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

cused only on the establishment of new plantations
.
The conditions for grapevine planting for big
and medium producers were not managed
objectively . The Program did not promote the
foreseen range of grapevine .
The Grapevine Nursery Development Program
was not developed . No efficient measures
were taken to ensure the biological
quality (of the nursery plants treated against
viruses) and promote them on the internal
sales market . As a result, the planters have to
import nursery plants .
The planters' financial requirements were
not met because of the insufficient accumulations
in the Support Fund for the Development
of New Grapevine Plantations, which
was supplemented from the State Budget
with delays .
The Fund Management Board did not apply
its own decisions on the proportional
payment to beneficiaries . The Board did not
manage the Program in a fair and unbiased
manner .
The initiative to develop new grapevine plantations
through mortgage funding failed and
generated a loss of MDL 4 .5 million .
«audit of the primary health care system»
is another audit carried out by the Court of Accounts
.
Why was this audit performed?
The Government decided to separate the primary
health care from the hospital health care, in
order to ensure a wider access of the population to
primary health care services . The first actions taken
by the Ministry of Health for the decentralization
of the primary health care system at rayon level
started in January 2008, when rayon Family Doctor
Centers were created, with the status of legal entity
and financial autonomy . The Court of Accounts
conducted a performance audit of the primary
health care system to determine if there are any
problems limiting the system effectiveness and,
if yes, to identify the actions needed to overcome
them and determine if the central line bodies and
founders have proper monitoring systems for the
primary health care systems .
audit results
Although the decentralization of the primary
health care system brought many progresses, there
are still opportunities to improve further the system
. Particularly, the Court has found out that:
The shortage of medical staff and lack of ongoing
training limit the effectiveness of the
primary health care system . Although the Mi-
nistry developed programs to attract specialists
with medical education to the rural areas,
they don’t work . Even if money was allocated
for the ongoing training of doctors, only little
amounts were used for this purpose .
One of the main goals of the decentralization
of primary health care system (PHC) was to
ensure a wider access to health care services
for the citizens of the Republic of Moldova .
Though standards were set with respect to accessibility,
the auditors found that there still
exist opportunities to improve significantly
the access to PHC services . The decentralization
also generated confusion regarding the
role and responsibilities of institutions for
pharmaceutic products . Some institutions, besides
distributing drugs, also sell pharmaceutic
products, although they should not do that .
Many of the non-autonomous facilities of
PHC institutions don't comply with the standards
. For instance, they found that a significant
share of facilities used for PHC services
are completely obsolete; a series of facilities
are in a deplorable state .
The Ministry of Health encounters many problems
when trying to monitor the effectiveness of
the decentralized PHC system . The Ministry has also
made significant achievements . For example, 20
protocols developed for the doctors from the PHC
system are used widely . At the same time, there are
opportunities to improve the Ministry's monitoring
system . The Court found out several PHC institutions
that operate in non-compliance with the legal
framework set by the Ministry . As well, the Court of
Accounts identified problems with the accuracy of
the reported information and that four out of the six
indicators set in 2008 are not followed any more .
In the opinion of the Court of Accounts, the implementation
of the recommendations made to
the audited entities in the audit reports will help
improve the management and enhance the accountability
of budget spenders . Most recommendations
have been implemented, while some of
them are under implementation . Thus, only thanks
to the implementation of the Court recommendations,
the Oncological Institute was accredited
on 07 .10 .2009, which proves the full commitment
of this Institute to implement health care policies
against cancer .
The performance audit is a new term for the Republic
of Moldova . Nevertheless, we think that by
carrying out audits of this type we could achieve
tangible performances in various areas of socialeconomic
development of the country and in the
efficient, effective, and economic use of the public
money .
39
Audit activity