In January, MoLHSA staff indicated that they had provisionally accepted the structure proposed by the MoF (subject to any necessary or appropriate adjustments that might arise through the process of preparing Sector Strategy Expenditure Matrices).
It had been intended that the Health Sector Working Group (for the MTEF) would start work on the SSEMs at the beginning of February. In the event this start was delayed. In order to make good use of consultant resources that had been scheduled to support MoLHSA in February, OPM
consultants took the initiative to produce a preliminary mapping of the administrative structure of MoLHSA to the proposed programme structure.
The results of this exercise are shown in Figures 8.1 and 8.2 and Tables 8.2 and 8.3.
Figure 8.1 is a diagrammatic presentation of the Budget Structure of the MoLHSA.
The first step in the mapping exercise was to indicate the sectoral responsibilities of the departments of MoLHSA. As shown in Figure 8.1, there are three types of departments: those managing exclusively health activities; those managing exclusively other sector activities; and those managing activities that relate to more than one sector. Figure 8.2 provides the same information for SUSIF.
The next step was to assess into which programmes the activities managed by these departments should be mapped. In many instances the mapping from the administrative to the programme classification was ‘many to one’. This means that the activities of these
Figure 8.1 Structure of MoLHSA 2005 Budget
Figure 8.2 Structure of SUSIF 2005 Budget
Table 8.2 Matrix of preliminary mapping of MoLHSA budget structure to sector programme areas
SP for Health Assistance for War Veterans √ √ √ √
√ √
Drugs Agency Staff √ √
SP of Pharmaceutical Sector Regulation & Monitoring √ √
Centre of Forensic Expertise √
L Sakvarelidze National Centre of Disease Control & Medical Statistics
SP Institutional & Functional Reform Promotion in the Social Sphere MoLHSA
MoLHSA Central Staff
MoLHSA Territorial Organisations
Table 8.3 Matrix of preliminary mapping of SUSIF budget structure to sector programme areas
Provision of Specific Medicaments for the Adults with Diabetes √ Provision of Specific Medicaments for the Adults & Children with
Diabetes √
Treatment of Children & Adults with Haemophilia √
Provision of Specific Medicines for Oncologica Patients √
Provision of Specific Medicines for Patients with Kidney
Transplants √
Provision of Specific Medicines for Patients with Diabetus
Insipidus √
Provision with Anti-rabies Specific Medicaments √
Immunization Component √
Provision of Food Supplements for Children with Fenolketonuria √
Expenses related to customs clearance transportation, storing &
delivery of specific medicines √
Provision of Specific Medicines for Patients with Kidney
Transplants √
The next step was to assess into which programmes the activities managed by these departments should be mapped. In many instances the mapping from the administrative to the programme classification was ‘many to one’. This means that the activities of these departments/state programmes will have to be further disaggregated to make the mapping in financial terms.
The ease with which the financial mapping can be made will depend on the degree of detail in the administrative/financial coding structure (chart of accounts). Of the coding structure does not facilitate a complete mapping (with no double counting and the adding up constraint respected) then the mapping will have to be completed through approximated apportionment of budget and these decisions will have to be made by MoLHSA.
The preliminary mapping process raised some issues that will need to be considered and resolved by the Health Sector Working Group.
The National Health Programme does not seem to be relevant for the activities of MoLHSA. At first glance it appears to relate to the activities of the National Institute of Public Health. This institute’s activities relate to a number of other programme areas and its overarching management activities should be apportioned to Health Sector Planning Management and Administration. This suggests that this programme is redundant.
Some activities of the Ministry do not obviously fit into any of the programmes proposed, so it might be useful to consider the creation of another programme such as health n.e.c (not elsewhere classified).101
Another additional programme has been proposed: Health Sector Training.
The primary reason for this addition is to take account of the subsidy paid by MoLHSA to the State Medical Academy (SMA). SMA manages a number of activities including training of future and existing health sector workers and the direct provision of health services to the public, albeit largely in relation to its training role.
The secondary reason for creating this programme was to take account of the envisaged re-training activities for doctors and nurses in those ambulatories selected for rehabilitation. Although it could be argued that these activities are part of primary health care, they are in some sense additional to the normal training process and are an extraordinary activity that will not endure.
For intertemporal comparisons of the amount of resources the Government chooses to devote to the delivery of primary health care services with the intention of showing increases over time, this separation of training is useful. It will avoid an apparent fall in the future when extraordinary training processes come to an end.
101 In the GFS functional classification health nec includes management activities, but in the proposed health sector programme classification there is a separate programme for Health Sector Planning Management and Administration.
Annex 8.1 Budget Expenditures by Economic Classification
Table 8.4 Budget Expenditures by Economic Classification
N Name Economic codes
1 2 3
I. Total Expenditures (II+VII)
II. Total Expenditures and Net Lending (III+VI)
III. Total Costs (IV+V)
IV. Operating Costs
1 Expenditures on Goods and Services 10 00 00 00
2 Compensation 10 01 00 00
3 Salaries and Wages 10 01 01 00
4 Bonuses 10 01 02 00
5 Supplements 10 01 03 00
6 Assistance 10 01 04 00
7 Contributions 10 02 00 00
8 To the State Consolidated Social Insurance Fund 10 02 01 00
9 Overnight expenses, in particular 10 03 00 00
10 Internal 10 03 01 01
11 External 10 03 01 02
12 Other goods and Services 10 04 00 00
13 Office Expenses 10 04 01 00
14 Utility service 10 04 02 00
15 Food expenses 10 04 03 00
16 Medical expenses 10 04 04 00
17 Soft inventory and uniform 10 04 05 00
18 Expenses for exploiting and maintaining transport and techniques 10 04 06 00 19 Co-financing in the projects financed by donors grants and 10 04 07 00
20 Other expenses 10 04 08 00
21 Paying Interest Rates 11 00 00 00
22 Paying interest rates for credits on the other budget levels 11 01 00 00
23 Paying interests rates for domestic debt 11 02 00 00
24 Paying interest rates on National Bank Credit 11 02 01 00
25 on State Securities 11 02 02 00
26 Paying interest rates on other credits 11 02 03 00
27 Paying interest rates for external debt 11 03 00 00
28 Paying interest rates on the credits of the government of other countries 11 03 01 00 29 Paying interest rates on credits of the international organization 11 03 02 00 30 Paying interest rates on securities of the other countries 11 03 03 00
31 Paying interest rates on other credits 11 03 04 00
32 Subsidies, Subventions and other Current Transfers 12 00 00 00
33 Subsidies 12 01 00 00
N Name Economic codes
34 on non-financial state enterprise 12 01 01 00
35 on financial organizations 12 01 02 00
36 on subordinated units and PLEs 12 01 03 00
37 Co-financing for investment projects financed by donors' credits and grants 12 01 04 00
38 on other enterprises 12 01 05 00
39 Subventions 12 02 00 00
40 on non-financial state enterprise 11 02 01 00
41 on financial organizations 12 02 02 00
42 on subordinated units and PLEs 12 02 03 00
43 Co-financing for investment projects financed by donors' credits and grants 12 02 04 00
44 Current Transfers 12 03 00 00
45 Current transfers for other levels of authority 12 03 01 00 46 Current transfers for organizations with no profit 12 03 02 00
47 Current transfers for Families 12 03 03 00
48 Current transfers outside the country 12 03 04 00
49 for governments of other countries and international organizations 12 03 04 01 50 Expenses for having share in the international organization 12 03 04 02
51 other current transfers outside the country 12 03 04 03
52 V. Capital Expenditures
53 Acquisition of Assets 13 00 00 00
54 Acquisition of machines, equipments, transport means and other assets 13 01 00 00 55 Acquisition of building-constructions, building and reconstruction 13 02 00 00 56 Capital repair of machines, equipments, transport means and buildings and
constructions
13 03 00 00 57 Co-financing for investment projects financed by donors' credits and grants 13 04 00 00 58 Acquisition of goods for creating state reserves 14 00 00 00
59 Acquisition of land and non-material assets 15 00 00 00
60 Acquisition of land 15 01 00 00
61 Acquisition of non-material assets 15 02 00 00
62 Capital Transfers 16 00 00 00
63 Within the country 16 01 00 00
64 To other level state governing bodies 16 01 01 00
65 To non-financial state organizations 16 01 02 00
66 To financial organizations 16 01 03 00
67 Other enterprises 16 01 04 00
68 Other capital transfers given within the country 16 01 05 00
69 Outside the country 16 02 00 00
70 To governments of other countries and international organizations 16 02 01 00
71 Other current transfers outside the country 16 02 02 00
72 VI. Net Lending
73 Domestic lending 17 00 00 00
74 Credits given to other level bodies of the state authority 17 01 00 00
N Name Economic codes 75 Credits given to non-financial state enterprises 17 02 00 00
76 Credits given to financial institutes 17 03 00 00
77 Co-financing for investment projects financed by donors' credits and grants 17 04 00 00
78 Credits given to other entities 17 05 00 00
79 External lending 18 00 00 00
80 Credit given to governments of other countries and international organizations 18 01 00 00
81 Other external lending 18 02 00 00
82 VII. Covering debts (financing)
83 Covering domestic debts 19 00 00 00
84 Financial organizations 19 01 00 00
85 Short-term state securities 19 02 00 00
86 Long-term credits 19 03 00 00
87 Covering long-term credits of the money credit bodies 19 03 01 00
88 Covering long-term credits of commercial banks 19 03 02 00
89 Long-term credits that are not classified anywhere else 19 03 03 00
90 Short-term credits 19 04 00 00
91 Covering short-term credits of the money credit bodies 19 04 01 00 92 Covering short-term credits of commercial banks 19 04 02 00 93 Long-term credits that are not classified anywhere else 19 04 03 00
94 Covering other domestic debts 19 05 00 00
95 Covering external debts 20 00 00 00
96 Long-term securities 20 01 00 00
97 Short-term securities 20 02 00 00
98 Covering long-term loans 20 03 00 00
99 Covering credits of the international organization 20 03 01 00 100 Covering credits of the governments of other countries 20 03 02 00
101 Covering commercial bank credits 20 03 03 00
102 Covering long-term credits that are not classified anywhere else 20 03 04 00
103 Short-term credits 20 04 00 00
104 Covering credits of the international organization 20 04 01 00 105 Covering credits of the governments of other countries 20 04 02 00
106 Covering commercial bank credits 20 04 03 00
107 Covering short-term credits that are not classified anywhere else 20 04 04 00
108 Covering other external debts 20 05 00 00
Annex 8.2 GFS Functional Classification
707 Health
Government outlays on health include expenditures on services provided to individual persons and services provided on a collective basis. Expenditures on individual services are allocated to groups (7071) through (7074); expenditures on collective services are assigned to groups (7075) and (7076). Collective health services are concerned with matters such as formulation and administration of government policy; setting and enforcement of standards for medical and paramedical personnel and for hospitals, clinics, surgeries, etc.; regulation and licensing of providers of health services; and applied research and experimental development into medical and health-related matters. However, overhead expenses connected with administration or functioning of a group of hospitals, clinics, surgeries, etc.
are considered to be individual expenditures and are classified to groups (7071) through (7074) as appropriate.
7071 Medical products, appliances, and equipment
This group covers medicaments, prostheses, medical appliances and equipment and other health related products obtained by individuals or households, either with or without a prescription, usually from dispensing chemists, pharmacists or medical equipment suppliers. They are intended for consumption or use outside a health facility or institution. Such products supplied directly to outpatients by medical, dental and paramedical practitioners or to in-patients by hospitals and the like are included in outpatient services (7072) or hospital services (7073).
70711 Pharmaceutical products (IS)
Provision of pharmaceutical products such as medicinal preparations, medicinal drugs, patent medicines, serums and vaccines, vitamins and minerals, cod liver oil and halibut liver oil, oral contraceptives; administration, operation or support of the provision of pharmaceutical products.
70712 Other medical products (IS)
Provision of medical products such as clinical thermometers, adhesive and non-adhesive bandages, hypodermic syringes, first-aid kits, hot-water bottles and ice bags, medical hosiery items such as elasticated stockings and knee-pads, pregnancy tests, condoms and other mechanical contraceptive devices; administration, operation or support of the provision of prescribed other medical products.
70713 Therapeutic appliances and equipment (IS)
Provision of therapeutic appliances and equipment such as corrective eyeglasses and contact lenses, hearing aids, glass eyes, artificial limbs and other prosthetic devices, orthopaedic braces and supports, orthopaedic footwear, surgical belts, trusses and supports, neck braces, medical massage equipment and health lamps, powered and unpowered wheelchairs and invalid carriages,
“special” beds, crutches, electronic and other devices for monitoring blood pressure, etc.;
administration, operation or support of the provision of prescribed therapeutic appliances and equipment.
Includes: dentures but not fitting costs; repair of therapeutic appliances and equipment.
Excludes: hire of therapeutic equipment (70724).
7072 Outpatient services
This group covers medical, dental and paramedical services delivered to outpatients by medical, dental and paramedical practitioners and auxiliaries. The services may be delivered at home, in individual or group consulting facilities, dispensaries or the outpatient clinics of hospitals and the like. Outpatient services include the medicaments, prostheses, medical appliances and equipment and other health-related products supplied directly to outpatients by medical, dental and paramedical practitioners and auxiliaries. Medical, dental and paramedical services provided to in-patients by hospitals and the like are included in hospital services (7073).
70721 General medical services (IS)
This class covers the services provided by general medical clinics and general medical practitioners. General medical clinics are defined as institutions which chiefly provide outpatient services which are not limited to a particular medical specialty and which are chiefly delivered by qualified medical doctors. General medical practitioners do not specialize in a particular medical specialty.
Provision of general medical services; administration, inspection, operation or support of general medical services delivered by general medical clinics and general medical practitioners.
Excludes: services of medical analysis laboratories and x-ray centres (70724).
70722 Specialized medical services (IS)
This class covers the services of specialized medical clinics and specialist medical practitioners.
Specialized medical clinics and specialist medical practitioners differ from general medical clinics and general medical practitioners in that their services are limited to treatment of a particular condition, disease, medical procedure or class of patient.
Provision of specialized medical services; administration, inspection, operation or support of specialized medical services delivered by specialized medical clinics and specialist medical practitioners.
Includes: services of orthodontic specialists.
Excludes: dental clinics and dentists (70723); services of medical analysis laboratories and x-ray centres (70724).
70723 Dental services (IS)
This class covers the services of general or specialist dental clinics and dentists, oral hygienists or other dental operating auxiliaries. Dental clinics provide outpatient services. They are not necessarily supervised or staffed by dentists; they may be supervised or staffed by oral hygienists or by dental auxiliaries.
Provision of dental services to outpatients; administration, inspection, operation and support of dental services delivered by general or specialist dental clinics and by dentists, oral hygienists or other dental auxiliaries.
Includes: fitting costs of dentures.
Excludes: dentures (70713); services of orthodontic specialists (70722); services of medical analysis laboratories and x-ray centres (70724).
70724 Paramedical services (IS)
Provision of paramedical health services to outpatients; administration, inspection, operation or support of health services delivered by clinics supervised by nurses, midwives, physiotherapists, occupational therapists, speech therapists or other paramedical personnel and of health services delivered by nurses, midwives and paramedical personnel in non-consulting rooms, in patients’
homes or other non-medical institutions.
Includes: acupuncturists, chiropodists, chiropractors, optometrists, practitioners of traditional medicine, etc.; medical analysis laboratories and x-ray centres; hire of therapeutic equipment;
medically prescribed corrective-gymnastic therapy; outpatient thermal bath or sea-water treatments; ambulance services other than ambulance services operated by hospitals.
Excludes: public health service laboratories (70740); laboratories engaged in determining the causes of disease (70750).
7073 Hospital services
Hospitalization is defined as occurring when a patient is accommodated in a hospital for the duration of the treatment. Hospital day-care and home-based hospital treatment are included, as are hospices for terminally ill persons.
This group covers the services of general and specialist hospitals, the services of medical centres, maternity centres, nursing homes and convalescent homes which chiefly provide in-patient services, the services of military base hospitals, the services of institutions serving old people in which medical monitoring is an essential component and the services of rehabilitation centres providing in-patient health care and rehabilitative therapy where the objective is to treat the patient rather than to provide long-term support. Hospitals are defined as institutions which offer in-patient care under direct supervision of qualified medical doctors. Medical centres, maternity centres, nursing homes and convalescent homes also provide in-patient care but their services are supervised and frequently delivered by staff of lower qualification than medical doctors. The group does not cover facilities such as military field hospitals (7021), surgeries, clinics and dispensaries devoted exclusively to outpatient care (7072), institutions for disabled persons and rehabilitation centres providing primarily long-term support (71012), retirement homes for elderly persons (71020). Neither does it cover payments to patients for loss of income due to hospitalization (71011). Hospital services include medicaments, prostheses, medical appliances and equipment and other health-related products supplied to hospital patients. It also includes non-medical expenditure of hospitals on administration, non-medical staff, food and drink, accommodation (including staff accommodation), etc.
70731 General hospital services (IS)
Provision of general hospital services; administration, inspection, operation or support of hospitals that do not limit their services to a particular medical specialty.
Excludes: medical centres not under the direct supervision of a qualified medical doctor (70733).
70732 Specialized hospital services (IS)
Specialized hospitals differ from general hospitals in that their services are limited to treatment of a particular condition, disease, or class of patient, for example, diseases of the chest and tuberculosis, leprosy, cancer, otorhinolaryngology, psychiatry, obstetrics, paediatrics, and so forth.
Provision of specialized hospital services; administration, inspection, operation or support of hospitals that limit their services to a particular medical specialty.
Excludes: maternity centres not under the direct supervision of a qualified medical doctor (70733).
70733 Medical and maternity centre services (IS)
Provision of medical and maternity centre services; administration, inspection, operation or support of medical and maternity centre services.
70734 Nursing and convalescent home services (IS)
Nursing and convalescent homes provide in-patient services to persons recovering from surgery or a debilitating disease or condition that requires chiefly monitoring and administering of medicaments, physiotherapy and training to compensate for loss of function or rest.
Provision of nursing and convalescent home services; administration, inspection, operation or support of nursing and convalescent home services.
Includes: institutions serving old people in which medical monitoring is an essential component;
rehabilitation centres providing in-patient health care and rehabilitative therapy where the objective is to treat the patient rather than to provide long-term support.
7074 Public health services 70740 Public health services (IS)
Provision of public health services; administration, inspection, operation or support of public health services such as blood-bank operation (collecting, processing, storing, shipping), disease detection (cancer, tuberculosis, venereal disease), prevention (immunization, inoculation), monitoring (infant nutrition, child health), epidemiological data collection, family planning services and so forth;
preparation and dissemination of information on public health matters.
Includes: public health services delivered by special teams to groups of clients, most of whom are in good health, at workplaces, schools or other non-medical settings; public health services not connected with a hospital, clinic or practitioner; public health services not delivered by medically qualified doctors; public health service laboratories.
Excludes: medical analysis laboratories (70724); laboratories engaged in determining the causes of disease (70750).
7075 R&D Health
Definitions of basic research, applied research and experimental development are given under (7014) and (7015).
70750 R&D Health (CS)
Administration and operation of government agencies engaged in applied research and experimental development related to health; grants, loans and subsidies to support applied research and experimental development related to health undertaken by non-government bodies such as research institutes and universities.
Includes: laboratories engaged in determining the causes of disease.
Excludes: basic research (70140).
7076 Health N.E.C.
70760 Health n.e.c. (CS)
Administration, operation or support of activities such as formulation, administration, coordination and monitoring of overall health policies, plans, programs and budgets; preparation and enforcement of legislation and standards for the provision of health services, including the licensing of medical establishments and medical and paramedical personnel; production and dissemination of general information, technical documentation and statistics on health.
Includes: health affairs and services that cannot be assigned to (7071), (7072), (7073), (7074) or
Includes: health affairs and services that cannot be assigned to (7071), (7072), (7073), (7074) or