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Health and Politics

Stevo MukAt the end of this month will be a year since I lost my father. After my father’s death, many issues are left, related to (the lack of) medical care for almost fifty days of the struggle for life. What could we have done differently? What the doctors could have done otherwise? Is that the way it was meant to be? One, to me very dear, person told me: “One thing to regret for is certain.” People who have lost their loved ones will understand what I’m saying. I’m trying to rid the text of a personal feeling, not to unfairly blame on others and save the general attitude towards the health care system. That’s why I’m writing this article today, a year later, only with the desire to encourage reflection on the issues of improving the quality of the health care system in Montenegro.

During these fifty days I learnt many things and changed my point of view on many things. Views on some issues I have built during a long period of time or confirmed. A senior doctor, chief of one of the clinics at the Clinical Center, said to me at the end of last year: “Most of things we do here is done thanks to the people who work here. Otherwise, as far as what we have available, Clinical Center should be closed tomorrow.”

He was telling me about the facts related to the time when the building of the Clinical Center was designed and built for the then much smaller population of Podgorica, about the problems of mentality and attitude towards patients. Will this one or some other doctor talk about this louder and more transparent? I do not think so. Will there be a significant change? I doubt it.

Just look at the barracks in Park of Petrovic in which are some departments of the Clinical Center, in order to see the wretched work conditions and where the doctors treat the patients. It is enough to glance at the reception of CC and hear how often is the primitivism a welcome to worried people. Just as is inhumane to drive patients along the long corridors, cramped hallways and in the ancient elevators to and from the operating block.

Most people at least once in their life will end up in one of the health clinics or will find in them because of the loved ones. That’s the main reason why the matter of quality of health care services is a matter of all citizens – the matter of public policy. It is a matter of health policy– what can public institutions offer us and how much money we need to set aside for the mandatory health insurance. It is a question of policy and budget – capital budget for health facilities, the issue of higher education (for example, whether is financing the state medical university rational choice for Montenegro?).

I read the report of the Clinical Center for the period 2007-2011. It states: “A significant and very limiting restrictions of funding in 2010 and 2011, which seriously threatens the maintenance of existing levels of health care.”

Ministry of Finance and Health Fund announced a reduction in finance for healthcare facilities in the coming years. I saw people who run KC protesting. How loud? Newspapers’ headlines are producing a painful echo: “Insulin only until the end of the month”, “The Clinical tumor markers missing for months,” and so on. I remember during those bloody fifty days during the last years, we were invited from the CC to buy various drugs, relatively cheap and common, which “cen be bought in a pharmacy within the CC” or to perform analysis at a private laboratory.

Citizens have a right to know what is the actual quality of healthcare services that can be expected today in Montenegro’s health care facilities. To what extent protocols used by us comply with the latest standards, which public health services can not get here. This includes the right of patients to the risk assessment of the planned operation, data on survival statistics, the possibility that the basis of available data make a decision on life issues.

Public opinion polls show that the health system is high on the public trust. Daily conversations with people are saying the opposite. People give money to doctors without dilemma, such as many of doctors have no problem accepting it. How many times have we said or heard “there is only one who has treated”, “for all beyond the cold, go outside of Montenegro.”

Sometimes we are unjust, believing that everything is better abroad. I know that our doctors save countless lives and bring health to many patients. However, I believe that there is ample room to save many more lives and improve the health of people.

The quality and continuous public and expert discussions, the struggle against negative professional solidarity among doctors, the fight against corruption in the health sector, joining patients, a wake of Medical Association would be helpfull.

I believe, too, that it could be done even more if we organize and connect people who want to transform their dissatisfaction with the functioning of the health system into a positive energy for its changes.

Stevo Muk
President of the Managing Board

Article was originally published in the web portal of the newspapers “Vijesti”

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More Than 200 Requests For the Government

More than 200 requests from the governmentEleven representatives of the Coalition of NGOs for monitoring the accession negotiations with the EU under the chapter 23, presented more than 200 new requests sent to the Government of Montenegro in the field of judicial reform, anti-corruption policies, promotion of human rights and freedoms, and sustainability of civil society at today’s press conference. The coalition will actively support and monitor the implementation of the requirements and regularly inform the general public about its effects.

As a representative of the Institute Alternative, a member of the Coalition, Dina Bajramspahic, presented the requests, based on the research of the Institute Alternative.

In the area of public procurement:

  • Harmonize legal framework for public procurement with the EU acquis, particularly in a relation to the definition of the shopping process
  • Commission for Public Procurement is necessary to establish an independent and autonomous body, in accordance with EU legislation, which requires that members of the Commission must be appointed by the Parliament of Montenegro
  • In a semi-annual period prepare detailed report on irregularities identified in the procurement processes, running processes and their solutions, in order to determine the causes of the lack of final decisions and the sanctions imposed in this area
  • Amend the Law on Conflict of Interest and expand its scope to those involved in the procurement process
  • Stipulate by amending the Law on budget that the Reports on the fulfillment of contracts on public procurement are available on the website of the purchasers
  • Improve the anti-corruption mechanisms within the Strategy and Action Plan for the development of public procurement system for 2011-2015
  • Integrity Plan which is to be adopted by the state authorities in accordance with the Law on Civil Servants should identify all persons involved in the planning of public procurement, tendering, contracting and execution and control of contracts.

In the area of concessions and public-private partnerships:

  • Harmonize the Law on concessions with the EU acquis
  • Expand the content of a register of concession contracts in order to contain also repayment plans and debt, as well as financial reports o implemented PPP contracts and concessions. It is essential that the contracts and awarded concessions are available to the public
  • Accelerate work on the legal framework for public-private partnerships.
  • Improve the institutional framework for PPP projects and concessions.

In the area of public finance:

  • In a short term- the Ministry of Finance should not reduce the amount of budget funds requested from the State Audit Office for 2013, and in a long term- is necessary to provide full financial independence of the State Audit Institution and strengthen its capacities
  • The Government’s Action Plan for implementing the recommendations of the State Audit Institution needs to be revised. Particularly, it needs to make more effective recommendations by concretizing activities, introducing clear success indicators, determining realistic deadlines and responsibilities for implementing the listed activities. At the same time, it is necessary to build the structure of the Ministry of Finance to monitor the implementation of the recommendations of the State Audit Institution and take care of their horizontal implementation
  • Provide budget planning by objectives and policy priorities, by intensifying work on setting up the program budget through the development of performance indicators for all programs of budget users
  • Edit fiscal calendar in the Law on budget in a way that the Parliament has at least three months to review the Proposal of budget for next year
  • Accelerate the process of establishing a system of internal financial control in the public sector with emphasis on concrete results in internal audit and financial management and control. Publish consolidated report on internal financial controls as soon as possible in order to inform public about the real situation in the field of public finance control.

All requirements of the Coalition can be found here.

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DCAF Young faces network – Workshop in Zagreb

Public Policy Researcher in Institute Alternative, Dina Bajramspahic, participated in a DCAF’s program – Young Faces Network 2012, in the workshop entitled “Oversight of the collection of information by the intelligence services” held on 11th and 12th December in Zagreb.

This is the second workshop as part of this program, organized by the Geneva Centre for the Democratic Control of Armed Forces (DCAF). Participants of the program were the counselors from 9 countries in Eastern Europe working in surveillance services and representatives of think tanks that deal with security and defence.

The workshop consisted of nine sessions that covered issues such as:

  • targeting and prioritizing the collection of information;
  • difference between the police and intelligence service;
  • forms and methods of gathering information;
  • approval of information collection;
  • Analysis of the collected material;
  • use of the collected material – inform policy decisions; submission of information to the police and prosecution, exchange of information with foreign intelligence services, the use of personal data;
  • Outsourcing: How much information can be collected by non-state actors, and the role of private security companies?
  • ex post evaluation of measures;
  • appeal in case of abuse.
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Investigating Telekom Affair in the Parliament – unrealistic expectations and realistic limitations

Through the adoption of the Decision on opening of the parliamentary inquiry and establishing an Inquiry Committee for gathering information and facts about corruption in the privatisation of Telekom Crne Gore, after a decade-long pause, an inquiry committee was formed which faced numerous challenges in achieving its goals. The Inquiry Committee’s mandate was limited to the period from the opening of the parliamentary inquiry – 28 February 2012 – until 1 October 2012, during which twelve persons were invited to provide statements, with a view to gathering the necessary information.

The goal of this analysis, which represents the continuation of research conducted by Institute Alternative in this area, is to answer the following question – which obstacles did the Inquiry Committee face in carrying out the parliamentary inquiry. The subject of this analysis were the circumstances in which the parliamentary inquiry was launched, the role of other actors involved in shedding light on the relevant issues, problems in the implementation of control mechanisms, as well as the political context in which the parliamentary inquiry was conducted. Based on the analysis of identified problems, and good solutions found in comparative practice, recommendations for enhancing this important control mechanism were formulated. Our intention is to contribute to the strengthening of the parliamentary inquiry as an instrument for overseeing the work of government, state bodies and institutions, and as a control mechanism which will be used more frequently in the most functional way, thus yielding concrete results.

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Press release: Public Administration Reform Needs To Be Intensified

Public Administration in Montenegro is still cumbersome, highly politicized and it lacks administrative capacities. Hence, public confidence in its work is steadily declining. Based on the data of public opinion conducted by the Institute alternative in collaboration with Ipsos Strategic Marketing for the purpose of analysis “Public administration reform in Montenegro – between the ambitious plans and real opportunities”, almost 2/3 of respondents considered that the institutions of public administration are managed by the political influence. More than a half of the respondents believe that the management is colored by more particulate than public interest. In the opinion of the citizens of Montenegro, lack of financial resources for the implementation of programs and activities of the state, corruption and poor organization are the three most important factors that hamper efficient functioning of the public administration.

According to the 2012 European Commission’s Progress Report, Montenegro has achieved some results in the further implementation of public administration and its de-politicization, but it is necessary to finalize a comprehensive plan for its reorganization, renew and strengthen the implementation of the legislation, which raise a series of questions. Improved legal framework is insufficient in practice, while the implementation of new solutions to employment, training and promotion is just about to start. Although the new Law on Civil Servants introduces significant improvements compared to the previous legal framework, it still leaves exceptional discretionary decision of the head of the selection of candidates for employment. This solution can prove as an obstacle in eliminating politicization. Finally, the legal framework for the functioning and reform of the public administration system will be completed only after the laws on Government and agencies are adopted.

Efforts to reform the public administration need to be strengthened and intensified. Clearly, the political positioning and operational coordination of reform; precise guidelines and deadlines for reporting on the implementation of Public Administration Reform Strategy and Action Plan for its implementation; improved plan for the reorganization and its consistent application, as well as the adoption of a strategy to attract and retain the best staff, are some of the necessary steps to be taken if the Montenegrin public administration is to become modern and functional.

Jovana Marovic
Research Coordinator

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IA Presented Research: “Committee for Anticorruption – Cure or Placebo?”

Today we have presented the key findings and recommendations of the IA’s new policy paper entitled “Committee for Anticorruption – Cure or Placebo?”.

Policy paper is a result of project financed by Friedrich Ebert Stiftung Foundation and is a part of permanent Institutes activities on strenghtening the parliamentary oversight role. Speakers at the press conference were Milena Milosevic and Marko Sosic, public policy researchers. Please, find key findings and recommendations below.

Key research findings:

Competences of the Committee for Anticorruption leave a room for an extensive interpretation. The manner in which they will be applied in practice will provide an answer to the question whether this working body will “be repeating” tasks that have been already assigned to other bodies, or whether it will substantially contribute to the fight against corruption and organized crime through the monitoring of the implementation of legislation and strategies, intensive use of control mechanisms, evaluation of the current legislation and other legislative initiatives.

Key recommendations:

  • Committee should be enabled to assume active role in the development of action plans and strategies prior to their adop¬tion by the Government, for the purpose of exercising greater influence on their final version and a more efficient oversight over their implementation.
    Oversight of the Government’s activities in the fight against corrup¬tion and organized crime, as well as of the accession negotiations with the EU, could be reinforced by introducing the obligation of quarterly reporting to the Committee on the implementation of the action plan(s) for the fight against corruption and orga¬nized crime.
    Government’s Decision should extend the composition of the National Commission to include the President of the Committee for Anticorruption.
    The cooperation mechanisms between the Committee for Anticorruption and the National Commission should be enhanced, in a manner which would ensure that the actions of the Committee’s representative are grounded on conclusions and recom¬mendations that have been previously agreed on the Committee’s meetings.
    Records on the number of Committee’s recommendations, which are adopted at the sessions of the National Commission and implemented in practice, should be kept.
    The Law on Data Confidentiality should be amended in order to provide the members of the new Committee the access to the confidential data.
    The Committee’s capacities for carrying out the evaluation of the legislative frame-work with regard to its compliance with the international standards in the fight against corruption and organized crime should be strengthened, by ensuring full support from the professional service and the Parliament’s Department for research, analysis, library and documentation.
    For the purpose of improving the anticor¬ruption provisions in the laws, the mem-bers of the Committee for Anticorruption should insist on the joint consideration of the proposals and draft laws with other competent permanent parliamentary working bodies that operate in a capacity of the parent Committees. Based on a special Rulebook, the mem¬bers of the Committee should define the procedures for petitions’ admission and consideration.
    The aforementioned Rulebook should define the minimum criteria to be met by any petition submitted by an individual or a group, including anonymous petitions, for the purpose of being addressed at the Committee’s Sessions.
    Procedure of considering the petitions by the Committee should be public, in terms of publication of petitions, responses of authorities, and the decision of the Committee brought after the consideration of each application, which has previously met certain criteria, on the web – site of the Parliament.
    Professional service is obliged to submit a corresponding justification to the petition¬ers who fail to meet pre- defined criteria.