. There are restrictions and
conditions for purchase of simple medical equipment. Medicines and other supplies are
also procured centrally and then distributed to the regional facilities. During discussions
some concern was raised regarding the misuse of resources if the procurement is
decentralized and regions are given more financial powers.
The regions are not empowered to authorize autonomous status to hospitals or launch
insurance plans. They have the authority to contract out maintenance, cleaning and
catering services to private companies. There are no regulations and means of
enforcement to regulate the private health facilities based on the existing norms and
standards. The regulatory functions are limited to registration and licensing. There are
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