Buletin 3_4-2010 web.pdf - Curtea de Conturi a Republicii Moldova

In this context, with a clear mandate stipulated
in the law, the Court of Accounts of the Republic of
Moldova started the implementation of the most
modern performance auditing practices, used at
the international level, meeting the society's requirements
of using the public means in an economic,
efficient and effective manner, including the funds
coming from the financial support provided by the
European Union and other international institutions
or organizations .
The Court of Accounts, operating since 1 January
2009 on the basis of the new Law on the Court
of Accounts no 261-XVI of 05 .12 .2008, which stipulates
the control of the management and use of
public funds and assets by means of performance
audit, has carried out a series of performance audit
missions in areas of major importance . The results
and findings of the respective missions and the
impact produced by the implementation of the recommendation
given as a result of some audits will
be presented further . Thus, one of the performance
audits carried out by the Court of Accounts aimed
at analyzing the outcome of the measures taken by
the Republic of Moldova to fight cancer . The final
audit conclusion was the following: «major changes
needed to significantly improve the effectiveness
of the public health care institution the
oncological Institute in fighting cancer»
Why was this audit performed?
Fighting cancer is a stringent problem for the
Republic of Moldova both in medical and social terms,
proved by the increase in the number of patients
with oncological diseases and the tendency of
affecting younger people . The Oncological Institute
(OI) was founded in 1960 and is the only curativepreventive
institution in the country that provides
specialized inpatient and outpatient care to population
in oncology . The Court of Accounts carried
out the performance audit at the Oncological Institute
to determine if it manages effectively the staff,
equipment, and material and financial resources .
audit results
The Court identified serious problems with the
resource management systems, problems that
must be corrected in order to enhance the effectiveness
of OI efforts against cancer . Particularly, the
Court has found out that:
The OI was operating on the basis of an outdated
statute and organizational chart (developed
more than 10 years ago) . The organizational
chart was not regulated by any regulatory
act . The lack of an approved organizational
structure and a set of regulatory acts
led to inefficiencies within the institution . For
example, using the standard norms develo-
ped by the Ministry of Health, the Institute
was understaffed by approximately 284 medical
employees, including 97 doctors .
The OI had no accreditation . The serious problems
identified during the 2006 accreditation
review have not been corrected yet .
Although the cost of drugs accounts for the
largest share in the expenditures of the Institute,
it didn't have control over the entire
process, from needs assessment to the distribution
and use of drugs .
The Institute lacked essential information
about the technical state of its equipment,
which must have shown if the equipment
was fully operational, needed repairs or was
not functioning, as well as must have included
its exploitation period . About 70% of the
equipment in the operating block was used
1 .5 to 2 .5 times longer than the required exploitation
period .
The Inpatient Department of the Institute
was used inefficiently . For instance, the therapy
units of the Inpatient Department had 1 .2
patients per bed on the average, exceeding
by far its capacity, because the same beds
were used to provide outpatient services . The
number of patients per doctor in the therapy
units was twice higher than the standard
norm set by the Ministry of Health . At the
same time, the beds in other departments
were not used fully .
The Institute did not always meet the legal
provisions on procurement . The Institute's
procurement process was not transparent
and was more vulnerable to fraud, waste, and
abuse . This resulted in additional costs because
of limited competition, eliminating with
no reasons the lower price bids . The performance
was also monitored poorly .
Another performance audit, carried out by the
Court of Accounts, was in the area of social aid . The
final conclusion of the Court of Accounts was the
following: «opportunities exist to improve the
efficiency and effectiveness of the social aid
process»
Why was this audit performed?
The social aid is a component of the national social
protection system . In 2008, a new mechanism
was developed and implemented for the provision
of means-tested social aid . The Court of Accounts
started an audit to determine if there were any problems
hampering the implementation of the new
social aid program and if yes, what actions need to
be taken to overcome the problems . This audit was
also requested by the European Union .
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Audit activity