Kyrgyz Republic Health Program for Results (P167598) Fiduciary Systems Assessment Report April 2019 1 Table of Contents A. Introduction .............................................................................................................................................. 5 A.1: Reasonable Assurance ......................................................................................................................... 5 A.2: Risk Assessment.................................................................................................................................... 5 B. Fiduciary Assessment Scope .................................................................................................................... 5 C. Review of Public Financial Management Cycle ...................................................................................... 6 C.1: Planning and Budgeting ...................................................................................................................... 7 C.1.1: Adequacy of Budgets .................................................................................................................... 7 C1.2: Procurement Planning .................................................................................................................... 9 C.1.3: Expenditure Framework and Procurement Profile of the Program ............................................. 10 C.2: Budget Execution ............................................................................................................................... 11 C.2.1: Treasury Management and Funds Flow ...................................................................................... 11 C.2.2: Accounting and Financial Reporting........................................................................................... 14 C.2.3: Procurement Processes and Procedures ...................................................................................... 16 C.2.3. Complaints Handling Mechanism ............................................................................................... 19 C.3: Internal Control System ..................................................................................................................... 20 C.3.1: Internal Controls, Contract Management and Internal Audit ...................................................... 20 C.3.2: Program Governance and Anticorruption ................................................................................... 23 C.4: Program Auditing .............................................................................................................................. 26 C.5: Procurement and Financial Management Capacity .......................................................................... 28 D. Program Systems and Capacity Improvements...................................................................................... 28 E. Implementation Support......................................................................................................................... 34 Annexes ......................................................................................................................................................... 36 2 Abbreviations ACG - Anti-Corruption Guidelines ACS - Anti-Corruption Service CoFM - Center of the Family Medicine CoHP - Center of the Healthcare Practice CJSC - Closed Joint Stock Company COA - Chamber of Accounts of Kyrgyz Republic DLI - Disbursement Linked Indicator FM - Financial Management FSA - Fiduciary Systems Assessment GFD - Group of Family Doctors GFMIS - Government Financial Management Information Systems HSFMIS - Health System Financial Management Information Systems IA - Internal Audit ICRC - Independent Complaints Review Commission IMF - International Monetary Fund IPSAS - International Public-Sector Accounting Standards ISA - International Standards on Auditing IT - Information Technology KfW - German government-owned development bank KRPSAS - Kyrgyz Republic Public Sector Accounting Standards LSG - Local Self-Government MID - Main Investigation Department MHIF - Mandatory Health Insurance Fund MoF - Ministry of Finance MoH - Ministry of Health MTBF - Medium Term Budget Framework MDA - Ministries, Departments and Agencies NBKR - National Bank of Kyrgyz Republic OJSC Open Joint Stock Company OPRC - Operational Procurement Review Committee PAP - Program Action Plan PBB - Program-Based Budgeting PEFA - Public Expenditure and Financial Accountability PFM - Public Financial Management PforR - Program for Results PHC - Primary Health Care PI - Performance Indicator PPD - Public Procurement Department of the Ministry of Finance PPL - Public Procurement Law SAI - Supreme Audit Institution SOE State Owned Enterprise SPD Standard Procurement Documents SSCEC - State Service for Combating Economic Crimes SNSC - State National Security Committee 3 SWAp2 - Second Health and Social Protection project TMIS - Treasury Management Information System TSA - Treasury Single Account UNCITRAL - The United Nations Commission on International Trade and Law WA - Withdrawal Application 4 A. Introduction A.1: Reasonable Assurance The fiduciary systems assessment (hereinafter referred to as FSA) has been carried out in accordance with the Bank Policy Program-for-Results1, and the Bank Directive Program-for-Results2, to determine whether the Program fiduciary (procurement and financial management) systems and governance framework are adequate to support the implementation of the proposed Kyrgyz Health Program for Results (hereinafter referred to as the Program). The findings of the FSA conclude that the Program fiduciary systems, in general, are adequate to support the Program and provide overall reasonable assurance that the Program financing proceeds will be used for intended purposes, with due attention to the principles of economy, efficiency, effectiveness, transparency, and accountability, subject to implementation of fiduciary actions as defined in the Program Action Plan. The FSA includes a summary key risks and respective mitigation measures, together with institutional strengthening actions reflected in the Program Action Plan. A.2: Risk Assessment The Program’s Fiduciary risk rating is High. The analysis took into consideration the latest Public Expenditure and Financial Accountability Assessment (PEFA 2014), the Bank’s recent assessment of the National Procurement Procedures carried out as part of the implementation of the Bank’s Regulations, the Bank’s knowledge of the health sector, reviews of internal and external audit reports as well as the results of field visits implemented within the assessment frames. The assessment also builds on the lessons from the implementation of the currently ongoing Kyrgyz Second Health and Social Protection project3 (hereinafter referred to as SWAp-2). Several financial management risks were identified during the review, and these include but are not limited to: (i) shortages of human resources and limited capacities for key FM functions in the sector; (ii) weak internal controls, particularly at PHC facility level; (iii) delayed availability of funds for spending at the beginning of the fiscal year. Procurement risks identified include: (i) lack of sustainability of the complaint review mechanism, (ii) weak contract management practice. (iii) conflict of interests between procurement and payment functions (iv) lack of procurement capacity (v) restricted competition due to difficulties of the foreign pharmaceutical companies to participate in tender process, and (vi) payment delays in PHC facilities. B. Fiduciary Assessment Scope The scope of the FSA covered the Program institutional framework, fiduciary capacity and implementation performance, and institutions and systems responsible for governance and anti- corruption aspects within the Program. The FSA, within the context of reviewing the performance of institutions responsible for implementing and management program expenditures, included an assessment of a sample of eleven PHC facilities to review their fiduciary management capacity in place. 1 November 10, 2017 2 March 2, 2018 3 P126278 5 The FSA covers (i) financial management (FM) arrangements such as planning, budgeting, accounting, internal controls, funds flow, financial reporting, and auditing, and (ii) procurement arrangements (such as planning, bidding, evaluation, contract award, and contract administration) of the Program. The FSA considers the degree to which: (a) from a procurement perspective there are reasonable: (i) arrangements for planning and budgeting; (ii) procurement rules and such rules are easily accessible to the public; (iii) capacity for efficient contract management and administration; (iv) complaint redressal mechanisms, including clarity on how they are used and (v) systems for the Program oversight and control; and (b) from a financial management perspective: (i) the budgeted expenditures are realistic, prepared with due regard to relevant policies, and executed in an orderly and predictable manner; (ii) reasonable records are maintained and financial reports produced and disseminated for decision- making, management, and reporting; (iii) adequate funds are available to finance the Program; (iv) there are reasonable controls over the Program funds; and (v) independent audit arrangements are in place. The FSA also considers how the Program systems handle the risks of fraud and corruption, including by providing complaint mechanisms, and how such risks are managed and/or mitigated. At the national level the Program will be implemented by the Ministry of Health (hereinafter referred to as the MoH) and Mandatory Health Insurance Fund (hereinafter referred to as MHIF) under the Government of Kyrgyz Republic, and at the local level by PHC facilities. The Program will be coordinated by the MoH. The Program fiduciary responsibilities will be carried out by the MHIF and the MoH. The key stakeholders of the Program will be the MoH and the Ministry of Finance Kyrgyz Republic (hereinafter referred to as the MoF). C. Review of Public Financial Management Cycle Under the leadership of the MoH, the Program implementation will be subject to country PFM systems and regulations. In the meantime, the latest PEFA report (conducted in 2014) identified that several critical country Public Financial Management (PFM) elements, including internal controls, external audit (Supreme Audit Institution - SAI), accounting and financial reporting remain weak (Data Source: PEFA 2014 – see also annex 5 below). In addition, the capacity among accounting professionals in the country, and specifically in health sector, is still low, with high turnover of the staff4. Accountants with professional qualification are rare, and the knowledge of the accountants on international accounting/ financial reporting and auditing standards, such as International Public- Sector Accounting Standards (IPSAS) and International Standards on Auditing (ISA) is limited. The Bank supported improvements in accounting/financial reporting system, though the implementation of national accounting standards in public sector (Kyrgyz Republic Public Sector Accounting Standards - KRPSAS) based on IPSAS still requires for the Government to invest substantial resources. 4 The health sector’s external auditor’s reports (for 2014 through 2017 periods) consistently indicate that the staff turnover in the sector is high for last several years. Similar trend was also persistent in 2018 (to be reflected in 2018 audit report): the MoH monitoring indicates over 18% turnover for FY2018. 6 During the last several years, with the Bank support, some reforms were initiated to enhance the country’s Supreme Audit Institution (SAI) - Chamber of Accounts5, particularly in the areas of annual audit planning, compliance and financial audit methodology development, audit workflow automation as well as legislative changes were introduced. However, a progress in the consistent quality of performance and financial audit is yet to be achieved. No audit opinion is issued on the budget execution reports as a whole nor for individual ministries, departments and agencies. In practice, Chamber of Accounts does not consistently follow international auditing standards, despite they have financial and compliance audit methodology developed based on international standards and good practices. With the Bank support, reforms were also initiated in internal audit (IA) function. In particular, the IA methodology was improved, the quality assurance and improvement program, continuous professional development program, training materials were developed and adopted. Necessary legislation and underlying regulations, development of a certification program of internal auditors is still expected to be done. Meanwhile, although there is an evidence of improvements in coverage and quality of public sector internal audit function, the frequency, quality and distribution of audit reports as well as the extent of management response to internal audit findings still needs to be improved. Recently the Bank also started to provide support6 to program-based budgeting (PBB) reforms in Kyrgyz Republic. Corruption is still acknowledged as a major issue in the public sector; according to 2018 Transparency International’s Corruption Perception Index, Kyrgyz Republic was ranked 132th in the list of 180 countries7. C.1: Planning and Budgeting C.1.1: Adequacy of Budgets The assessment confirmed that the Program budgeted expenditures, in general, are prepared with due regard to relevant government policies and will be executed overall in an orderly and predictable manner. The Program will be reflected in the republican and MHIF budgets after the Program effectiveness. The country’s budget system includes republican budget, local governance budgets, Social Fund budget and the budget of MHIF8. The latter mostly consists of allocations from the republican budget, which is the largest part (around 75%), and the Social Fund budget transfers (around 16% - Data Source: The MHIF FY2019 Budget Law). The budget also includes revenue from for-fee state services, co-pay from population, sales of non-mandatory health insurances and transfers from international organizations. The expectation that the required resources for the Program will be appropriated in the fiscal years, in general, is reasonable given overall adequate level of budget execution of the republican budget during last several years. The actual expenditure out-turn in total republican budget deviated from the originally approved budget by less than 2% percent between FY2011-2013. Since then though the out-turn rates considerable increased, but remained below 10% for 2014-2017 (specifically, for 2017 – 6.3%, for 2016 – 7.0%, for 2015 – 8.7% and 2014 – 6.5%). While total expenditure remained 5 Strengthening the Chamber of Accounts Project (TF017895). 6 Second Capacity Building in PFM Project (TFA3998). 7 https://www.transparency.org/cpi2018 8 MHIF has a separate budget law starting 2018 7 close to the budget, the composition of the expenditure by functional classification deviated considerably (around 15%) for the period (Data Source: PEFA-2014, and Annual budgets and Financial Statements by Central Treasury and Budget Policy Department of the MoF). For health sector budget, the overall out-turn for funds provided from republican budget was between 3-5% for 2016-2018 fiscal years, with 9-17% for MoH, and less than 5% for MHIF allocated funds (Data Sources: IFR, Audit reports for FY2016-17, MHIF/MoH reports for 2018, see also the data in Technical Assessment). No deviations were observed with relation of funding of the MHIF from Social Fund budget for FY2015-17 (Data Source: Social Funds budget execution reports for FY2015-2017). Starting 2018, funds annually allocated to MHIF are governed under a separate law on MHIF Budget, which specifies that any remaining year-end balance at the MHIF accounts, unlike for other government budget holders, would be carried forward to be spent in the next fiscal year. This is an important mechanism for reducing the risk of arears in the Program at least on MHIF side (to be allocated to PHCs), which will be responsible for major part of the Program funds (around 88% - See Table 1 below). The planning and budgeting capacity at both the MoH and the MHIF is relatively better than in other government bodies, which also is expressed by the fact that the MoH has been chosen to be one of two pilots (together with the Ministry of Transport and Roads) to implement program-based budgeting (PBB) in parallel with conventional budgeting. Meanwhile the planning and budgeting capacity at some PHC facilities (mostly at small PHCs located in regions) is weak due to weak staff capabilities. Program classification of expenditures was developed and approved in 2015. PBB standards are foreseen in Budget Code of the Kyrgyz Republic. Guidance materials on developing, reviewing and implementing program-based budgets are approved by the Government resolution. The piloting of full cycle of PBB for two ministries including the MoH has started from January 1, 2019. In the meantime, there is still a need for enhancing capacity at the MoH to cope with challenges with introduction of PBB. Given that 2019 will be the first year of piloting for the sector, the expectation is that the learning curve will improve during subsequent years when relevant experience and knowledge is accumulated. For better implementation of PBB, there is a need to develop and implement PBB based resource planning software. The Bank, within the ongoing Second Capacity Building in PFM project6, plans to provide necessary support in strengthening the PBB process and legal framework, improving training materials and conduction of training to the MoF, and line ministries. The support will also include the review of functional requirements on development of information system for PBB planning process, midterm and annual budget planning. It was agreed that the Program funds will be reflected in the republican budget under separate functional classification for the MoH and MHIF. The MoH will prepare a detailed implementation plan based on the indicated disbursement schedule to ensure that the approved budget incorporates the annual planned DLI disbursements. During the formation of the subsequent year’s republican budget (as per the budget calendar), the expected amounts of cash flow under the Program will be reflected in the income and expenditure parts of the republican budget. The budget would later be revised in case of unavailability of some part of the Program funds during the year. The budgeting process for health sector is based mostly on “top-downâ€? approach: the budgeting processes are different for MHIF and the MoH, and in general MHIF (which implements the 8 significant portion of the sector’s budget) follows a “top-down’ approach, while the MoH process is rather “bottom-upâ€?. Allocations to PHC facilities are mainly channeled via MHIF and are mostly based on the capitation rate (number of population registered/attached to each PHC facility) with some level of additional incentive payments. PHC facilities are responsible for accuracy of the attached population information and number. This information is entered into e-Health system based on the citizens’ unique ID numbers. The system is in the process of being fully automated. Currently the population movements (births and deaths as well as relocations between PHC facilities) are updated in the centralized database of e-Health Center of the MoH and the information is transferred to MHIF once a quarter, while a full automation of the system will allow the system users to register and monitor the changes constantly. The capitation rate is the primary factor in defining each PHC facilities’ annual funding share, while in parallel the financing also consists of relatively small portions of ad hoc additional financing toward the end of year upon request to cover existing liabilities; results-based financing according to the Bank funded RBF project outcomes (as well as using the MHIF own funding starting 2018), as well as incentive payments to family doctors and nurses. PHC facilities also have small funding pools from population co-pay for medical services, and various income apart from delivery of medical services (i.e. rent of premises, grants from various sources, etc.). Each health institution develops its annual Estimated Expenditures plan (EE) based on the expected allocations from the MHIF and/or the MoH budgets and other sources, which is agreed with the MHIF and/or the MoH. Around 75% of primary health care EE relate to salary payments, including statutory tax and social payments (Data Source: the MoH and MHIF - see Table 1 below). The salary consists of several components (i.e. basic salary, additional top-ups, etc.), the limits of which are defined by the MoH. The planning and budgeting process of the republican budget is formed on the basis of the country’s social-economic development projections, the Parliament’s budget resolution, and the main directions of the country’s fiscal policy and in compliance with the requirements of the Budget Code. After the government approves the calendar plan for the budgeting process, instructions on preparation of Medium-Term Budget Framework (MTBF) are received, the MoH issues an order, specifying the activities, deadlines and responsible staff for the MTBF and annual budget preparation. The draft annual budget is discussed with the MoF. The MTBF is approved by the Macroeconomic and Investment Coordination Council of the Government of Kyrgyz Republic. The MTBF serves as a basis for the annual budget formation. The MHIF budget is separately presented for the government review the Parliament (Jokorgy Kenesh) and approval along with the republican budget. C1.2: Procurement Planning There is overall acceptable procurement planning capacity at the MoH. In general majority of PCH facilities have acceptable procurement planning capacity, however in certain PCH facilities there is a lack of certified procurement specialists, while in some other the procurement function is carried over by accountants. The MHIF has no any role in procurement planning for the health sector. Funds for the public procurement contracts are secured from the state budget. An annual procurement plan is prepared on the basis of the annual budget of MoH. All procurement entities prepare procurement plans separately (decentralized). The MoH issues an Order with which the annual procurement plan is approved. In preparing the procurement plan, the MoH collects information with regard to the needs of the various departments within the MoH and also from the various health institutions (state and county hospitals, primary health care departments etc.). It contains information in line with the 9 requirements of the Public Procurement Law, i.e. including the subject matter of procurement and its reference number, estimated value, type of public procurement procedure, including the procedure for awarding of a public service contract, as relevant, information if the public procurement procedure would result in a public procurement contract. The procurement plan is published on the Public Procurement Portal of the MoF immediately after the Order for it is issued, as well as it is sent to the Public Procurement Department under the MoF. Only after the budget funds are allocated, the PHC facilities can commence the procurement process. C.1.3: Expenditure Framework and Procurement Profile of the Program Table 1. Program Expenditure Framework (2020-2024 total) Estimated Expenditures % Proportion of for 2020-2024 Expenditures Financing In thousand In thousand Between the sources KGS USD equivalent9 MoH and MHIF TOTAL Government funds, of which 26,327,394 377,183 100% to be allocated to the MoH 2,040,918 29,240 8% Government to be allocated to MHIF 24,286,476 347,944 92% TOTAL Donor funds, of which 2,582,600 37,000 100% to be allocated to the MoH 1,413,450 20,250 55% IDA, TFs to be allocated to MHIF 1,169,150 16,750 45% TOTAL Government and Donor Funds, of which 28,909,994 414,183 100% to be allocated to the MoH 3,454,368 49,490 12% to be allocated to MHIF 25,455,626 364,693 88% Broken down by years (in thousand KGS) – Total Government and Donor funds 2020 2021 2022 2023 2024 Total The MoH 677,813 732,482 827,964 571,304 644,805 3,454,368 MHIF 4,769,793 4,901,979 5,214,876 5,148,522 5,420,456 25,455,626 TOTAL 5,447,606 5,634,461 6,042,840 5,719,826 6,065,261 28,909,994 Broken down by major economic classification (in thousand KGS) - Total Government and Donor funds Expenditure type MoH MHIF Total % share Salary and social payments 2,027,357 19,412,460 21,439,818 74.2% Goods and services (except audit and IVA) 1,297,516 5,002,031 6,299,546 21.8% Other (such as investments in fixed assets) 94,595 1,041,135 1,135,731 3.9% Audit and IVA services 34,900 - 34,900 0.1% TOTAL 3,454,368 25,455,626 28,909,994 9 This assumes an exchange rate of 69.8 Kyrgyz som for 1 US$. This rate is used by the Kyrgyz Government for 2019 budget as stated in the Explanatory Note to the Budget. 10 Expenditure economic classification at PHC Expenditure economic classification at PHC level % level % 2111 Salary 64.01% 2223 Purchase, sewing and repair of uniform 0.08% 2121 Social payments 10.34% 2224 Purchase of coal and other type of fuel 0.81% 2211 Travel 0.67% 2225 Security Services 0.04% 2212 Communication expenses 0.26% 2226 Bank fees 0.02% 2213 Rental expenses 0.05% 2231 Utility fees 3.89% 2214 Transportation expenses 1.62% 2235 Other utility fees 0.01% 2215 Other goods and services 1.81% 2721 Humanitarian support to population 0.00% 2217 Drugs and medical services 5.82% 2823 Legal fees 0.01% 2218 Food 0.84% 3111 Buildings and constructions 0.50% 2221 Repair expenses 2.45% 3112 Machinery and equipment 3.66% 2222 Inventory for administrative purposes 3.11% TOTAL 100.00% Data Source: the MoH and MHIF Major part of the Program will finance salary payments (including statutory tax and social payments). The Program will also finance minor repairs, goods contracts, which will include pharmaceuticals, medical equipment, various consumables and materials, as well as consultancy services including audits and verification. The procurement activities to be undertaken under the program will be noncomplex low value activities below the OPRC thresholds. Based on conducted procurement analysis for 2016-2017, procurement packages at PHC facilities did not exceed US$700 thousand equivalent. The total amount of all public procurement at PHC facilities level was 911,314,005 KGS (or around US$13 mln.) in 2016 and 848,371,582 KGS (or around US$12 mln. equivalent) in 2017 (Data Source: e-Portal. For details refer to Annex 2 below). Exclusions from the Program are major constructions and high-risk activities. These include activities which: (a) are judged to likely have significant adverse impacts that are sensitive, diverse or unprecedented on the environment and/or affected population; and (b) involve procurement of goods, works and services under high-value contracts. High-value contracts are specified as followed: (i) works, estimated to cost US$ 10,000,000 equivalent or more per contract; (ii) goods and non-consulting services, estimated to cost US$ 5,000,000 equivalent or more per contract; or (iii) consulting services, estimated to cost US$ 3,000,000 equivalent or more per contract. The risk associated with Program Planning and Budgeting is assessed as Substantial. C.2: Budget Execution C.2.1: Treasury Management and Funds Flow The government operates a treasury system with a Treasury Single Account (TSA) of the Ministry of Finance (the MoF) maintained at the National Bank of the Kyrgyz Republic (NBKR). The NBKR maintains overall adequate operational control over its exchange reserve management. The NBKR has established safeguards in financial reporting and external and internal audits, meanwhile it continues having vulnerabilities in the legal structure, particularly in governance arrangements; the audit committee's authority remains limited, and the NBKR Board is comprised only of executive members (Source: the IMF Staff Country Report - 2018). 11 The State Treasury implements an overall adequate control system, including commitment controls, application of automated transaction processing system and use of TSA, which, in general is adequate for the Program implementation. Cash planning and monitoring has been considerably facilitated by the automated IS: Kazna treasury software in which all expenditure and revenue are registered as transactions take place, and which prevents the execution of any payment which is not provided for in the budget. However, there is no integrated TMIS existing at the treasury system. While there were several attempts to implement the system during past several years, however this has not been done and there is still uncertainty about the authorities’ intentions in regards of implementation of the TMIS system. The MoF initiated the introduction of PBB classification to the Treasury automated system. Relevant IT system functionality for budget execution was developed and since January 1, 2019, program classification of expenditures is being piloted to be introduced to the automated informational system of budget implementation “IS: Kazna, treasury softwareâ€? for central government’s ministries and agencies. The central government’s ministries and agencies will be able to fully use the program classification as well as economical, functional and administrative classifications during budget execution, as the system will allow forming reports on actual budget expenditures by budget programs and measures. Each health sector organization has sub-accounts at the treasury system within the TSA, to which the Treasury controls are applicable. MHIF annually signs service provider agreements with PHC facilities, which specifies the level of allocated funding as well as the level and types of expected services. Based on the agreement, the PHC facilities prepare their annual budgets and agreed with MHIF. Based on the approved budget the PHC facilities prepare monthly cash plans for their needs of funds and submit for MHIF approval, and the transactions are processed according to such approved plans via treasury system and subsequently reported to MHIF via MHIF territorial departments. The co-pay for medical services contributed by the population at a PHC facility in the form of petty cash is promptly placed to the respective treasury sub-account of the PHC. Respective reports are available through treasury system for reporting on the use of the allocated funds. The Program will rely on the country treasury system, and the Program’s IDA and MDTF funds will be disbursed upon achievement of the DLIs. Evidence of achievement will be based on the MoH’s and/or the MHIF’s respective technical documentation and will be verified by the IVA following the Verification Protocol. The Bank will review the documentation submitted and will reserve the right for further due diligence on the robustness of data as needed. After the World Bank formally considers the DLI(s) met, it will then issue an official letter to the government confirming the achievement of the DLI targets and the value of disbursement. The MoH then will submit a Withdrawal Application (WA) for the disbursement of the respective amount. For some DLIs, for which the achievement relates to calendar year (such as number of diabetic patients receiving HbA1C test at least once a year), the verification will take place during the first quarter of the subsequent calendar year, and disbursement will be made during the second quarter of the subsequent year. Overall, disbursements for the Program will be made twice a year as applicable. The achievement of time-bound DLIs must happen by the deadline for achievement as outlined in the DLI matrix in the PAD. For non-scalable DLIs, the World Bank will disburse the DLI value only upon full achievement of the DLI targets. For scalable DLIs, the World Bank will disburse against the formulas as set out in the DLI matrix. 12 The major risk for the Program implementation would be the ability of the treasury to release necessary level of funding for the Project implementation at the beginning of a fiscal year. Recently significant underfunding of the sector was observed for January-February 2019 for MHIF and the MoF funds (see Table 2 below - Data Source: the MoH and MHIF), which was sufficient to cover only "protected" category of expenditure (such as salaries, transfers to the social fund). Table 1. Republican Budget Funding Release Data for Health Sector (in million KGS) MoH MHIF Periods Budget Budget Budget Actual Budget Actual Release % Release % January 202.7 151.0 -25.5% 904.4 633.1 -30.0% 2019 February Not available Not available - 904.4 723.5 -20.0% Quarter1 425.3 343.0 -19.3% 2,537.9 2,537.9 0.0% Quarter2 618.0 549.6 -11.1% 2,537.9 2,537.9 0.0% 2018 Quarter3 628.1 497.7 -20.8% 2,605.9 2,605.9 0.0% Quarter4 1,234.0 1,025.9 -16.9% 2,884.9 2,784.9 -3.5% TOTAL 2,905.4 2,416.2 -16.8% 10,566.7 10,466.7 -0.9% Quarter1 424.5 417.5 -1.6% 1,779.0 1,756.1 -1.3% Quarter2 728.6 596.3 -18.2% 2,641.2 2,664.4 0.9% 2017 Quarter3 736.7 573.1 -22.2% 2,470.4 2,470.1 0.0% Quarter4 1,064.7 884.6 -16.9% 2,670.4 2,589.2 -3.0% TOTAL 2,954.5 2,471.5 -16.3% 9,561.0 9,479.8 -0.8% Quarter1 703.5 427.3 -39.3% 1758.3 1799.0 2.3% Quarter2 766.2 686.0 -10.5% 1852.2 1815.7 -2.0% 2016 Quarter3 569.8 409.1 -28.2% 2202.1 2363.5 7.3% Quarter4 619.9 946.8 52.7% 2722.8 2553.3 -6.2% TOTAL 2659.3 2469.2 -7.2% 8535.4 8531.5 0.0% To ensure timely availability of the Program funds to the MoH and MHIF, upon achievement of DLIs and their verification, satisfactory to the Bank, the Program funds will be transferred by the Bank to the Treasury Single Account of the MoF. Upon receipt of the funds, the MoF, based on the MoH request, will convert the received US$ funds into equivalent amount in local currency and transfer the funds in full to the MoH and MHIF. In order to enable the MoH year-end balances of unspent funds to be carried over the next fiscal year, the MoF proposed using a special account to be opened at the Treasury for the MoH, to which the respective part of the Program funds will be transferred. Given that as per the MHIF budget law, the year-end balances of unspent funds will remain at MHIF disposal, there is no need to have a similar special account for the MHIF. It was agreed that the MoF will ensure that the transfer of the Program funds to the MoH and the MHIF in corresponding amounts is made within a reasonable time after the Program funds are received to the MoF treasury account. 13 It was agreed that disbursements against the achievement of DLIs 1-8 will be equally split between the MoH and MHIF, while disbursements against the achievement of DLI 9 will be fully made available to the MoH. Following the effectiveness of the legal agreements, the Bank will make available in total of US$ 5 million as an advance payment: US$2.5 million from the IDA grant and US$2.5 million from the IDA credit, respectively. It was further agreed that the Advance will be equally split between the MoH and MHIF. The need for the advance is driven by the constrained fiscal environment and the need to kick-start Program implementation by carrying out initial activities (such as developing technical specifications for several e-platforms). This is particularly important because the Program effectiveness is planned for the beginning of a calendar year (CY 2020), when tax collection is typically low and Kyrgyz government is faced with a cash constraint situation. When the DLIs are achieved, the amount of the advance is deducted (recovered) from the amounts due to be disbursed under such DLIs. The advance amount recovered by the Bank is then available for additional advances (“revolving advanceâ€?). The Bank requires that the Borrower refunds, no later than six months after the legal agreement(s) closing date, any advances (or portion of advances) if the DLIs have not been met (or have been only partially met) by the PforR Program Closing Date. At the end of the Program, any amount disbursed under DLIs that will exceed the actual expenditures level for the whole Program period till the Program closing date, will be reimbursed to the Bank. Summary of disbursement schedule by DLI is described in the below table. The risk associated with Treasury Management and Funds Flow is assessed to be Substantial. C.2.2: Accounting and Financial Reporting The FSA confirmed that, while in general, the accounting and financial reporting systems of the MoH, MHIF and PHC facilities are overall adequate with adequate records to be maintained for the Program, the major risk to the accounting and financial reporting systems is the staff low capacity and high turnover4. The 2014 PEFA notes that accounting and reporting system in the country still needs to be improved. At the central level detailed monthly budget execution reports are produced by the State Treasury that are compatible with the budget estimates, administratively, economically and functionally but as yet not programmatically. As explained in the above section, the MoF takes necessary steps to improve the system for allowing PBB classification as well. The reports capture expenditure at the payments stage but not at the commitment stage. Monthly and quarterly in-year budget reports are 14 prepared timely. The Treasury produces also an annual set of financial statements, which are submitted for audit within five months of the end of the financial year as required by the legislation. Public sector accounting and financial reporting is based on the MoF approved respective instruction and manual issued in 2014 with latest update in December 2018. Despite the efforts of the government, the full implementation of national accounting standards in public sector (Kyrgyz Republic Public Sector Accounting Standards - KRPSAS) based on IPSAS, still requires investing substantial resources, in particular, for training and retaining the experienced accounting staff. In the course of the implementation of SWAp project, significant resources have been invested for developing accounting and financial reporting systems at PHC facility level. The systems at local level are automated, and all health facilities have installed 1C accounting software, which has major accounting modules such as general ledger, accounts payable and receivable, warehouse (for medications, food, payroll), HR, non-current asset register, etc. The maintenance of the accounting and financial reporting systems at PHC facility level is reliant on a number of accounting and IT support consultants currently being financed under SWAp-2 Project. These consultants provide critical support to the sector’s accounting and financial reporting system by providing timely updates to the accounting software at each PHC facility as well as providing hands on training to the PHC facilities’ accounting staff on any changes in the legislative requirements and reporting forms. As of September 2018, the MoH monitoring indicated the following statistics on the use of the accounting software by health facilities: only 64% of them fully utilize the accounting software, with 3% not using it at all, while the rest is using the software only partially. In addition, only 47% of the accounting staff of health facilities has certification in 1C software (Data Source: the MoH monitoring report). Therefore, given the low capacity and high turnover of the accounting staff at PHC facilities and the MoH, the MoH should ensure that the required level of critical support by the consultants to the system is maintained and additional necessary steps are taken to enhance the accounting and financial reporting systems. For this purposes, it has been agreed that the MoH will continue using services of two key consultants who would provide development and maintenance services for the sector’s IT and accounting systems at centralized level. Additionally, the relevant staff of the MHIF regional departments will provide support to PHCs’ accounting staff for the upgrade on the 1C accounting software as well as accounting/financial reporting policies, procedures and reporting formats as necessary. The MHIF regional department staff will also be responsible for providing IT and accounting related hands on training to the PHCs’ accounting staff as needed. The IT and accounting consultants at the MoH central level will be also responsible for providing methodological and technical guidance as well as training to the respective MHIF regional staff as needed. For purposes of the Program accounting and financial reporting, the Bank will rely on the existing government accounting and financial reporting arrangements, and the MoH will be responsible for submission of Program annual audited financial statements to the Bank. The Program annual financial statements to be audited will be consolidated by the MoH based on inputs provided by MHIF, and will include: (i) a summary of Program funds received (separately indicating those received under each DLIs) and a summary of Program Expenditures under the Program headings, both for the current fiscal year and accumulated to-date; and (ii) Notes, comprising a summary of significant accounting policies and other explanatory notes. Modified cash basis accounting is used in the health sector, with 1C accounting software installed at each PHC facility. However, as indicated above, there are still cases observed when the software is not fully utilized due to lack of sufficient software skills and high turnover of the accounting staff 15 due to low salary level. In particular, due to lack of sufficient knowledge, the accounting staff of some PHC facilities are not aware of the full functionality of the accounting software and make the preparation and submission of the financial reports without the use of electronic submission through the 1C system but manually with the help of consultants and the staff at the territorial departments of the MHIF. Also, there is a risk of unauthorized access to 1C accounting software due to lack of individual passwords to the system, use of unofficial mail servers for official communication, were observed (Source: External and Internal Audit reports). The risk associated with Accounting and Financial Reporting is assessed to be High. C.2.3: Procurement Processes and Procedures The legislative and regulatory framework of Kyrgyz Republic is generally comprehensive and uses competitive bidding as its default method of procurement. There are different methods of procurement and their conditions of use are outlined in the Public Procurement Law (PPL) enacted in April 2015, which are generally aligned with international good practice, including UNCITRAL Model Law on Procurement, that can be used for goods, works, services and consulting services. The PPL represents the following features: • Establishes Independent Complaint Review Commission (ICRC), • Allows challenges in procurement planning, procurement method to contract award, • Mandates publication of intent to go for Direct Contracting, • Introduces modern procurement methods such as Framework Agreement and e-reverse auction, • Mandates development and use of standard bidding documents, • Does not permit splitting of requirements with a view to avoiding competitive procedures, • Requires establishment of the clear criteria for rejecting a bidder from the bidding process, • Introduces the anti-bribery clause, violation of which is among the criteria for inclusion into the database of unreliable suppliers and prohibits bidding that is not included in the procurement plan. Since May 14, 2015, all Public Procurements in Kyrgyz Republic have been done electronically, which means a complete transition to e-Procurement. The official e-Portal is in operation and a single uniform system of Public Procurement has been created. The introduction of the e-Portal helped to ensure transparency, openness and public access to information on the opening of the bids, procurement procedures and competitive award of contracts. The conditions for suppliers and contractors have also been made uniform, and any party registered on the e-Portal can participate in a tender announced on the e-Portal, on equal footing with all others, except when domestic preference is used. Standard bidding documents exist for goods, works. consulting and non-consulting services and secondary legislation are available on the e-Portal to all procuring entities and suppliers and contractors. The guidelines available on the e-Portal are comprehensive covering many elements of the procurement life cycle as detailed in the following table. Topic Document Law • Procurement in Government organizations, SOEs and OJSCs with Government share more than 51% • Code of administrative offences 16 • Procurement from societies/organizations of disabled people Secondary legislation • Regulations on Government Procurement Department • Regulations for centralized procurement • Threshold regulations • Regulations on how to implement the Law on Procurement from societies/organizations of disabled people • Decree on accumulation of savings from procurement • Regulations of procurements in national security, defence and state secrets. Orders of the Ministry of • Regulations of e-Procurement for Government entities Finance • Instructions how to apply domestic preferences in procurement • Instructions how to evaluate the bids • Instruction for Framework (long-term) contracts • SPD’s for Single Stage, Two Stage and Simplified Acquisition • Order of the Ministry on the establishment of Independent complaints review committee • Guidance on reverse method of procurement • Guidance on consultant selection • Program of improvement of Government procurement system Templates for procurement • Instruction on bidding documents, advertisement and planning and other aspects publishing the results of tenders • Template for procurement report • Description and volume of goods produced by society/organizations of disabled people Information pertaining to Public Procurement can be found on the Public Procurement Departments (PPD) e-Portal10. The web portal is in Russian, Kyrgyz and English (limited coverage). For transparency in Public Procurement in Kyrgyz Republic and to enable open competition, all procurement opportunities must be advertised on the e-Portal and any questions received through the procurement process must be shared with all bidders through the Portal and within a timely manner. The procurement of goods, works and services must be performed using one of the following methods. Method Description are10 http://zakupki.gov.kg/popp/home.xhtml 17 Single Stage The key Public Procurement method under the PPL. The number of Bidding suppliers/contractor is not limited. Two Stage Bidding The first stage invites bidders to submit initial bids containing their proposals without specifying the bid price. The second stage the procuring entity invites all bidders who didn’t have their initial bid rejected to submit their final bids with specification of prices based on the revised procurement terms. Simplified Simplified acquisition method is used when procuring finished products Acquisition that do not require special manufacturing, as well as works and services with specific description valued less than the thresholds. To ensure competition bids must be considered from at least two contractors. The successful bid shall be an eligible bid with the lowest price that meets the needs of procuring entity. Reverse Auction Procuring entities may conduct electronic Reverse Auction for the procurement of goods and services if such goods and services have established standards of quality and a specific description of services. There must be at least three suppliers to ensure efficient competition. Direct Contracting Direct contracting enables the procuring entity to sign a contract with one supplier after the monitoring of prices. Within two days prior to the Direct Contracting the procuring entity shall publish on the e-Portal information about the procurement. The procuring entity may also Direct Contracting if the additional procurement of goods not exceeding 15 percent of the awarded contract price or if additional construction works or services do not exceed 25 percent of original contract price of a contract. While the PPL adopted in 2015 was in line with good international practices, the Government initiated revisions of PPL soon after effectiveness. Amendments to the PPL were signed by the President of KR in January 2019. There amendments did not include any major changes impacting procuring entities and private sector. Preparation of tender documents and technical specifications. The persons involved in the preparation of the specifications are medical doctors and other various experts, depending on the material(s) to be tendered. The preparation of technical specifications and the tender documents is a lengthy process and often takes significant time to accumulate basic information, as it involves numerous consultations with the public institutions for which the joint procurement is conducted, with the business community, and a consultative group comprising various ministries and institutions. The tender documents, including technical specifications are prepared in-house. The technical experts that have prepared the technical specifications usually participate later on in the evaluation process. Opening and evaluation of bids. Tenders are opened in public and minutes of public opening are prepared in a form and content as defined in the above referenced Regulation. A copy of the minutes is made available to all authorized representatives of the tenderers. Evaluation is done in accordance 18 with the evaluation and qualification criteria in the tender documents and is carried out by an evaluation committee. Public Procurement Capacity Building. The Training Centre (TC) of the MoF delivers, on a regular basis, a five-day introductory course on management of public procurement of goods, works and services. In addition to five-day training a two-week advanced course (face-to-face) is offered. And an online version of the introductory course is available on the TC’s website. Certificates are issued for the training. Because Internet connectivity is still unavailable in remote villages, the training course is also distributed in a CDs version. The CD version is to assure that local MoF offices and municipalities as well public organizations have access to the course anytime/anywhere. Mandatory certification is required for conducting public procurement. e-Portal. The introduction of the Governments e-Portal has strengthened the transparency of Public Procurement in Kyrgyz Republic. It has also made the procurement process more effective and efficient. For the moment e-Portal is missing functionality to support selection of consultants and procurement of specialized goods (pharmaceuticals), but actions to fulfil this gap are ongoing and shall be completed by the end of 2019. Eligibility. Open eligibility applies and registration of bidders to the e-Portal does not seem to pose a barrier to participation. The use of domestic preference applies but is used in less than 1% of procurements. Recently prepared amendments to PPL propose mandatory use of domestic preference. In addition, there are difficulties for foreign pharmaceutical companies to participate in tender process. According the local legislation (Law #165 dated August 2, 2017 “On pharmaceuticalsâ€? of the Kyrgyz Republic) the foreign pharmaceutical companies should be registered in the License Department of the MoH before participation in a tender. In 2017 and 2018, 11621 tenders were conducted by health procurement entities in the country. Only one foreign company registered before tender. This confirmed that there is no attraction for foreign companies to register before awarding the contract. It is necessary to allow for foreign pharmaceutical companies to participate in tender process, while the bidder is starting in parallel the registration with the Licence Department (14 days). In case such bidder is recommended for contract award, the License Department of the MoH will have to register the firm in 21 days. All above mentioned conditions only applicable for Stringent Regulatory Authorities countries, Regulator Countries and suppliers of pre-qualificator pharmaceuticals according Decree #405 of the Government of the Kyrgyz Republic dated August 28, 2018. For other countries, duration of registration about 90 days. C.2.3. Complaints Handling Mechanism On October 14, 2015 the MoF approved the regulation on the procedures of the ICRC. The ICRC was established six months later in March 2016 with a mandate to ensure fair resolution of any procurement related complaints. Unreliable suppliers can be included for non-fulfilment of their contractual obligations, and for violation of the rules of participation in the PPL by the ICRC. Currently complaints are reviewed by a panel of experts who have completed the mandatory procurement training. When a complaint is received an automated computer programme randomly selects one expert from each of the three groups to review and decide on the complaint. The selected member from each group reviews the complaint and any accompanying documentation online and required to submit their response through the e-Portal and the use of e-signatures will be implemented subject to the approval of the PPD’s development plan and appropriate funding. The PPL includes a standstill period between notification to award the contract and contract 19 signature. The standstill period for Simplified Acquisition is two (2) working days and for Single/Two Stage is seven (7) working days. The PPD are looking at options so that when a complaint is received, the e-Portal automatically stops the procurement process and locks the system so that access isn’t given to the procurement process that a complaint has been received until the complaint has been reviewed by the ICRC. While existing complaints review mechanism is sufficient, there is risk of sustainability/quality of complaint review due to the fact that penal of experts is working on voluntary basis. Conducted analysis showed that in the health sector 147 complaints were received by ICRC during the year of 2018. Review period in 54% (80 complaints) was more than 10 days while PPL requires that review is conducted within 7 days (see details in Annex 7 - Data Source from E-Portal) Database of the unreliable contractors and suppliers. The PPL has provisions to blacklist poor performing suppliers and contractors. If a blacklisted contractor or supplier feels they have been unfairly blacklisted, they can present their case to the ICRC for independent review. If the ICRC upholds the blacklisting, the contractor or supplier still has the rights to take their case to court. The modules for online filing of complaints and for publication of decisions on the e-Portal have been developed, tested and launched. In accordance with Articles 9 and 49 of the PPL the decisions of the ICRC for review of complaints are posted on the e-Portal. Despite of obvious improvements, sustainability of the complaints review system raises certain concerns because experts are working in this commission on voluntary base. These arrangements do not provide for required professional capacity of the commission. The government should introduce either a small fee for submission of complaints or consider other ways of the experts’ motivation and capacity building. The risk associated with Procurement Processes and Procedures is assessed to be Substantial C.3: Internal Control System C.3.1: Internal Controls, Contract Management and Internal Audit The internal control procedures in health sector are regulated by the Budget Code, budget laws, government decrees, ministerial orders and internal instructions of the MoH and the MHIF. The PEFA 2014 founds that the controls over non-salary and salary expenditures still need to be improved. Control over non-salary expenditure is exercised only at the payment/liability stage, and not at the order/commitment stage. Controls over payroll remain weak, with each health facility responsible for its own payroll within aggregate allocations from the MoF and MHIF. The procurement control procedures are defined in the PPL, according to which, if the value of procurement made under one bidding (taking into account the total amount of all lots) exceeds the fivefold ceiling amount, prior to concluding a procurement contract with the bid winner, each procuring entity must conduct a procurement audit (to be conducted by Internal Audit department) in order to ascertain the compliance of the procurement with the requirements, established in this Law and other regulations of the Kyrgyz Republic, regulating public procurement. Compliance with the PPL is the responsibility of the PPD and is reviewed by the Chamber of Accounts and Internal Auditors. The Program will largely finance salary payments (including statutory tax and social payments), estimated to be around 75% of the Program expenditures (see Table 1 above). Salary and related statutory payments are made via treasury transfers with no use of petty cash. There is overall 20 acceptable level of payroll controls at central, the MoH and MHIF level. Although the sample review of payroll and salary payments at selected eleven PHCs conducted during the assessment did not identify major issues, the level of payroll controls at PCH facility needs to be improved as the internal and external audit reports of on-going Bank-financed projects in health sector identified cases of inaccuracies with payroll calculations (as a result of lack of sufficient knowledge on relevant legislations and regulations), and improper maintenance of timesheets at some health facilities (Source: External and Internal Audit report) . Additionally, the reviews conducted by Internal Audit functions of the MoH, the MHIF and the Chamber of Accounts identified cases of falsified doctors’ qualification certificates (used to obtain additional top-ups to the salary levels), improper application of top-up rates (such as for work experience or improper documentation) and conducting purchase of goods without proper bidding procedures. Some of the above issues are the result of low capacity of the respective staff at PHC facilities, while others indicate a need for enhanced controls. To eliminate such practices, the MoH takes actions such as making online accessible the information regarding the doctors’ qualification issued by training center. Starting the FY2018 end the MHIF implements the result-based incentive payments to PHC’s with the aim to improve the financial situation of PHC facilities and medical staff salary. The MoH has developed specific instructions on the result-based incentive payments, which are overall adequate, however do not include procedures for physical verification of the delivered results (such as contacting patients via phone and verifying the fact of service provision). Another area of concern is improper segregation of duties between procurement and accounting functions at some PHC facilities. As per the MoH monitoring data, as of November 2018, around at 30% of PHC facilities the procurement function is carried out by accounting specialists (Data Source: MoH monitoring report). The MoH should adopt respective measures to eliminate such a practice by segregating these duties. In general, there are adequate contract management arrangements at the MoH level, with some minimal contract management arrangements in place at PHC facilities, which however need to be improved. PHC facilities have their own systems to monitor the usage of goods and materials. While each PHC facility operates an inventory monitoring system, it is not connected to the general ledger or accounting system. In eleven sample PHC facilities reviewed goods acceptance procedures were not clear and could lead to increased fiduciary risks. There is overall adequate control at the PHC and MHIF level over medication prescription and payment scheme under state guaranteed drug benefit packages. The prescriptions are issued in prenumbered forms in three copies with different colors, one of which is issued to the patient, who based on the prescription gets the necessary medication at participating drug stores. The PHC facility enters the prescription information into the MHIF electronic prescription database. The medication cost is reimbursed to drug stores at predetermined rates directly by MHIF, upon the requests received from drug stores and after reconciliation of the payment request with information the electronic prescription database. In the meantime, the registration and distribution scheme at PHC facility level for medication procured locally and to be used in-house at PHC facility should be improved. The in- house procured medication is registered in warehouse module of 1C accounting software, with details indicating the medication name, quantity, price, expiration day, and other details. The medication is distributed as per the per the doctors’ request accompanied with three copies of medication distribution note (one stays at ware house, the other is sent to accounting division, while the third one stays with the recipient). At this level the register and distribution of medications are automated and reflected in the accounting software. However, further distribution of medication to 21 patients is only manually recorded in patients’ medical cards, and there are no any controls exercised to verify that the medication actually was delivered to patients as recorded in books. A sample physical verification for medication distribution to patients should be exercised at PHC facility level. To reduce the above risks, with the support of KfW, internal instructions for acceptance of medical goods have already been developed, and it is expected that the MoH will approve and disseminate the instructions to PHC facilities for execution. Additionally, the MoH and MHIF internal auditors will conduct a sample physical verification of medication distribution to patients. During the fiduciary systems assessment, cases of delayed payments for goods accepted were observed, which were due to unclear payment terms in contracts, not specifying a specific deadline for payments; instead the contract indicates that the payment will be made upon provision of financing from the budget. The MoH should ensure that the contracts specify specific deadlines for payments, which should not exceed 3 months period after goods acceptance, as indicated in PPL. During the assessment, payments under 55 sample contracts at eleven PHCs were reviewed, and it was observed that in only around 55% of payments were made within 90 days of the receipt of goods/services. The rest of the contracts were paid within a period exceeding 90 days, of which seven contracts were paid during the period exceeding 150 days, with one paid on the 339-th day after the delivery (Data Source: e-Portal. Also see Annex 6 below). In general, the payable period for such arrears for goods/services is no more than a year. The imposition of a specific payment deadline in contract would significantly improve the payment practice at PHC facilities. The Internal Audit (IA) function in Kyrgyz Republic is gradually gaining more importance and reliance in the public sector. The IA function is governed by the Law on Internal Audit. In 2014, a Council on Internal Audit was established, chaired by the MoF. This body was established by law and is responsible for developing recommendations on internal audit strategy. Internal audit units report to senior management of their respective organizations. The Central Internal Audit Department in the MoF has overall responsibility for Government internal audit methodology. Internal audit works independently of routine payment and accounting systems. All agencies are subject to annual financial audits by internal audit. Internal audits are carried out through the year findings/recommendations are acted upon in a timely manner as all recommendations are mandatory. The government reforms in IA function were continuously supported by the Bank11. In particular, the IA methodology was improved, the quality assurance and improvement program, continuous professional development program, training materials were developed and adopted. Meanwhile, although there is an evidence of improvements in coverage and quality of public sector internal audit function, the frequency, quality and distribution of audit reports as well as the extent of management response to internal audit findings still need improvement. Another aspect for concern is the high turnover of qualified staff. There is overall adequate IA function at both the MoH and the MHIF, while no IA function exists at PHC facility level. In total 12 staff in the sector is involved with the Internal Audit function (the IA unit of the MHIF consists of eight staff, while the IA unit of the MoH has only four staff), making it the largest in the public sector, constituting over 10% of the IA resources in the public sector (Data Source: MoF annual reports on IA function activities). Most of the IA staff has passed local 11 Under IDF Grant for Capacity Building for Public Sector Internal Audit Project (TF012781). 22 IA qualification exams and participated in a number of accounting, financial reporting and procurement trainings (Data Source: IA staff CVs). The professional qualities of the staff to conduct audits are overall adequate, and the audits are conducted as per annual audit plans and cover health institutions, including PHC facilities with higher risks determined based on the size of the institution’s budget and issues identified during previous years’ audits. It was observed that due to limited number of the IA staff as well as increasing level of requests from other supervisory bodies (such as Chamber of Accounts, Prosecutor’s Office, and other Law Enforcement bodies) to assist in their inspections and to conduct special and ad hoc audits, the annual audit plans are underperformed resulting in some health institution not being audited for long periods. In total in 2017 the health sector’s IA function conducted audits of the health facilities with 1,588 staff/day input, of which 544 staff/days input (or around 34% of total input) was provided for special reviews. The latter represents over 27% of total special reviews/investigations in public sector, indicating greater reliance of the law enforcement bodies on the professional qualities of the health sector IA function. In 2018 the use of the law enforcement bodies of the health sector IA function increased to over 38% of total staff/day input by IA function of the health sector. (Data Source: The MoF annual report on IA function activities, the MoH and MHIF IA reports). It is also worthwhile to indicate that the sector’s IA function is among those few in public sector with highest level of follow up and implementation rate for audit recommendations: 653 recommendations out of 703 issued in 2017 (amounting to 93%) and 617 out of 641 issued in 2018 (amounting 96.3%) were implemented during the audit year (Data Source: The MoF annual report on IA function activities, the MoH and MHIF IA reports). To ensure stricter control at PHC facility level, it has been agreed that within the Program, the IA units of the MoH and the MHIF will combine their resources and will conduct joint audits of the PHC facilities, including test of control systems on achievement of results (such as sample based physical verification of service delivery to patients). The annual plans of the IA units of the MoH and MHIF will also include the review of implementation of the activities under the Program. The annual audit plans of the MoH and the MHIF will ensure that each PHC facility is audited at least once in a three-year period, with more regular audits of health institutions with higher risks. During the IA audit, particular attention should be paid to payroll controls at PHC facility level, sample physical verification of medical services delivered to patients, review of control system over medication and drug prescription registration and distribution. The IA units of the MoH and MHIF will agree with the Bank the annual audit plans, terms of reference and the audit scope. Also, the audit reports and findings will be shared with the Bank. The risk associated with Internal Controls and Internal Audits is assessed to be High. C.3.2: Program Governance and Anticorruption Kyrgyz Republic ranked 132th out of 180 countries according to Transparency International Corruption Perceptions Index 201812 representing a slight change since the last year position of 135th. Although there is a quite intense anti-corruption agenda in the country and the current efforts of the Government and the state bodies on setting anti-corruption measures are encouraging, the current 12 https://www.transparency.org/cpi2018 23 system of distribution and coordination of anti-corruption functions is ineffective as the functions are dispersed among too many authorities, when everyone does everything without proper coordination, making it impossible to ensure the necessary level of independence, allocation of resources and specialization of these authorities in accordance with the international standards13. The Law of the Kyrgyz Republic "On National Security Bodies of the Kyrgyz Republic" specifies that the national security bodies of the Kyrgyz Republic combat corruption and carry out operative and investigative activities, inquiries and preliminary investigations of individuals who have committed offences or are suspected of committing them, including through the use of operational, technical and other means, and keep records of these persons. In the framework of the State National Security Committee of the Kyrgyz Republic, the Anti- Corruption Service (ACS) was established by the decree of the President of the Kyrgyz Republic. The ACS’s task is to prevent, suppress, identify, and investigate corruption offences, for cases established by the law, against individuals at top political and administrative positions at state and municipal level, staff of law enforcement, judicial and other state and municipal bodies, heads of institutions, organizations which are financed from the state budget or if the state has its stake in. On the other hand, the investigation of criminal cases in the system of national security bodies is carried out by the Main Investigation Department (MID) and investigative units of the regional departments of the State National Security Committee (SNSC) of the Kyrgyz Republic. Both the ACS and the MID are structural subdivisions of the State National Security Council (SNSC) and report to the senior management of SNSC. Another national level body, which is assigned anti-corruption functions is the State Service for Combating Economic Crimes (also called Financial Police), the specific functions of which are defined by the Regulation "On the State Service for Combating Economic Crimes (SSCEC) under the Government of the Kyrgyz Republic," approved by Government Resolution in 2012. Among several tasks of the Financial Police are carrying out investigation and operational search activities, registering, examining applications, reports, incoming materials from state bodies and individuals on crimes committed, being committed or prepared, and also taking timely measures to prevent, disclose, detain persons who committed them. Also, it determines tactics and methods of operative and investigative activities, develops methods to counter economic and official offences, conducting professional training. The Office of the Government coordinates the state bodies’ work to develop and implement state anti-corruption plans, as well as controls the implementation and analyzes the anti-corruption situation in the country and develops improvement measures. The Prosecutor General is responsible for coordination of activities on fighting corruption of law enforcement, fiscal and other state bodies, state administration and local self-government bodies, analyses information on the state of corruption in the country, assesses the effectiveness of the measures taken. At the national level regular coordination meetings are held under the chairmanship of the Prosecutor General with the participation of the Secretary of the Security Council, the Prime Minister/Vice Prime Minister, deputies of the Supreme Council, representatives of the Office of the President, the 13 https://www.oecd.org/corruption/acn/OECD-ACN-Kyrgyzstan-4th-Round-Monitoring-Report-2018-ENG.pdf 24 heads of the Supreme Court, the Chamber of Accounts, ministries and departments. Similar meetings are held by at regional level. An institution of the Commissioner for Preventing Corruption in the State Bodies has also been established. In connection with the introduction of this office there were introduced full-time offices of the Commissioner for Preventing Corruption for 43 state bodies in the Register of the State and Municipal Offices of the Kyrgyz Republic (Decree of the President of the Kyrgyz Republic as of January 31, 2017 No. 17). In some ministries and departments there operate anti-corruption departments (units) with a staffing of 3-4 full-time offices. At the MoH the anti-corruption Commissioner’s unit is functioning relatively recently and is at its premature stage. It has only one staff assigned to this function who is working at this position since October 2018. The main responsibilities of the Commissioner include coordination the MoH activities in combating corruption, and developing anti-corruption action plan for fraud and corruption prevention as well as monitoring of implementation of anti-corruption measures. The anti-corruption action plan for such units is approved by the Government, and the reports are approved by SNSC. The Commissioner is also responsible for assessing corruption risks in the sector, identifing factors that may create potential for conflict of interest, conducts analysis of the MoH Public Reception Center’s work on registering and addressing complaints received from citizens, as well as monitoring of mass media information on fraud and corruption. The anti-corruption Commissioner represents the main chain linking the MoH and SNSC on fraud and corruption agenda. The MoH Public Reception Center is responsible for registration of and follow up with written and oral appeals of citizens. The Center is guided by the Law of the Kyrgyz Republic No. 8 “Procedure for considering proposals, applications and complaints of citizensâ€? dated July 05, 1995 and other regulatory and legal acts. The main task of the Center is the timely response to complaints of citizens of the Kyrgyz Republic on health issues. The Center employs three specialists, who are responsible for transferring the application for consideration to relevant authorities and taking respective actions or rejecting a complaint (if unjustified) with respective clarification provided. The complains are registered in two books of records (one for personal visits to the Center and the other for complains received via “hot-lineâ€? phone at the MoH). Citizens are promptly notified on the results of their complaint. Once a year, the Prosecutor’s Office of the Kyrgyz Republic conducts routine inspection of the registration of complaints and respective measures taken. During 2017, 1871 appeals (1,294 via phone calls and 577 in person appeals) were registered, and during 2018 1766 appeals (1,417 via phone calls and 349 in person appeals). Complaints mostly relate to poor treatment, poor quality of services (such as rudeness and negligence), issues relating to co-payment, poor ambulance work, extortion of money, etc. At year end all complaints have been resolved (or justifications provided for rejected complains), with no pending issues. To address the possible cases of fraud and corruption associated with the Program implementation, the Program will rely on the respective country systems, and the MoH anti-corruption Commissioner will be the responsible staff for the implementation of the Program anti-corruption measures. The Program implementation will be aligned to the Anti-Corruption Guidelines (ACG) applicable to PforR operations, and will include the below measures: Sharing of debarment list of firms and individuals. The Recipient will use the World Bank’s List of Debarred and Cross-Debarred firms and individuals to ensure that persons or entities debarred or suspended by the Bank are not awarded contracts under the Program during the period of such debarment or suspension. The list can be accessed on the World Bank’s website 25 (www.worldbank.org/debarr). The compliance with this requirement would be checked by the Program’s procurement auditor. Sharing of information on fraud and corruption allegations. The Recipient will share with the World Bank information on all complaints and actions taken or being taken on complaints and grievances received on fraud and corruption under the Program. The World Bank will be also informed about the actions and decisions taken by the relevant institutions to address the matter raised in the complaint. The Commissioner for Preventing Corruption located in MoH will be responsible for collecting this information and sharing with the Bank. Investigation of fraud and corruption allegations. The implementing agencies will provide full support to the country’s anti-corruption agencies and the World Bank when carrying out investigations related to fraud and corruption allegations made during the Program implementation. The World Bank will be informed on all credible and material allegations or other indications together with the investigative and other actions that the Recipient proposed to take with respect thereto. The World Bank will retain a right to investigate allegations, and the Recipient will provide the World Bank the necessary access to needed persons and information applicable to the Program. Other pillars of the Program Anti-Corruption system include use of independent auditors/verifiers for the audit/verification of the Program. The auditors will be appointed from the list of auditors acceptable to the Bank. In addition, as it was agreed during the Program assessment, the IA units of the MoH and the MHIF will combine their resources and will conduct joint audits of the PHC facilities. The annual plans of the IA units of the MoH and MHIF will also include the review of implementation of the activities under the Program. The risk of fraud and corruption under the Program is Substantial. C.4: Program Auditing All public-sector entities are subject to oversight by the country’s Supreme Audit Institution (SAI) – the Chamber of Accounts of Kyrgyz Republic. The Chamber of Accounts is responsible for the audit of Government, including Republican and Local Self-Governments (LSG’s) accounts, the Mandatory Health Insurance Fund14 and the Social Fund budgets. The Chamber of Accounts annually submits to the Parliament and the President a report of the result of audit of Government revenue and expenditure. Financial, performance and compliance audits are carried out by the Chamber of Accounts who use a defined methodology for auditing accounts, which includes a section on procurement compliance. In 2014, a guidance was developed on Auditing of Public Procurements, which must be used during audits. Audit reports are made public by the Chamber of Accounts on its website. During the last several years, with the Bank support, some reforms were initiated to enhance the Chamber of Accounts, particularly in the areas of annual audit planning, compliance and financial audit methodology development, audit workflow automation as well as legislative changes were introduced. However, a progress in the consistent quality of performance and financial audit is yet to be achieved. No audit opinion is issued on the budget execution reports as a whole nor for individual ministries, departments and agencies. In practice, Chamber of Accounts does not consistently follow international auditing standards, despite they have financial and compliance audit methodology developed based on international standards and good practices. Considering the 14 The latest published audit is for FY2017 is available at http://www.esep.kg/images/docs/2018/09/Otchet_foms2017_ru.pdf 26 above, the Bank does not rely on the Chamber of Accounts for conducting audits of the Bank- financed projects’ financial statements, and all the financial audits of the projects in the World Bank portfolio in the country are conducted by private auditors acceptable to the Bank. PEFA 2014 assessed PI-26 (i) Scope and nature of audit performed dimension to be scored at “Câ€?, while PI-26 (iii) Evidence of follow-up on audit recommendations is scored at “Aâ€?. The latter indicates strong follow up arrangements for implementation of the Chamber of Accounts recommendation. PI-28 (ii) Extent of hearings on key findings undertaken by the legislature and PI- 28 (iii) Issuance of recommended actions by the legislature and implementation by the executive dimensions are both rated “Bâ€? meaning that there is overall adequate attention paid by parliamentarians to the audit findings, and the Parliament endorses the Chamber of Accounts’ recommendations/prescriptions in a Resolution sent to the Government at the end of its consideration of each annual budget execution report. The implementation of recommendations issued by the Chamber of Accounts is mandatory for the country’s government bodies. While for monitoring purposes the Bank will use the information reflected in the Chamber of Accounts audit reports on the sector, the Program audit arrangements will rely on the existing independent auditing arrangements under the Bank-financed on-going projects implemented by the MoH. By the time of the assessment there were no due audits under those projects, thought delays in the submission were observed for FY2017 audits. The audit of the Program annual financial statements will be conducted (i) by independent private auditors, acceptable to the Bank, on the Terms of Reference acceptable to the Bank and procured by the MoH, and (ii) according to the International Standards on Auditing (ISA) issued by the International Auditing and Assurance Standards Board of the International Federation of Accountants (IFAC). The audited financial statements of the Program will be presented to the Bank within 9 months15 after the end of each reporting period, and at the end of the Program. The Recipient has agreed to disclose the audit reports for the Program within one month of their receipt from the auditors and acceptance by the Bank, by posting the reports on the MoH web sites. Following the Bank's formal receipt of these reports from the Recipient, the Bank will make them publicly available according to World Bank Policy on Access to Information. The audit of the Program procurement will be conducted by independent private firm, including a thorough review of the procedures and processes followed by the procuring entities and the contracts selected for verification. The review of contracts will include (i) an overview of the documentation available in the files of the procuring agencies, (ii) visits to facilities for quality inspection and the number of goods, works and services delivered. Where required, compare prices with similar contracts in the country and region and international market prices for the items of interest. The audit report also will include information about average length of procurement, time for bid evaluation, percent of contracts (by value) awarded on a sole source basis and bidders participation and timeliness of payments. The Program procurement audit will be procured by the MoH, on the terms of reference agreed with the Bank, and the report will be presented to the Bank within 9 months after the end of each reporting period, and at the end of the Program. The risk associated with External Auditing is assessed to be Substantial. 15 The 9 month submission period for the audited financial statements of the Program is proposed considering the lengthy process of preparation of statutory financial statements, based on which the Program financial statements will be produced, as well as the fact that as per the public procurement regulations, the audit firm selection process can be commenced only after the reporting year is completed and the process itself takes quite long. 27 C.5: Procurement and Financial Management Capacity Within the context of reviewing the performance of institutions responsible for implementing and management of the Program expenditures, the assessment included a sample of eleven PHC facilities to review their fiduciary management capacity. The review found that in some cases the functions of procurement specialists are assigned to PHCs accountants. It is necessary to avoid possible conflict of interests by separating functions of accountants and procurement specialists. Also, there is a lack of procurement capacity as more than half of the procurement specialists from PHC facilities do not have mandatory procurement certificate required by PPL. They shall be trained in the Training Center of the MoF or through on-line courses and then shall be certified. Financial management capacity of the whole health sector is also weak. The IT and accounting skills of FM staff of PHC facilities vary from quite developed to very week. As a result, 1C accounting software is not fully used in all PHC facilities. There is significant turnover of FM staff both in the MoH and in PCH facilities. The main reason is low salary level resulting is qualified staff to move to private sector. The health sector FM information system should continue to rely on qualified consultants who provide critical support to the sector’s FM system. The health sector’s external auditor’s reports consistently indicate that the fiduciary staff turnover in the sector is high for last several years (2014 through 2017 being above 10%). Increasing trend was persistent in 2018: as per the MoH monitoring, the accounting staff turnover as of September 1, 2018 was around 18% (Data Source: The MoH). Many of the fiduciary weaknesses discussed in this assessment are common capacity constraints of the country’s Public Finance Management (PFM) system including public procurement. The Program action plan aims at maintaining at least minimum required level of fiduciary capacity of the health sector. In parallel with maintaining at the required level of fiduciary capacity in the sector, the MoH should develop and implement the health sector fiduciary capacity building plan, including measures to reduce the fiduciary staff turnover rate as well as to increase the fiduciary staff professional capacity both at the MoH and the PHC level. The action plan, agreed with the Bank, to be developed and approved by the MoH no later than 6 months after the Program effectiveness. The risk associated with procurement and financial management capacity is assessed to be High. D. Program Systems and Capacity Improvements The key institutions, the MoH and the MHIF as well as the PHCs facilities have overall acceptable procurement and financial management systems to plan budgets, execute and record transactions and produce the Program’s annual financial reports subject to the actions to be implemented as per the Action Plan below. The assessment findings conclude that the fiduciary framework for the Program is overall acceptable to support its implementation and to achieve its desired results. Overall the fiduciary risk for the operation is assessed as High given weaknesses identified FM arrangements, including internal controls, accounting, financial reporting, and procurement risks. A summary of key Fiduciary risk and mitigation measures are described in the below table: Risk Mitigation Measure Timing Type of Outcomes Action 28 (PAP, DLI, etc.) Potential for The Program’s IDA and Throughout PAP The approved dilution of the MDTF funds will be reflected Program and published Program funds in the republican budget implementation republican within the health under separate functional budget will sector overall classification for the MoH separately budget and MHIF. indicate the Program funds. The Program (P4R) During the formation of the During the PAP As per the annual budget not subsequent year’s republican formation of MoH and approved. budget, reflect the expected the republican MHIF requests amount cash flow under the budget (as per the Program Program in the income and the budget funds will be expenditure parts of the calendar) reflected in the republican budget. The income and budget would later be revised expenditure in case of unavailability of parts of the some part of the Program approved funds during the year. budget. Potential for Ensure timely transfer of the Within PAP The MoH and underfunding of the IDA and MDTF funds to the reasonable time MHIF will Program MoH and the MHIF in after the IDA confirm the corresponding amounts. and MDTF receipt of funds are relevant funds received to the after each MoF treasury transfer. account Accountability on The MoH and MHIF will Throughout PAP The MoH and the use of the present the quarterly financial Program MHIF will Program funds reports to the MoF on implementation present utilization of the Program quarterly funds considering also the financial reports effectiveness of achieved to the MoF. indicators. There are no Develop and approve a Before the Effectiven The approved formalized Memorandum of Program ess copy of arrangements for Understanding, acceptable to effectiveness condition Memorandum 29 defining the MoF, the Bank, between the MoH of MoH and the the MHIF and the MoF, Understanding MHIF specific which specifies each party’s will be shared responsibilities responsibilities in carrying with the Bank within a jointly out the Programs fiduciary before the implemented and technical functions. Program Program, which effectiveness may result in unclarity of parties’ specific responsibilities including those relating to fiduciary and technical arrangements. The low capacity Ensure adequate fiduciary Throughout PAP Roster of staff and high turnover capacity at the central (at Program and consultants of the accounting MoH) and regional levels (at implementation to be reported staff in the sector MHIF regional departments) semi-annually and particularly at with at least the following The action plan, prior to PHC facilities. numbers and qualifications of agreed with the implementation individuals to be maintained: Bank, to be support developed and missions. 1. Head of Procurement Unit approved by the and three specialists (full- MoH no later The health time staff) and Procurement than 6 months sector fiduciary Specialist and Contract after the capacity Manager (consultants) in Program building plan, Procurement Unit/MoH; and effectiveness. with specifying concrete 2. Two consultants at the activities, MoH for FM/Disbursement resources and function, as well as two deadlines, is consultants (accounting and developed, IT support) in the central agreed with the level for MoH. Additionally, Bank and the relevant staff of the approved by the MHIF regional departments MoH. The Bank will support the IT and will monitor the accounting consultants at implementation central level and will be of the action responsible for providing plan activities support to PHCs’ accounting staff for the upgrade on the 30 1C accounting software as by their well as accounting/financial deadlines. reporting policies, procedures and reporting formats as necessary. Develop and implement the health sector fiduciary capacity building plan, including measures to reduce the fiduciary staff turnover rate as well as to increase the fiduciary staff professional capacity both at the MoH and the PHC level. Improper Adopt measures to eliminate No later than PAP A MoH order segregation of the practice of dual fiduciary 6 months after prohibiting the duties between function (procurement and Program practice of procurement and accounting/financial effectiveness dual fiduciary accounting/financia management functions function. MoH l management staff assumed by the same to report semi- of PHC facilities individuals) at PHC facilities annually as create a potential by segregating these duties. part of for conflict of Program interest. implementatio n progress reports and prior to World Bank implementatio n support visits indicating the percentage of PHC facilities where the two functions are separately assumed by different individuals. 100% of segregation shall be 31 achieved within two years after Program effectiveness. Risk of Ensure that each PHC facility Throughout PAP Annual internal inaccuracies in is audited, at least, once in a Program audit plans, payroll calculations three-year period, with more implementation terms of and timesheets, frequent audits of PHC reference and document facilities with higher audit scope will falsification, fiduciary risks as assessed by be agreed with unauthorized MoH and MHIF Internal the Bank. access to data, and Audit units. Annual audit overriding controls. reports of MoH and MHIF Internal Audit units will be share with the Bank. Risk of Ensure that ICRC function is During the PAP MoF (PPD) to sustainability/qualit sustainable and includes Program report annually y of complaint sufficient members with implementation that ICRC review process capacity and qualifications to experts are perform their duties in motivated using appropriate manner. relevant incentives to perform quality reviews of procurement complaints in the health sector in a timely manner within the period outlined in the PPL. Payment delays in Ensure that PHC facilities Throughout the PAP Contract organizations pay according to exact dates Program execution report indicated in the contract implementation that is included conditions but not later than in the annual four months after fulfilment procurement by audit. At list Contractors/Suppliers/Consul 80% of the PHC 32 tants of the obligations under facilities pay the contract. within four months. The difficulties of Revise Standard Bidding One year after PAP Revised SBD the foreign Document for project with provision pharmaceutical pharmaceuticals to allow effectiveness that submission companies to companies from countries of the License participate in tender with Stringent Regulatory and certification process due to Authorities (including GMP shall be long/complicated certified pharmaceuticals), condition for licensing/certificati and WHO prequalified contract on process. pharmaceuticals to participate signature on in tender process and submit pharmaceuticals registration in the License are adopted. Department in parallel. Lack of internal Approve internal instructions 6 months after PAP Approved mechanisms of the for acceptance of medical project instructions to acceptance of goods and disseminate to effectiveness be shared with medical goods in PHC facilities for execution the Bank upon PHC facilities dissemination to PHC facilities Lack of certified Ensure that all PHC Throughout the PAP MoH’s to ensure procurement procurement specialists are Program 100% specialists in tender trained in the Training Center implementation compliance commissions, of the MoF (or trained within one years which is required through online courses) and after by para 4 of Article are certified. All individuals effectiveness of 10 of PPL. carrying out procurement the project and functions for PHCs shall be to report semi- trained and certified as per annually prior to requirements of PPL as soon implementation s as possible but not later support mission than one month from commencing their procurement duties. Lack of eGP Complete the E-Government 6 months after PAP MoF with input capacity to support Procurement Module for project from PPD to selection of selection of consultants effectiveness report that E- GP Module for consultancy is 33 consultants (firms completed and and individuals) functional Lack of eGP Complete adjustment of e- 6 months after PAP MoH with input capacity in terms of Government Procurement project from PPD of the specialized portal to include standard effectiveness MoF to report procurement bidding documents for that E-GP procedures for pharmaceuticals module for pharmaceuticals pharmaceuticals is completed and functional E. Implementation Support During the Program implementation the Bank’s fiduciary team will (i) review the implementation progress and working with the task teams to examine the achievement of Program results and/or legal covenants/PAP that are of a fiduciary nature; (ii) help the Recipient to resolve implementation issues and carry out institutional support; (iii) monitor the performance of fiduciary systems and audit reports, including the implementation of the PAP; and (iv) monitoring changes in fiduciary risks to the Program and, as relevant, compliance with the fiduciary provisions of legal covenants capacity building. More specifically the Bank fiduciary team will: - Monitor changes in fiduciary risks of the Program and the MoF compliance with agreed funds flow arrangements for the Program to ensure timely availability to the MoH and MHIF of the donor funds transferred to the MoF against the achieved DLIs and advance payment. - Monitor the Program financial statement preparation process and assist the Recipient as necessary. - Review the Program annual financial and procurement audit reports and management letters, discuss with the Recipient and monitor the implementation of the auditor’s recommendation. - Based on the information provided by these audit reports assess and analyze changes in identified procurement performance indicators (Annex 1 below) and propose actions, as needed. - Review the MoH and MHIF internal audit annual plans, terms of reference and the scope of the audit at PHC facilities. Review the annual internal audit reports, and discuss with the Recipient the auditors’ finding and recommendations as well as the necessary actions to address the observations and implement the recommendations. - Monitor and help the Recipient as needed with institutional fiduciary capacity building. In particular: (i) Monitor the compliance with PPL in terms of mandatory certification for procurement specialists in the sector; (ii) Conduct semi-annual review the MoH fiduciary staff and consultants’ roster to ensure that MoH maintains adequate level of fiduciary support to the Program; (iii) During the implementation support missions review the level and scope of consultants’ support provided to the sector’s accounting and IT systems. (iv) Periodically review the lists of the PHC facilities’ staff carrying out procurement and 34 accounting functions to ensure that there is proper segregation of duties between those functions. (v) Review the implementation of the health sector fiduciary capacity building action plan, with particular attention to implementing specific actions within the specified deadlines as indicated in the action plan. 35 Annexes Annex 1. Proposed Procurement Indicators to be monitored during the program implementation Indicator Measure Baseline Recommended Standard Average length of Number of days Simplified method – 2.5 Simplified method - 2 procurement between date of award weeks weeks and date of invitation to One stage method – 6 One stage method – 5 bid. weeks weeks Time for bid evaluation Number of days between Simplified method – 1.5 Simplified method – 1 bid opening and week week publication of award. One stage method – 2.5 One stage method – 2 weeks weeks Direct contracting Percent of contracts (by value) awarded on a sole 24,5% 22% source basis. Bidders participation Average number of 2 bidders 2.3 bidders bidders submitting a bid in each bid process. 36 Annex 2. Procurement analysis by procurement method, amount and number of tenders in 110 PHCs (2016, 2017) In KGS 2016 year 2017 year Total number of bids Total number of bids Simplified method Simplified method Simplified method Simplified method Total SUM (100%) direct contracting direct contracting direct contracting direct contracting Total SUM(100%) City or Region one stage one stage one stage one stage % % % % % % N Bishkek 1 PHC â„–1 87 51 8 28 72 6,804,884 9 824,450 19 1,792,585 9,421,919 31 7 2 22 19 2,086,760 23 2,560,940 58 6,382,632 11,030,332 2 PHC â„–2 28 17 4 7 45 4,171,249 42 3,944,262 13 1,173,004 9,288,515 23 18 2 3 73 5,223,710 26 1,874,608 1 54,879 7,153,197 3 PHC â„–3 31 11 14 6 46 2,926,805 43 2,758,702 12 739,050 6,424,557 24 8 7 9 18 985,340 59 3,196,661 23 1,259,789 5,441,790 4 PHC â„–4 44 12 23 9 10 681,946 79 5,567,169 11 781,111 7,030,226 51 12 32 7 15 1,096,368 83 5,980,709 1 88,414 7,165,491 5 PHC â„–5 66 39 17 10 57 4,470,482 28 2,151,553 15 1,186,982 7,809,017 51 20 19 12 43 3,262,638 52 3,981,590 6 430,375 7,674,603 6 PHC â„–6 40 2 6 32 9 738,289 27 2,180,325 64 5,113,690 8,032,304 28 6 2 20 40 2,325,000 17 961,477 43 2,460,328 5,746,805 7 PHC â„–7 25 15 2 8 66 1,996,989 16 482,013 18 550,568 3,029,570 28 13 12 3 37 1,450,810 59 2,331,511 4 145,166 3,927,487 8 PHC â„–8 35 3 3 29 6 361,532 18 1,133,964 77 4,887,816 6,383,312 22 9 2 11 37 2,067,920 26 1,422,438 37 2,065,216 5,555,574 9 PHC â„–9 35 1 20 14 2 124,607 72 4,105,750 26 1,452,091 5,682,448 40 17 8 15 35 2,876,130 23 1,860,939 43 3,509,253 8,246,322 10 PHC â„–10 24 2 5 17 5 126,500 33 829,055 62 1,554,165 2,509,720 8 2 1 5 7 69,985 54 543,340 39 397,264 1,010,589 11 PHC â„–11 32 15 3 14 51 916,585 25 446,951 25 442,998 1,806,534 32 17 3 12 35 670,115 26 508,358 39 742,050 1,920,523 12 PHC â„–12 72 22 34 16 14 1,388,392 47 4,775,534 39 3,899,139 10,063,065 38 17 18 3 46 3,258,059 45 3,160,268 9 600,400 7,018,727 13 PHC â„–13 34 20 2 12 77 2,222,035 3 100,000 19 557,025 2,879,060 33 16 17 72 3,393,334 0 0 28 1,290,787 4,684,121 14 PHC â„–14 34 16 13 5 32 1,718,750 52 2,751,376 16 823,526 5,293,652 26 7 12 7 30 1,915,947 60 3,780,939 9 594,931 6,291,817 15 PHC â„–15 31 13 13 5 24 911,140 66 2,494,415 11 399,542 3,805,097 10 1 3 6 1 44,500 37 1,123,790 62 1,907,545 3,075,835 16 PHC â„–16 28 8 12 8 18 393,156 42 923,654 39 859,305 2,176,115 22 8 7 7 25 569,195 54 1,225,051 21 485,152 2,279,398 17 PHC â„–17 23 12 2 9 42 886,277 21 445,772 36 759,627 2,091,676 13 3 6 4 20 284,416 66 925,040 13 185,366 1,394,822 18 PHC â„–18 14 13 1 97 1,694,263 0 0 3 51,150 1,745,413 16 8 4 4 31 742,211 49 1,172,918 20 464,430 2,379,559 19 PHC â„–19 53 23 9 21 50 2,134,758 35 1,473,165 15 635,825 4,243,748 29 11 8 10 26 878,490 51 1,726,585 23 785,969 3,391,044 Sub-total 736 295 190 251 34,668,639 37,388,110 27,659,199 99,715,948 525 200 148 177 33,200,928 38,337,162 23,849,946 95,388,036 Chui oblast GFD v. Tash- 1 3 0 2 1 0 0 96 37,600 4 1,571 39,171 5 2 0 3 77 550,000 0 0 23 159,875 709,875 Dobo GFD v. 2 0 0 0 0 0 0 0 0 0 0 0 4 1 0 3 23 84,100 0 0 77 283,824 367,924 Sadovoe 37 GFD Ñ?. 3 13 0 0 13 0 0 0 0 100 1,098,072 1,098,072 8 0 0 8 0 0 0 0 100 1,087,807 1,087,807 Alexandrovka GFD 4 7 0 7 0 0 0 100 626,182 0 0 626,182 10 2 5 3 20 410,775 50 1,006,381 30 600,260 2,017,416 Leninskoe 5 GFD Kuntuu 2 1 0 1 52 70,000 0 0 48 64,000 134,000 1 0 0 1 0 0 0 0 100 150,000 150,000 6 Chui PHC 25 10 5 10 46 7,944,156 45 7,915,425 9 1,598,613 17,458,194 19 8 3 8 47 9,025,498 37 7,126,882 16 3,006,705 19,159,085 PHC Jayil 7 10 1 4 5 7 398,733 79 4,662,354 14 819,332 5,880,419 45 5 17 23 9 1,080,185 48 5,867,029 43 5,169,665 12,116,879 rayon PHC Yssyk 8 36 11 4 21 37 9,443,387 28 7,249,019 35 8,937,119 25,629,525 30 12 6 12 49 8,947,540 18 3,351,870 33 6,066,174 18,365,584 ata PHC Kemin 9 10 2 3 5 31 1,622,184 55 2,893,726 14 746,274 5,262,184 18 7 0 11 36 827,371 0 64 1,489,081 2,316,452 rayon PHC 10 Moskovskiy 34 15 13 6 48 8,218,533 42 7,225,964 9 1,600,058 17,044,555 48 15 21 12 32 3,980,650 48 6,029,480 20 2,494,337 12,504,467 rayon PHC Sokuluk 11 21 4 13 4 13 1,564,120 77 9,576,203 10 1,298,310 12,438,633 26 11 10 5 36 5,050,963 59 8,207,635 4 617,970 13,876,568 rayon PHC 12 Chuiskogo 41 20 10 11 50 5,238,571 32 3,409,950 18 1,851,368 10,499,889 32 13 6 13 51 3,800,136 29 2,191,478 20 1,467,826 7,459,440 rayona 13 PHC Tokmok 16 2 4 10 8 561,168 39 2,884,434 54 3,968,801 7,414,403 32 10 1 21 52 3,963,871 3 207,865 45 3,447,841 7,619,577 PHC 14 60 30 5 25 71 10,626,766 14 2,025,395 15 2,263,572 14,915,733 59 36 4 19 52 8,713,510 36 6,027,170 11 1,868,728 16,609,408 Panfilovka CoHP 15 0 0 0 0 0 0 0 0 0 0 0 14 4 1 9 24 530,036 21 461,148 54 1,186,077 2,177,261 Suusamyr CoHP 16 8 0 0 8 0 0 0 0 100 1,314,900 1,314,900 19 3 2 14 10 201,645 18 369,475 72 1,472,532 2,043,652 Orlovka CoHP Jany 17 16 6 3 7 21 451,158 15 339,000 64 1,406,074 2,196,232 26 16 10 55 1,683,582 0 45 1,403,229 3,086,811 Jer CoHP 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Arashan Sub-total 302 102 73 127 46,138,776 48,845,252 26,968,064 121,952,092 396 145 76 175 48,849,862 40,846,413 31,971,931 121,668,206 Osh oblast 1 PHC Osh #1 25 12 5 8 38 5,837,097 56 8,477,599 6 911,910 15,226,606 41 18 5 18 65 16,034,136 26 6,563,016 9 2,187,886 24,785,038 PHC Alai 2 43 29 4 10 61 9,023,852 29 4,248,188 11 1,565,112 14,837,152 38 25 8 5 77 8,567,474 16 1,724,778 7 767,938 11,060,190 rayon PHC Aravan 3 40 12 18 10 39 4,631,613 49 5,782,726 13 1,502,280 11,916,619 49 28 12 9 53 6,447,316 35 4,241,634 12 1,473,147 12,162,097 rayon PHC Kara 4 79 54 4 21 65 28,003,807 24 10,128,361 11 4,856,021 42,988,189 79 64 1 14 89 43,866,048 5 2,308,210 6 3,070,191 49,244,449 suu rayon PHC Kara- 5 67 29 8 30 40 4,747,582 28 3,367,917 32 3,802,259 11,917,758 35 5 18 12 15 1,059,480 70 4,981,119 15 1,076,970 7,117,569 Kuldja rayon 6 PHC "Baryn" 24 8 1 15 60 10,075,735 12 2,000,000 28 4,775,150 16,850,885 24 6 0 18 44 5,962,970 0 0 56 7,709,595 13,672,565 PHC 7 69 38 1 30 71 15,931,802 8 1,708,797 21 4,720,060 22,360,659 47 28 1 18 79 14,567,629 9 1,680,853 11 2,088,377 18,336,859 "Medigos" PHC Uzgen 8 40 18 0 22 73 19,444,558 0 0 27 7,159,788 26,604,346 44 24 3 17 51 12,137,805 20 4,685,650 30 7,181,468 24,004,923 rayon CoHP 9 88 27 13 48 32 4,148,278 42 5,345,252 26 3,299,841 12,793,371 51 15 15 21 29 3,470,858 51 6,175,070 20 2,418,456 12,064,384 Kurshab CoHP 10 48 25 6 17 52 20,199,710 32 12,309,218 16 6,151,569 38,660,497 54 35 1 18 68 27,399,640 8 3,389,331 24 9,499,513 40,288,484 MyrzaAke 11 CoHP Papan 21 7 0 14 60 2,100,318 0 0 40 1,390,259 3,490,577 28 10 0 18 53 1,724,095 0 0 47 1,511,566 3,235,661 38 CoHP Chon- 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Alai Sub-total 544 259 60 225 124,144,352 53,368,058 40,134,249 217,646,659 490 258 64 168 141,237,451 35,749,661 38,985,107 215,972,219 Batken oblast PHC Batken 1 22 0 9 13 0 0 70 8,890,335 30 3,859,051 12,749,386 19 4 5 10 28 3,127,563 40 4,430,304 32 3,599,692 11,157,559 obl PHC Leilek 2 19 0 5 14 0 0 60 5,134,569 40 3,426,009 8,560,578 21 1 10 10 4 345,000 58 5,459,850 38 3,545,484 9,350,334 rayon PHC 3 Kadamjay 9 0 2 7 0 0 57 3,390,276 43 2,576,767 5,967,043 22 7 2 13 16 1,042,710 43 2,707,356 41 2,596,429 6,346,495 rayon PHC Kyzyl 4 38 10 1 27 26 2,376,185 9 870,798 65 6,027,325 9,274,308 18 5 0 13 21 943,968 0 0 79 3,590,350 4,534,318 Kiya CoHP 5 13 2 11 9 202,070 0 0 91 2,050,283 2,252,353 30 5 0 25 34 3,219,922 0 0 66 6,282,709 9,502,631 Samarkandyk CoHP 6 19 0 6 13 0 0 57 5,426,826 43 4,147,765 9,574,591 27 2 11 14 4 514,070 65 7,548,884 30 3,463,015 11,525,969 Aidarken CoHP 7 15 1 13 1 5 1,030,472 94 20,120,283 1 180,386 21,331,141 26 5 14 7 9 1,701,539 83 16,023,930 9 1,664,877 19,390,346 Kulunda CoHP 8 29 3 13 13 11 1,848,410 68 11,310,907 21 3,572,891 16,732,208 29 8 5 16 35 5,408,314 31 4,742,266 34 5,288,207 15,438,787 UcKorgon CoHP 9 33 1 10 22 2 220,037 54 6,201,163 44 5,031,165 11,452,365 43 4 10 29 4 285,255 46 3,665,891 51 4,046,284 7,997,430 Sulukta CoHP 10 4 3 0 1 91 2,488,642 0 0 9 250,005 2,738,647 4 1 0 3 25 95,475 0 0 75 290,920 386,395 JanyJer Sub-total 201 20 59 122 8,165,816 61,345,157 31,121,647 100,632,620 239 42 57 140 16,683,816 44,578,481 34,367,967 95,630,264 Jalalabad oblast PHC 1 20 6 0 14 60 6,680,483 0 0 40 4,399,483 11,079,966 18 10 1 7 66 3,423,072 18 916,965 16 829,193 5,169,230 Jalalabad PHC Aksy 2 39 14 3 22 47 4,749,025 11 1,156,223 41 4,184,488 10,089,736 39 5 3 31 13 1,358,650 16 1,730,572 71 7,493,703 10,582,925 rayon PHC Ala- 3 35 19 1 15 74 14,681,166 6 1,255,233 20 3,964,074 19,900,473 35 16 3 16 58 8,266,136 16 2,300,565 26 3,713,117 14,279,818 Buka rayon PHC Bazar- 4 108 23 12 73 41 12,495,530 40 12,051,372 19 5,589,608 30,136,510 71 22 23 26 37 10,010,000 53 14,587,428 10 2,774,597 27,372,025 Korgon PHC Nooken 5 41 11 9 21 26 2,589,474 38 3,772,668 36 3,584,860 9,947,002 56 35 0 21 76 8,406,301 0 0 24 2,625,218 11,031,519 rayon PHC 6 39 14 4 21 38 2,764,520 34 2,468,960 27 1,962,495 7,195,975 45 14 3 28 43 3,925,676 21 1,891,845 37 3,401,769 9,219,290 Kochkor ata PHC Suzak 7 53 11 9 33 22 7,109,243 59 18,805,973 19 5,911,192 31,826,408 61 13 9 39 23 5,275,543 51 11,489,656 26 5,924,065 22,689,264 rayon 8 PHC Oktyabr 72 24 0 48 62 6,196,222 0 0 38 3,722,643 9,918,865 59 27 0 32 68 5,365,300 0 0 32 2,573,493 7,938,793 PHC 9 Toktogul 4 4 0 0 100 5,458,192 0 0 0 0 5,458,192 27 9 6 12 51 4,239,314 29 2,411,030 20 1,712,197 8,362,541 rayon PHC Tash- 10 30 7 5 18 19 828,064 34 1,503,870 48 2,122,401 4,454,335 44 13 8 23 41 2,866,567 26 1,823,587 33 2,287,578 6,977,732 Komur CoHP 11 57 10 5 42 15 1,094,585 44 3,220,340 42 3,081,510 7,396,435 42 22 4 16 46 3,841,682 45 3,731,192 9 771,613 8,344,487 ToguzToro CoHP 12 1 0 1 0 0 0 100 2,324,540 0 0 2,324,540 3 1 1 1 8 432,890 90 5,000,000 2 120,000 5,552,890 Chatkal CoHP Kara 13 41 4 15 22 7 843,647 71 8,196,561 21 2,447,880 11,488,088 41 13 5 23 24 2,092,888 41 3,587,890 35 3,110,073 8,790,851 Kul CoHP Kok- 14 40 20 0 20 59 4,052,415 0 0 41 2,780,630 6,833,045 39 26 0 13 72 3,166,520 0 0 28 1,261,765 4,428,285 Jangak 39 CoHP 15 Shamaldy 18 7 1 10 64 3,674,700 15 855,481 21 1,203,000 5,733,181 37 16 2 19 52 5,201,410 24 2,408,432 24 2,361,136 9,970,978 Say CoHP 16 37 11 4 22 41 3,780,543 16 1,456,483 44 4,085,157 9,322,183 30 11 1 18 64 3,575,925 6 317,780 30 1,662,180 5,555,885 Sumsar CoHP 17 0 0 0 0 0 0 0 0 0 0 0 21 3 0 18 20 747,900 0 0 80 2,951,376 3,699,276 Ozgorush CoHP 18 4 1 1 2 11 188,000 44 750,656 45 763,672 1,702,328 22 3 1 18 14 375,261 18 500,619 68 1,838,132 2,714,012 Uchterek CoHP 19 87 44 9 34 62 8,758,692 17 2,460,726 21 2,973,538 14,192,956 71 16 22 33 27 3,797,897 42 5,805,240 31 4,237,023 13,840,160 MailySuu Sub-total 726 230 79 417 85,944,501 60,279,086 52,776,631 199,000,218 761 275 92 394 76,368,932 58,502,801 51,648,228 186,519,961 Issyk kul oblast 1 GFD Chelpek 26 7 0 19 29 247,316 0 0 71 591,582 838,898 15 2 0 13 10 80,200 0 0 90 698,116 778,316 2 GFB Baltabai 11 3 1 7 21 93,080 14 61,685 64 280,307 435,072 18 6 2 10 30 168,790 7 38,320 63 355,345 562,455 GFB 3 17 6 2 9 17 170,847 9 90,849 74 733,035 994,731 22 9 1 12 36 460,733 1 12,000 63 794,462 1,267,195 JetiOguz 4 GFB Tamga 18 7 0 11 25 31,780 0 0 75 96,630 128,410 38 8 9 21 20 64,493 44 144,743 37 121,058 330,294 GFB 5 0 0 0 0 0 0 0 0 0 0 Grigor`evka 0 0 0 0 0 0 0 0 0 0 0 0 GFB 6 4 2 1 1 55 176,905 25 80,000 20 64,610 321,515 7 6 1 0 0 95 463,394 5 23,700 487,094 KaraTalaa GFB Sary 7 18 12 0 6 65 184,280 0 0 35 101,200 285,480 11 7 0 4 36 41,400 0 0 64 73,200 114,600 Kol GFB 8 0 0 0 0 0 0 0 0 0 0 YssykKol 0 0 0 0 0 0 0 0 0 0 0 0 9 GFB Voshod 18 9 0 9 61 425,787 0 0 39 272,846 698,633 14 5 0 9 59 330,656 0 0 41 227,142 557,798 10 GFB Nazik 7 2 0 5 11 40,000 0 0 89 313,966 353,966 12 4 0 8 28 193,615 0 0 72 492,944 686,559 11 GFB Umut 17 2 0 15 27 218,690 0 0 73 601,436 820,126 17 4 0 13 56 622,449 0 0 44 494,532 1,116,981 PHC Ak-Suu 12 74 31 14 29 42 2,922,770 25 1,753,825 33 2,288,551 6,965,146 57 23 25 9 45 2,949,695 42 2,719,272 13 842,933 6,511,900 rayon PHC Yssyk- 13 78 35 8 35 49 4,366,320 23 2,033,557 28 2,521,520 8,921,397 48 27 10 11 55 3,040,223 28 1,558,716 17 922,690 5,521,629 Kul rayon PHC Ton 14 31 11 15 5 42 2,485,060 49 2,885,484 9 548,273 5,918,817 29 6 21 2 37 2,385,835 62 3,962,762 1 72,050 6,420,647 rayon PHC Tup 15 47 22 3 22 46 3,040,048 14 904,600 40 2,625,598 6,570,246 40 22 7 11 45 3,102,364 41 2,812,891 14 946,660 6,861,915 rayon PHC 16 68 41 0 27 68 7,273,875 0 0 32 3,377,221 10,651,096 77 51 1 25 73 5,791,299 0 37,600 26 2,076,010 7,904,909 Balyckchy PHC Yssyk 17 35 12 12 11 44 3,186,902 37 2,646,493 19 1,379,341 7,212,736 43 15 15 13 25 2,081,690 63 5,250,853 13 1,050,235 8,382,778 Kul obl CoHP Jeti- 18 122 86 20 16 56 25,189,952 41 18,479,522 3 1,160,703 44,830,177 52 33 7 12 49 12,008,379 47 11,527,236 5 1,122,868 24,658,483 Oguz CoHP 19 47 2 6 39 2 66,260 15 408,430 83 2,288,965 2,763,655 10 0 7 3 0 0 36 583,720 64 1,041,290 1,625,010 Anan`evo Sub-total 638 290 82 266 50,119,872 29,344,445 19,245,784 98,710,101 510 222 111 177 32,506,205 28,453,050 9,289,354 70,248,609 Naryn oblast PHC Aktalin 1 0 0 0 0 0 0 0 0 0 0 0 0 rayon 0 0 0 0 0 0 0 0 0 0 40 PHC At 2 23 2 15 6 23 1,175,895 70 3,661,508 7 364,278 5,201,681 41 2 25 14 3 130,205 79 3,567,907 18 831,655 4,529,767 Bashy rayon PHC Jumgal 3 19 4 2 13 13 654,162 38 1,885,520 48 2,373,224 4,912,906 10 1 1 8 2 55,685 17 588,285 81 2,758,622 3,402,592 rayon PHC 4 Kochkor 60 25 5 30 39 2,639,914 18 1,197,188 43 2,865,800 6,702,902 68 34 3 31 35 4,116,084 45 5,346,263 20 2,415,749 11,878,096 rayon PHC Naryn 5 32 3 25 4 6 818,391 90 12,130,011 4 486,460 13,434,862 28 2 20 6 8 489,175 79 4,605,017 13 739,063 5,833,255 oblast PHC Naryn 6 60 21 29 10 18 1,126,936 73 4,611,727 9 536,983 6,275,646 53 12 33 8 24 1,718,830 71 5,044,297 5 329,764 7,092,891 rayon CoHP 7 0 0 0 0 0 0 0 0 0 Minkush 0 0 0 0 0 0 0 0 0 0 0 0 0 Sub-total 194 55 76 63 6,415,298 23,485,954 6,626,745 36,527,997 200 51 82 67 6,509,979 19,151,769 7,074,853 32,736,601 Talas oblast GFD â„– 3 1 Bakai-Ata 13 0 0 13 0 0 0 0 100 636,730 636,730 13 0 0 13 0 0 0 0 100 705,859 705,859 rayon PHC Kara 2 15 4 7 4 24 1,001,736 66 2,764,653 10 440,028 4,206,417 38 11 15 12 25 1,734,885 53 3,652,770 22 1,537,729 6,925,384 Buura rayon PHC Talas 3 33 16 1 16 46 2,655,746 3 194,790 51 2,943,390 5,793,926 31 12 8 11 28 992,283 30 1,069,418 42 1,475,355 3,537,056 rayon PHC Talas 4 8 4 4 65 1,107,683 0 0 35 595,565 1,703,248 11 4 7 45 1,488,307 0 0 55 1,840,701 3,329,008 oblast CoHP Bakai 5 7 0 4 3 0 0 89 11,516,561 11 1,363,850 12,880,411 9 2 3 4 5 288,900 72 3,894,960 23 1,243,705 5,427,565 ata rayon CoHP Manas 6 39 13 9 17 42 4,278,390 43 4,372,886 16 1,605,682 10,256,958 24 9 3 12 33 1,823,885 33 1,803,987 34 1,857,050 5,484,922 rayon Sub-total 115 37 21 57 9,043,555 18,848,890 7,585,245 35,477,690 126 38 29 59 6,328,260 10,421,135 8,660,399 25,409,794 Total 3,456 1,288 640 1,528 364,640,809 332,904,952 212,117,564 909,663,325 3,247 1,231 659 1,357 361,685,433 276,040,472 205,847,785 843,573,690 41 Annex 3. Economic Classification of the Program Estimated Expenditures (Data Source: the MoH and MHIF). MHIF (at PHC level) in thousand KGS 2,020 2,021 2,022 2,023 2,024 Total 2020-2024 2111 Salary 2,961,774 3,018,308 3,144,795 3,276,583 3,413,893 15,815,353 2121 Social payments 506,667 516,338 537,976 560,521 584,011 2,705,513 2211 Travel 28,199 28,737 29,941 31,196 32,503 150,576 2212 Communication expenses 11,370 11,587 12,073 12,579 13,106 60,716 2213 Rental expenses 455 463 483 503 524 2,429 2214 Transportation expenses 69,132 70,452 73,404 76,480 79,685 369,154 2215 Other goods and services 82,322 83,893 87,409 91,072 94,889 439,585 2217 Drugs and medical services 255,608 260,487 271,403 282,776 294,627 1,364,900 2218 Food 33,657 34,299 35,736 37,234 38,794 179,720 2221 Repair expenses 106,882 108,922 113,487 118,243 123,198 570,732 2222 Inventory for administrative purposes 141,903 144,612 150,672 156,986 163,565 757,738 2223 Purchase, sewing and repair of uniform 3,639 3,708 3,863 4,025 4,194 19,429 2224 Purchase of coal and other type of fuel 27,744 28,273 29,458 30,693 31,979 148,148 2225 Security Services 1,364 1,390 1,449 1,509 1,573 7,286 2226 Bank fees 455 463 483 503 524 2,429 2231 Utility fees 130,533 133,024 138,599 144,407 150,459 697,022 2235 Other utility fees 455 463 483 503 524 2,429 2721 Humanitarian support to population - - - - - - 2823 Legal fees - - - - - - 3111 Buildings and constructions 20,922 21,321 22,214 23,145 24,115 111,718 3112 Machinery and equipment 165,099 168,250 175,301 182,647 190,301 881,599 TOTAL 4,548,178 4,634,994 4,829,231 5,031,608 5,242,465 24,286,476 The MoH in thousand KGS 2020 2021 2022 2023 2024 Total 2020-2024 Salary 193,821 198,228 204,100 210,146 216,372 1,022,666 Salary related Social Payments 33,194 33,948 34,954 35,990 37,056 175,142 Goods and services 148,934 152,654 157,176 161,832 166,626 787,221 Non-financial investments 10,450 10,867 11,189 11,521 11,862 55,889 Total 386,398 395,697 407,419 419,489 431,915 2,040,918 42 Annex 4. List of PHC specialists assigned to procurement function (as of November 2018) Presence of Procurement Bishkek Name Position Certificate 1 PHC â„–1 Sydyev U Procurement specialist Yes 2 PHC â„–2 Janboeva L Accountant - 3 PHC â„–3 Muratov I Procurement specialist - 4 PHC â„–4 Asanova J Procurement specialist Yes 5 PHC â„–5 Muratov I Procurement specialist - 6 PHC â„–6 Sydyev U Procurement specialist - 7 PHC â„–7 Asanova J Procurement specialist - 8 PHC â„–8 Jusumaliev B Procurement specialist - 9 PHC â„–9 Beisheeva A Procurement specialist - 10 PHC â„–10 Karaev J Procurement specialist - 11 PHC â„–11 Kasymova N Procurement specialist - 12 PHC â„–12 Malabaeva J Procurement specialist Yes 13 PHC â„–13 Djakabalieva A Procurement specialist - Monanina G Procurement specialist Yes 14 PHC â„–14 Accountant Badachieva F 15 PHC â„–15 Abylkasymova G Procurement specialist - 16 PHC â„–16 Japarbekov N Procurement specialist Yes 17 PHC â„–17 Ibraeva A Procurement specialist - 18 PHC â„–18 Duishonkul u Azat Procurement specialist - Japarbekov N Mailikova Procurement specialist - 19 PHC â„–19 E Chui oblast 1 GFD v. Tash-Dobo Jumalieva A Accountant - 2 GFD v. Sadovoe Chymchykova A Procurement specialist - 3 GFD Ñ?. Alexandrovka Kadyrova A Procurement specialist - 4 GFD Leninskoe Ermolov B Procurement specialist - 5 GFD Kuntuu Saradarbekova J Accountant - 6 Chui PHC Ermolov B Procurement specialist - 7 PHC Jayil rayon Kurmanbekova A Procurement specialist Yes 8 PHC Yssyk ata Atanbekova G Procurement specialist - 9 PHC Kemin rayon Kadyralieva B Procurement specialist - 10 PHC Moskovskiy rayon Terenteva S Procurement specialist Yes Adjieva N Procurement specialist - 11 PHC Sokuluk rayon 12 PHC Chuiskogo rayona Sadyrkulov J Accountant Yes 13 PHC Tokmok Tamabaeva Z Procurement specialist - 14 PHC Panfilovka Djoldoshalieva A Accountant - 15 CoHP Suusamyr Ahunjan kyzy Baktygul Procurement specialist Yes 16 CoHP Orlovka Suroegin K Procurement specialist - 17 CoHP Jany Jer Taichieva B Procurement specialist Yes 18 CoHP Arashan Ajymatov K Procurement specialist - Osh oblast 1 PHC Osh #1 Pirmatova N Accountant Yes 2 PHC Alai rayon Kaldarbek k A Accountant - 3 PHC Aravan rayon Abdulajanov I Procurement specialist - 4 PHC Kara suu rayon Orunbaeva M Procurement specialist - 5 PHC Kara-Kuldja rayon Tashieva N Procurement specialist Yes 6 PHC "Baryn" Narbaev J Accountant - 7 PHC "Medigos" Muratali u K Accountant Yes 43 8 PHC Uzgen rayon Kayipkulov M Accountant - 9 CoHP Kurshab Salyjan u D Procurement specialist - 10 CoHP MyrzaAke Termechikova G Accountant Yes 11 CoHP Papan Zaripov M Accountant Yes 12 CoHP Chon-Alai Kursanbai u K Procurement specialist Yes Batken oblast 1 PHC Batken obl Dyikanov O Procurement specialist Yes 2 PHC Leilek rayon Jalilov K Procurement specialist - 3 PHC Kadamjay rayon Toktomatova E Procurement specialist Yes 4 PHC Kyzyl Kiya Arzybaev M Procurement specialist - 5 CoHP Samarkandek Gaparov Sh Accountant - 6 CoHP Aidarken Kabilov D Procurement specialist Yes 7 CoHP Kulunda Akramov I Procurement specialist Yes 8 CoHP UcKorgon Shaibekov A Procurement specialist Yes 9 CoHP Sulukta Rahmanova E Procurement specialist Yes 10 CoHP JanyJer Musaev U Procurement specialist - Jalalabad oblast 1 PHC Jalalabad Akynbaev K Procurement specialist Yes 2 PHC Aksy rayon Murzaraiomov U Procurement specialist Yes 3 PHC Ala-Buka rayon Tashbaltaeva E Procurement specialist Yes 4 PHC Bazar-Korgon Abduhamidova G Procurement specialist - 5 PHC Nooken rayon Myrzabekov D Procurement specialist - 6 PHC Kochkor ata Osmonov N Procurement specialist Yes 7 PHC Suzak rayon Baktybekova A Accountant Yes 8 PHC Oktyabr Asan k A Procurement specialist - 9 PHC Toktogul rayon Jeenmyrzaev B Procurement specialist - 10 PHC Tash-Komur Abdulahap u K Procurement specialist - Kalykova G Accountant - 11 CoHP ToguzToro Abazova G 12 CoHP Chatkal Satieva M Accountant - 13 CoHP Kara Kul Jusupova T Procurement specialist - 14 CoHP Kok-Jangak Jumasheva Z Accountant Yes 15 CoHP Shamaldy Say Chodueva G Procurement specialist - 16 CoHP Sumsar Kunieva D Accountant - 17 CoHP Ozgorush Koshalieva A Accountant - 18 CoHP Uchterek Junusova T Procurement specialist Yes 19 CoHP MailySuu Anarbaev U Financial specialist Yes Issyk kul oblast 1 GFD Chelpek Baiseitov J Accountant - 2 GFB Baltabai Omuralieva K Accountant - 3 GFB JetiOguz Omuralieva K Accountant Yes 4 GFB Tamga Akunova A Accountant Yes 5 GFB Grigor`evka Turdakunova N Accountant - 6 GFB KaraTalaa Kataganova M Accountant - 7 GFB Sary Kol Konurbaeva M Accountant - 8 GFB YssykKol Kaparova A Accountant Yes 9 GFB Voshod Mukanbetova M Procurement specialist Yes 10 GFB Nazik Kasymakunova G Procurement specialist Yes 11 GFB Umut Soronbaeva B Procurement specialist Yes 12 PHC Ak-Suu rayon Dumukenova K Procurement specialist - 13 PHC Yssyk-Kul rayon Bolotkaniova M Procurement specialist - 14 PHC Ton rayon Boshkoev S Procurement specialist - 15 PHC Tup rayon Kojobaeva S Procurement specialist - 16 PHC Balyckchy Mukabet k G Procurement specialist - 44 17 PHC Yssyk Kul obl Maketaev A Procurement specialist - 18 CoHP Jeti-Oguz Ilesbek u R Procurement specialist - 19 CoHP Anan`evo Marusova L Accountant Yes Naryn oblast 1 PHC Aktalin rayon Nurbek k G Procurement specialist - 2 PHC At Bashy rayon Jundubaev T Procurement specialist - 3 PHC Jumgal rayon Abyshov T Procurement specialist Yes 4 PHC Kochkor rayon Kaidyldaeva A Procurement specialist - 5 PHC Naryn oblast Omorova A Procurement specialist Yes 6 PHC Naryn rayon Esenbek u T Procurement specialist - 7 CoHP Minkush Narynbaev A Procurement specialist - Talas oblast GFD â„– 3 Bakai-Ata Shukuev B Procurement specialist Yes 1 rayon 2 PHC Kara Buura rayon Aidarbekov A Procurement specialist Yes 3 PHC Talas rayon Botukeeva G Procurement specialist Yes 4 PHC Talas oblast Bekturov N Procurement specialist Yes 5 CoHP Bakai ata rayon Turdumat u A Procurement specialist Yes 6 CoHP Manas rayon Turgumbaev T Procurement specialist - 45 Annex 5. PEFA Indicators PEFA - 2014 Indicators Score PI-1 Aggregate expenditure out-turn compared to original approved budget A PI-2 Composition of expenditure out-turn compared to original approved budget D+ PI-3 Aggregate revenue out-turn compared to original approved budget A PI-4 Stock and monitoring of expenditure payment arrears D+ PI-5 Classification of the budget B PI-6 Comprehensive-ness of information included in budget documentation B PI-7 Extent of unreported government operations D+ PI-8 Transparency of Inter-Governmental Fiscal Relations A PI-9 Oversight of aggregate fiscal risk from other public sector entities C+ PI-10 Public Access to key fiscal information C+ PI-11 taxpayer registration and tax assessment B PI-12 Multi-year perspective in fiscal planning, expenditure policy and budgeting C+ PI-13 Transparency of taxpayer obligations and liabilities B PI-14 Effectiveness of measures for taxpayer registration and tax assessment B PI-15 Effectiveness in collection of tax payments B+ PI-16 Predictability in the availability of funds for commitment of expenditures C+ PI-17 Recording and management of cash balances, debt and guarantees A PI-18 Effectiveness of payroll controls D+ PI-19 Competition, value for money and controls in procurement B PI-20 Effectiveness of internal controls for non-salary expenditures C PI-21 Effectiveness of internal audit C PI-22 Timeliness and regularity of accounts reconciliation A PI-23 Availability of information on resources received by service delivery units A PI-24 Quality and timeliness of in-year budget reports C+ PI-25 Quality and timeliness of annual financial statements C+ PI-26 Scope, nature and follow-up of external audit C+ PI-27 Legislative scrutiny of the annual budget law C+ PI-28 Legislative scrutiny of external audit reports C+ D1 Predictability of Direct Budget Support D+ Financial information provided by donors for budgeting and reporting on project and program D2 aid A D3 Proportion of aid that is managed by use of national procedures D 46 Annex 6. Review of payments under sample contracts of selected PHCs (2016-2017) Payment period Estimated cost advertisement advertisement Contract date Contract sum Procurement Procurement Date of final Delivery act Contractor/ Number of (days after delivery) >90 days payment Supplier method date of PHC title Direct 31-10-17 contracting Pharmaceuticals 16:32 16-11-17 17103176143617 LLC RЕМÐ?К 525,000.00 520,000.00 11-16-17 11-24-17 8 Direct 14-12-17 contracting Soap detergent 19:56 20-12-17 17121482422871 LLC "Erbol" 579,070.00 425,475.00 12-20-17 12-27-17 7 PHC Direct 25-12-17 LLC "Amina Kyzyl- contracting Pharmaceuticals 19:11 28-12-17 17122584526275 pharm" 469,000.00 407,500.00 12-28-17 02-08-18 42 Kiya Direct 31-10-17 LLC "Garant contracting Pharmaceuticals 16:32 15-11-17 17103176143617 Aseptik" 285,000.00 285,000.00 11-15-17 12-07-17 22 Direct 22-08-17 contracting Paper 14:58 21-09-17 17082266711284 PE Adiev a 279,200.00 249,000.00 09-21-17 12-27-17 97 yes Repairing the 22-08-17 Simplified medical building 14:16 21-09-17 17082267593062 LLC ПГС-ВЭК 1,934,427.00 1,749,667.00 10-21-17 11-20-17 30 Ultrasound 16-12-17 LLC "Unit reactiv PHC Simplified machine 16:58 28-12-17 17121682729966 pharma" 1,250,000.00 885,000.00 12-20-17 12-27-17 7 Osh Medical 22-06-16 LLC Favorit "Family Single stage equipment 17:25 21-07-16 16062216798089 service 1,023,000.00 755,000.00 08-21-17 12-28-17 129 yes piece" Repairing of the 29-08-16 LLC "Aalam- Simplified roof 17:52 14-09-16 16082922499113 Kurulush" 958,285.00 600,200.00 12-14-17 03-28-18 104 yes 08-05-17 Simplified Paper 14:25 16-06-17 17050851255015 PE Kurbanova G 692,600.00 559,480.00 06-18-17 12-26-17 191 yes 20-05-16 Simplified other goods 9:26 20-06-16 16052012808767 PE Ahmatova G 2,406,950.00 1,525,660.00 06-20-16 12-27-16 190 yes 07-02-17 PHC of Single stage petrol 11:12 01-03-17 17020738746039 LLC"Alfa-oil" 916,965.00 853,585.00 02-24-17 12-15-17 294 yes Jalal- 20-05-16 PE Abdullahunov Abad Simplified other goods 9:26 20-06-16 16052012808767 M 1,114,500.00 715,000.00 05-20-16 12-27-16 221 yes obl Direct Medical 19-09-16 contracting equipment 14:15 26-09-16 16091923525501 LLC "DAKU" 700,000.00 670,000.00 09-19-16 12-27-16 99 yes Direct 22-08-16 contracting Building repair 11:54 24-08-16 16082221782660 LLC "Ken-Timur" 816,303.00 571,412.00 08-22-16 11-29-16 99 yes Simplified 15-03-17 Pharmaceuticals 16:52 07-06-17 17031540987652 LLC"Altyn-Tamyr" 816,500.00 614,955.00 07-10-17 10-23-17 105 yes Simplified 26-07-17 petrol 15:16 04-09-17 17072664306008 PE Muratbek u Iran 358,593.50 358,594.00 12-26-17 04-18-18 113 yes PHC of 17-07-17 LLC "Bimed Toktogul Single stage Pharmaceuticals 16:08 23-08-17 17071746690864 Pharm" 231,600.00 215,990.00 09-06-17 10-23-17 47 17-07-17 Single stage Pharmaceuticals 16:08 23-08-17 17071746690864 LLC RЕМÐ?К 256,000.00 212,370.00 08-23-17 09-05-17 13 15-09-17 Single stage Pharmaceuticals 15:25 20-11-17 17091570293570 LLC RЕМÐ?К 250,000.00 209,420.00 11-20-17 12-04-17 14 47 purchasing 02-11-17 LLC "Unit reactiv Single stage fluoroapparate 14:53 14-12-17 17110276399019 pharma" 5,000,000.00 4,988,000.00 03-23-18 12-28-18 280 yes Purchasing of 28-06-17 Simplified coal 15:18 25-07-17 17062860974155 LLC "Eles" 360,000.00 305,850.00 09-20-17 11-10-17 51 Direct purchasing of 06-06-17 PE Kubanychbek u PHC of contracting special box 14:50 08-06-17 17060657491332 Avtandil 168,000.00 164,500.00 07-08-17 07-17-17 9 Kochkor Direct procurement of 16-12-17 contracting dental materials 10:53 22-12-17 17121682063134 LLC Dent Trade 147,719.00 143,705.00 01-22-18 12-27-18 339 yes Purchasing of Direct medical 08-08-17 LLC "Unit reactiv contracting equipment 15:14 15-08-17 17080866060423 pharma" 160,500.00 133,650.00 09-15-17 12-29-17 105 yes 30-08-17 LLC "Unit reactiv Single stage Xrays 17:14 09-10-17 17083068895855 pharma" 3,500,000.00 3,490,000.00 09-10-17 11-10-17 61 Direct Medical 13-12-17 LLC "Unit reactiv contracting equipment 15:55 18-12-17 17121382083493 pharma" 1,915,800.00 1,915,800.00 12-28-17 12-30-17 2 PHC of Repairing of the 17-08-16 Uzgen Simplified building 8:58 15-09-16 16081721378468 LLC "KBB" 2,010,000.00 1,188,620.00 10-15-17 12-20-17 66 Repairing of the 15-08-16 LLC "Kylym Simplified building 14:49 29-08-16 16081521214152 Kurulush" 1,623,144.00 1,034,780.00 10-01-17 12-21-17 81 Medical 21-09-16 Simplified equipment 11:51 06-10-16 16092124217202 LLC Kokomeren 1,042,950.00 877,950.00 11-07-17 12-21-17 44 27-05-17 Single stage Pharmaceuticals 10:19 21-06-17 17052755276012 LLC " Adinai " 356,819.00 349,989.00 06-21-17 06-21-17 0 Direct 20-06-17 contracting purchasing coal 9:36 29-06-17 17062059134687 PE Kurmanaliev N 357,420.00 337,995.00 07-28-17 07-28-17 0 PHC of Direct 19-12-17 Talas contracting Pharmaceuticals 11:16 25-12-17 17121981986166 LLC " Adinai " 308,175.00 308,050.00 12-25-17 12-28-17 3 rayon 31-10-17 Simplified Purchasing of PC 9:24 16-11-17 17103175974760 PE Balybaev K 205,000.00 200,000.00 12-16-17 12-28-17 12 14-02-17 Single stage Pharmaceuticals 11:47 14-03-17 17021439088411 LLC " Adinai " 174,330.00 161,145.00 03-21-17 03-31-17 10 Direct 19-12-16 contracting Food 15:32 21-12-16 16121931454153 PE Beishenaliev A 400,000.00 400,000.00 12-25-17 12-25-17 0 Direct stabilizers 75 28-09-17 contracting кВÐ? и 60 кВÐ? 15:02 02-10-17 17092872220485 PE Abdrazakova A 250,000.00 246,000.00 10-02-17 10-03-17 1 PHC of Direct repairing 19-04-17 PE Abdybachaeva Orlovka contracting materials 13:37 21-04-17 17041950092744 B 235,200.00 235,200.00 04-22-17 04-24-17 2 Direct 30-05-16 contracting Food 10:21 02-06-16 16053014390915 PE Beishenaliev A 174,000.00 173,910.00 06-01-16 06-12-16 11 Direct 30-03-17 contracting petrol AI92 11:57 05-04-17 17033046900132 LLC "Alfa Oil" 180,000.00 168,616.00 08-10-17 12-28-17 140 yes 15-06-17 Simplified Petrol AI92 14:13 29-06-17 17061559150123 LLC "Alfa Oil" 288,065.70 284,016.00 08-07-17 12-23-17 138 yes Direct 03-05-17 LLC "Unit reactiv PHC of contracting Pharmaceuticals 13:25 10-05-17 17050351258986 pharma" 201,710.00 167,915.00 10-28-17 12-22-17 55 Kemin Direct 30-01-17 rayon contracting Petrol AI 92 15:53 10-02-17 17013037739522 LLC "Alfa Oil" 120,000.00 112,980.00 11-02-17 12-15-17 43 Direct purchasing of 03-07-17 LLC "MNG contracting coal 10:49 13-07-17 17070361493745 Consulting" 149,985.00 111,080.00 08-25-17 12-15-17 112 yes 48 18-08-17 Simplified Soap detergent 18:27 11-09-17 17081867125059 PE Majikeev N 102,270.00 89,914.00 12-22-17 12-22-17 0 06-12-17 Single stage Furniture 14:42 28-12-17 17120677447756 PE Ismailova J 45,950.00 45,265.00 02-02-18 06-05-18 123 yes 27-11-17 Single stage Purchasing of PC 16:08 26-12-17 17112774574487 PE Bannikov M 35,500.00 34,500.00 12-26-17 06-03-18 159 yes GFD Purchasing of 21-07-17 "Grigore Single stage coal 12:44 19-08-17 17072157966101 LLC Doka-Trans 23,800.00 20,230.00 09-05-18 12-15-18 101 yes vka" Direct 15-12-16 contracting paint for printer 12:58 26-12-17 16121531443324 PER Bannikov M 19,100.00 19,100.00 12-26-17 12-26-17 0 29-11-17 PE Abdymomunov Single stage Soap detergent 10:06 27-12-17 17112978795183 M 19,750.00 18,270.00 12-21-17 12-27-17 6 Medical 27-05-17 Simplified equipment 11:22 13-06-17 17052756368735 LLC "Harvi spektr" 178,000.00 172,800.00 07-10-17 07-18-17 8 24-11-17 Simplified Purchasing of PC 15:09 12-12-17 17112478952498 PE Kochorbaeva G 119,000.00 115,500.00 12-20-17 12-27-17 7 PHC Direct 26-12-17 LLC "Artel Balykch contracting Pharmaceuticals 15:37 29-12-17 17122684658612 EkoMed" 145,000.00 99,800.00 12-29-17 12-30-17 1 y 03-04-17 LLC "Verona Simplified Petrol AI92 9:49 10-04-17 17040347466658 group" 100,860.00 95,310.00 06-10-17 06-15-17 5 20-02-17 Simplified Pharmaceuticals 14:15 29-03-17 17022039041693 LLC RЕМÐ?К 122,000.00 77,600.00 04-15-17 05-30-17 45 49 Annex 7. Review of complaints in health sector (2018) Date of Date of Days for >10 Tender # Complaint # Complaint from Procuring entity Complaint resolution review days 180605106905641 COM-18119870854 LLC Nivelir SOE "Digital Center of the MoH KR" 8/23/2018 9/12/2018 20 yes 180601105412148 COM-18110216211 LLC Farvater MoH KR 6/21/2018 7/5/2018 14 yes 180601105412148 COM-18110217769 LLC Farvater MoH KR 6/21/2018 6/28/2018 7 180601105412148 COM-18110217769 LLC Farvater MoH KR 6/21/2018 6/28/2018 7 180531105250721 COM-18111983251 LLC "Aqua Medtek" MoH KR 7/3/2018 7/11/2018 8 180531105250721 COM-18111983251 LLC "Aqua Medtek" MoH KR 7/3/2018 7/11/2018 8 180601105412148 COM-18110216211 LLC Farvater MoH KR 6/21/2018 7/5/2018 14 yes 180601105412148 COM-18110217769 LLC Farvater MoH KR 6/21/2018 6/28/2018 7 180601105412148 COM-18110216211 LLC Farvater MoH KR 6/21/2018 7/5/2018 14 yes 180607107944264 COM-18111665803 LLC Mir Ul Medical Academy (Ahunbaev) 6/29/2018 8/6/2018 38 yes 180607107944264 COM-18111665803 LLC Mir Ul Medical Academy (Ahunbaev) 6/29/2018 8/6/2018 38 yes 180531105250721 COM-18116207772 LLC "UniHelp" MoH KR 7/30/2018 8/10/2018 11 yes 180531105250721 COM-18116061795 LLC "Aqua Medtek" MoH KR 7/27/2018 8/3/2018 7 180531105250721 COM-18114856948 LLC "UniHelp" MoH KR 7/20/2018 7/27/2018 7 180531105250721 COM-18111983251 LLC "Aqua Medtek" MoH KR 7/3/2018 7/11/2018 8 180605106905641 COM-18113402296 LLC "Дорболжун-Курулуш" SOE "Digital Center of the MoH KR" 7/11/2018 7/12/2018 1 180605106905641 COM-18113523973 LLC "Amal-NT" SOE "Digital Center of the MoH KR" 7/11/2018 8/15/2018 35 yes 180605106905641 COM-18113402296 LLC "Дорболжун-Курулуш" SOE "Digital Center of the MoH KR" 7/11/2018 7/12/2018 1 180605106905641 COM-18113402296 LLC "Дорболжун-Курулуш" SOE "Digital Center of the MoH KR" 7/11/2018 7/12/2018 1 ОбщеÑ?тво Ñ? ограниченной 180605106905641 COM-18119870854 ответÑ?твенноÑ?тьюÐ?ивелир SOE "Digital Center of the MoH KR" 8/23/2018 9/12/2018 20 yes ОбщеÑ?тво Ñ? ограниченной 180605106905641 COM-18113523973 ответÑ?твенноÑ?тью "Ð?мал-Ð?Т" SOE "Digital Center of the MoH KR" 7/11/2018 8/15/2018 35 yes 180531105250721 COM-18114856948 ОÑ?ОО "UniHelp" (ЮниХелп) MoH KR 7/20/2018 7/27/2018 7 180605106905641 COM-18119870854 LLC Nivelir SOE "Digital Center of the MoH KR" 8/23/2018 9/12/2018 20 yes 180531105250721 COM-18116061795 LLC "Aqua Medtek" MoH KR 7/27/2018 8/3/2018 7 180607107944264 COM-18111665803 LLC Mir Ul Medical Academy (Ahunbaev) 6/29/2018 8/6/2018 38 yes 180531105250721 COM-18114856948 LLC "UniHelp" MoH KR 7/20/2018 7/27/2018 7 180725115551020 COM-18117215605 LLC "Кыргыз-Чек и Тем" Naryn medical college 8/4/2018 1/1/2019 150 yes 180919124127776 COM-18129264680 LLC Nivelir SOE "Digital Center of the MoH KR" 10/17/2018 10/23/2018 6 180704112035492 COM-18116559742 LLC "Тилек и Ко" Kyrgyz state institute on retraining 7/31/2018 1/1/2019 154 yes 180704112035492 COM-18116559742 LLC "Тилек и Ко" Kyrgyz state institute on retraining 7/31/2018 1/1/2019 154 yes 50 180704112035492 COM-18116559742 LLC "Тилек и Ко" Kyrgyz state institute on retraining 7/31/2018 1/1/2019 154 yes 180709112924984 COM-18116559870 LLC "Тилек и Ко" Kyrgyz state institute on retraining 7/31/2018 1/1/2019 154 yes 180709112924984 COM-18116559870 LLC "Тилек и Ко" Kyrgyz state institute on retraining 7/31/2018 1/1/2019 154 yes 180709112924984 COM-18116559870 LLC "Тилек и Ко" Kyrgyz state institute on retraining 7/31/2018 1/1/2019 154 yes 181004126523564 COM-18129278380 LLC "Бай Энерго" Kyrgyz science reproduction center 10/17/2018 10/19/2018 2 180601105412148 COM-18116719580 LLC "ДÐ?ЙРÐ?-ФÐ?РМ" MoH KR 8/1/2018 11/2/2018 93 yes 180601105412148 COM-18116719580 LLC "ДÐ?ЙРÐ?-ФÐ?РМ" MoH KR 8/1/2018 11/2/2018 93 yes 180531105250721 COM-18116207772 LLC "UniHelp" (ЮниХелп) MoH KR 7/30/2018 8/10/2018 11 yes 180531105250721 COM-18116061795 LLC "Aqua Medtek" MoH KR 7/27/2018 8/3/2018 7 180725115551020 COM-18117215605 LLC "Кыргыз-Чек и Тем" Naryn medical college 8/4/2018 1/1/2019 150 yes 180601105412148 COM-18116719580 LLC "ДÐ?ЙРÐ?-ФÐ?РМ" MoH KR 8/1/2018 11/2/2018 93 yes 180608108104937 COM-18118057032 LLC "UniHelp" (ЮниХелп) MoH KR 8/9/2018 8/13/2018 4 180608108104937 COM-18118057032 LLC "UniHelp" (ЮниХелп) MoH KR 8/9/2018 8/13/2018 4 180608108104937 COM-18118057032 LLC "UniHelp" (ЮниХелп) MoH KR 8/9/2018 8/13/2018 4 180531105250721 COM-18116207772 LLC "UniHelp" (ЮниХелп) MoH KR 7/30/2018 8/10/2018 11 180627110238205 COM-18118313242 LLC МЦ Кокомерен National Hospital under the moH KR 8/11/2018 10/9/2018 59 yes 180605106905641 COM-18113523973 LLC "Amal-NT" SOE "Digital Center of the MoH KR" 7/11/2018 8/15/2018 35 yes 180901121747481 COM-18122979579 LLC "ИрВир Курулуш Строй" Medical Academy (Ahunbaev) 9/11/2018 9/15/2018 4 180627110238205 COM-18118313242 LLC МЦ Кокомерен National Hospital under the moH KR 8/11/2018 10/9/2018 59 yes 180720114596467 COM-18127197690 LLC "Ð?й-Ñ?трой" MoH KR 10/8/2018 12/27/2018 80 yes 180725115551020 COM-18117215605 LLC "Кыргыз-Чек и Тем" Naryn medical college 8/4/2018 1/1/2019 150 yes 180901121747481 COM-18122979579 LLC "ИрВир Курулуш Строй" Medical Academy (Ahunbaev) 9/11/2018 9/15/2018 4 180901121749967 COM-18124352652 LLC "Партнер Дом" Medical Academy (Ahunbaev) 9/19/2018 1/1/2019 104 yes 180901121749967 COM-18124352652 LLC "Партнер Дом" Medical Academy (Ahunbaev) 9/19/2018 1/1/2019 104 yes 180901121749967 COM-18124352652 LLC "Партнер Дом" Medical Academy (Ahunbaev) 9/19/2018 1/1/2019 104 yes 180723115225801 COM-18116085734 PE Orunbaev D Nookat rayon center of Epidemiology review 7/28/2018 1/1/2019 157 yes 180723115225801 COM-18116085734 PE Orunbaev D Nookat rayon center of Epidemiology review 7/28/2018 1/1/2019 157 yes 180709112924984 COM-18116764332 C "Тилек и Ко" Kyrgyz state institute on retraining 8/1/2018 1/1/2019 153 yes 180709112924984 COM-18116764332 LLC "Тилек и Ко" Kyrgyz state institute on retraining 8/1/2018 1/1/2019 153 yes 180723115225801 COM-18116085734 PE Orunbaev D Nookat rayon center of Epidemiology review 7/28/2018 1/1/2019 157 yes 180709112924984 COM-18116764332 LLC "Тилек и Ко" Kyrgyz state institute on retraining 8/1/2018 1/1/2019 153 yes 180901121749967 COM-18124435473 LLC "СТЭЭР" Medical Academy (Ahunbaev) 9/20/2018 1/1/2019 103 yes 180901121749967 COM-18124435473 LLC "СТЭЭР" Medical Academy (Ahunbaev) 9/20/2018 1/1/2019 103 yes 180901121749967 COM-18124435473 LLC "СТЭЭР" Medical Academy (Ahunbaev) 9/20/2018 1/1/2019 103 yes 181129138049897 COM-18140834607 LLC "Гарант Ð?Ñ?ептик" Kyrgyz rehabilitation center (kurortology) 12/11/2018 1/1/2019 21 yes 180901121747481 COM-18122979579 LLC "ИрВир Курулуш Строй" Medical Academy (Ahunbaev) 9/11/2018 9/15/2018 4 51 180906122235607 COM-18123184529 LLC "ЗаÑ?вка на ремонт" SOE "Digital Center of the MoH KR" 9/12/2018 1/1/2019 111 yes 180906122235607 COM-18123184529 LLC"ЗаÑ?вка на ремонт" SOE "Digital Center of the MoH KR" 9/12/2018 1/1/2019 111 yes 180906122235607 COM-18123184529 LLC "ЗаÑ?вка на ремонт" SOE "Digital Center of the MoH KR" 9/12/2018 1/1/2019 111 yes 180720114596467 COM-18127197690 LLC "Ð?й-Ñ?трой" MoH KR 10/8/2018 12/27/2018 80 yes 181205138367849 COM-18141765988 LLC "Медикал СервиÑ? Компани" Medical Academy (Ahunbaev) 12/14/2018 1/11/2019 28 yes Toktogul rayon center of Epidemiology 181023130173001 COM-18130974885 PE Tokobaev A review 10/29/2018 12/5/2018 37 yes Toktogul rayon center of Epidemiology 181023130173001 COM-18130974885 PE Tokobaev A review 10/29/2018 12/5/2018 37 yes 180720114596467 COM-18125154651 LLC "ТоолоÑ? Строй" MoH KR 9/24/2018 9/26/2018 2 180720114596467 COM-18125154651 LLC "ТоолоÑ? Строй" MoH KR 9/24/2018 9/26/2018 2 180720114596467 COM-18125154651 LLC "ТоолоÑ? Строй" MoH KR 9/24/2018 9/26/2018 2 Toktogul rayon center of Epidemiology 181023130173001 COM-18130974885 PE Tokobaev A review 10/29/2018 12/5/2018 37 yes 180627110238205 COM-18118313242 LLC МЦ Кокомерен National Hospital under the moH KR 8/11/2018 10/9/2018 59 yes 180905121310417 COM-18127803375 LLC "Мега-Ремонт" Osh city enter of Epidemiology review 10/10/2018 10/15/2018 5 180905121310417 COM-18127803375 LLC "Мега-Ремонт" Osh city enter of Epidemiology review 10/10/2018 10/15/2018 5 180905121310417 COM-18127803375 LLC "Мега-Ремонт" Osh city enter of Epidemiology review 10/10/2018 10/15/2018 5 180914123394801 COM-18128266180 LLC "Бай Энерго" National Hospital under the moH KR 10/13/2018 10/23/2018 10 180914123394801 COM-18128266180 LLC "Бай Энерго" National Hospital under the moH KR 10/13/2018 10/23/2018 10 181004126523564 COM-18129278380 LLC "Бай Энерго" Kyrgyz Science Center of reproduction 10/17/2018 10/19/2018 2 180919124127776 COM-18129264680 LLC Nivelir SOE "Digital Center of the MoH KR" 10/17/2018 10/23/2018 6 181004126523564 COM-18129278380 LLC "Бай Энерго" Kyrgyz Science Center of reproduction 10/17/2018 10/19/2018 2 180914123394801 COM-18128266180 LLC "Бай Энерго" National Hospital under the moH KR 10/13/2018 10/23/2018 10 180919124127776 COM-18129264680 LLC Nivelir SOE "Digital Center of the MoH KR" 10/17/2018 10/23/2018 6 181018129483695 COM-18130573994 LLC «Ð?наш и Ко» Medical Academy (Ahunbaev) 10/25/2018 11/3/2018 9 181119135003942 COM-18138146067 PE Ibraimov KaraBalta medical colleage 11/30/2018 12/7/2018 7 Kyrgyz Research Institute of Health Resort 181126137072151 COM-18139695783 LLC "Ð?зиÑ?СтройЛÑ?нд" and Rehabilitation 12/6/2018 1/1/2019 26 yes Kyrgyz Research Institute of Health Resort 181126137072151 COM-18139695783 LLC "Ð?зиÑ?СтройЛÑ?нд" and Rehabilitation 12/6/2018 1/1/2019 26 yes 181018129483695 COM-18130573994 LLC «Ð?наш и Ко» Medical Academy (Ahunbaev) 10/25/2018 11/3/2018 9 181018129483695 COM-18130573994 LLC «Ð?наш и Ко» Medical Academy (Ahunbaev) 10/25/2018 11/3/2018 9 181102131761217 COM-18133317621 PE Ibraimov Panfilov rayon center of Epidemiology review 11/14/2018 1/1/2019 48 yes 181102131761217 COM-18133317621 PE Ibraimov Panfilov rayon center of Epidemiology review 11/14/2018 1/1/2019 48 yes 181102131761217 COM-18133317621 PE Ibraimov Panfilov rayon center of Epidemiology review 11/14/2018 1/1/2019 48 yes 52 Establishment Republican Center for Forensic Medical Examinations of the Ministry of 181210138250853 COM-18141608311 PE Karimkulova Health of the Kyrgyz Republic 12/13/2018 12/28/2018 15 yes Department of drug provision and medical 181001126068279 COM-18138678110 LLC "DISTRITECH"(ДиÑ?тритех) equipment at the Ministry of Health 12/3/2018 12/7/2018 4 Department of drug provision and medical 181001126068279 COM-18138678110 LLC "DISTRITECH"(ДиÑ?тритех) equipment at the Ministry of Health 12/3/2018 12/7/2018 4 Department of drug provision and medical 181001126068279 COM-18138678110 LLC "DISTRITECH"(ДиÑ?тритех) equipment at the Ministry of Health 12/3/2018 12/7/2018 4 Establishment Republican Center for Forensic Medical Examinations of the Ministry of 181210138250853 COM-18141608311 PE Karimkulova Health of the Kyrgyz Republic 12/13/2018 12/28/2018 15 yes Establishment Republican Center for Forensic Medical Examinations of the Ministry of 181210138250853 COM-18141608311 PE Karimkulova Health of the Kyrgyz Republic 12/13/2018 12/28/2018 15 yes 181119135003942 COM-18138146067 PE Ibraimov KaraBalta medical college 11/30/2018 12/7/2018 7 181119135003942 COM-18138146067 PE Ibraimov KaraBalta medical college 11/30/2018 12/7/2018 7 Department of drug provision and medical 181001126068279 COM-18140579112 LLC "DISTRITECH"(ДиÑ?тритех) equipment at the Ministry of Health 12/11/2018 1/11/2019 31 yes Kyrgyz Research Institute of Health Resort 181126137072151 COM-18139695783 LLC "Ð?зиÑ?СтройЛÑ?нд" and Rehabilitation 12/6/2018 1/1/2019 26 yes Kyrgyz Research Institute of Health Resort 181129138049897 COM-18140834607 LLC "Гарант Ð?Ñ?ептик" and Rehabilitation 12/11/2018 12/18/2018 7 Kyrgyz Research Institute of Health Resort 181129138049897 COM-18140834607 LLC "Гарант Ð?Ñ?ептик" and Rehabilitation 12/11/2018 12/18/2018 7 Kyrgyz Research Institute of Health Resort 181204138932088 COM-18142711288 LLC "Гарант Ð?Ñ?ептик" and Rehabilitation 12/18/2018 12/27/2018 9 181205138367849 COM-18141765988 LLC "Медикал СервиÑ? Компани" Medical Academy (Ahunbaev) 12/14/2018 1/11/2019 28 yes Kyrgyz Research Institute of Health Resort 181204138932088 COM-18142711288 LLC "Гарант Ð?Ñ?ептик" and Rehabilitation 12/18/2018 12/27/2018 9 Kyrgyz Research Institute of Health Resort 181217142432216 COM-18145033783 PE Karimkulova and Rehabilitation 12/27/2018 1/12/2019 16 yes 181213141586993 COM-18144990778 LLC "ПлюÑ? СБ" Osh obl medical center 12/26/2018 12/27/2018 1 181218142671159 COM-18145249677 LLC "JUNUS LTD" (ЖунуÑ? ЛТД) MoH KR 12/28/2018 1/16/2019 19 yes Department of drug provision and medical 181001126068279 COM-18140579112 LLC "DISTRITECH"(ДиÑ?тритех) equipment at the Ministry of Health 12/11/2018 1/11/2019 31 yes 181224144257353 COM-18144977406 PE Alymbaev Talas obl inf medical center 12/26/2018 1/1/2019 6 181217141296265 COM-18144253677 LLC"ПлюÑ? СБ" Students healthcare 12/24/2018 1/11/2019 18 yes 181224144257353 COM-18144977406 PE Alymbaev Talas obl inf medical center 12/26/2018 1/1/2019 6 181213141586993 COM-18144990778 LLC "ПлюÑ? СБ" osh oblast medical inf center 12/26/2018 12/27/2018 1 181224144257353 COM-18144977406 PE Alymbaev Talas obl inf medical center 12/26/2018 1/1/2019 6 181211140834514 COM-18144815656 LLC "MIKS Trade" Medical Academy (Ahunbaev) 12/26/2018 12/26/2018 0 Kyrgyz Research Institute of Health Resort 181129138049897 COM-18144150612 LLC МЦ Кокомерен and Rehabilitation 12/24/2018 12/24/2018 0 Kyrgyz Research Institute of Health Resort 181129138049897 COM-18144150612 LLC МЦ Кокомерен and Rehabilitation 12/24/2018 12/24/2018 0 53 Kyrgyz Research Institute of Health Resort 181129138049897 COM-18144150612 LLC МЦ Кокомерен and Rehabilitation 12/24/2018 12/24/2018 0 181211140834514 COM-18144815656 LLC "MIKS Trade" Medical Academy (Ahunbaev) 12/26/2018 12/26/2018 0 Department of drug provision and medical 181001126068279 COM-18140579112 LLC "DISTRITECH"(ДиÑ?тритех) equipment at the Ministry of Health 12/11/2018 1/11/2019 31 yes 181211140834514 COM-18144815656 LLC "MIKS Trade" Medical Academy (Ahunbaev) 12/26/2018 12/26/2018 0 180720114596467 COM-18127197690 LLC "Ð?й-Ñ?трой" MoH KR 10/8/2018 12/27/2018 80 yes Kyrgyz Research Institute of Health Resort 181204138932088 COM-18142711288 LLC "Гарант Ð?Ñ?ептик" and Rehabilitation 12/18/2018 12/27/2018 9 181218142671159 COM-18145249677 LLC "JUNUS LTD" (ЖунуÑ? ЛТД) MoH KR 12/28/2018 1/16/2019 19 yes Kyrgyz Research Institute of Health Resort 181217142432216 COM-18145033783 PE Karimkulova and Rehabilitation 12/27/2018 1/12/2019 16 yes 181217141296265 COM-18144253677 LLC "ПлюÑ? СБ" Students healthcare 12/24/2018 1/11/2019 18 yes 181205138367849 COM-18141765988 LLC "Медикал СервиÑ? Компани" Medical Academy (Ahunbaev) 12/14/2018 1/11/2019 28 yes 181213141586993 COM-18144990778 LLC "ПлюÑ? СБ" osh medical informational center 12/26/2018 12/27/2018 1 The southern branch of the Kyrgyz State Medical Institute of Retraining and Advanced Training named after Sanzharbek Bakiyrovich 181224144263385 COM-18145235684 LLC «Ð?наш и Ко» Daniyarov 12/28/2018 12/28/2018 0 The southern branch of the Kyrgyz State Medical Institute of Retraining and Advanced Training named after Sanzharbek Bakiyrovich 181224144263385 COM-18145235684 LLC «Ð?наш и Ко» Daniyarov 12/28/2018 2/20/2019 54 yes The southern branch of the Kyrgyz State Medical Institute of Retraining and Advanced Training named after Sanzharbek Bakiyrovich 181224144263385 COM-18145235684 LLC «Ð?наш и Ко» Daniyarov 12/28/2018 2/20/2019 54 yes 181218142671159 COM-18145249677 LLC "JUNUS LTD" (ЖунуÑ? ЛТД) MoH KR 12/28/2018 1/16/2019 19 yes 181201138417526 COM-18145312703 LLC "Юнит Реактив Фарма" MoH KR 12/29/2018 1/9/2019 11 yes 181201138417526 COM-18145312703 LLC "Юнит Реактив Фарма" MoH KR 12/29/2018 1/9/2019 11 yes 181201138417526 COM-18145388691 MoH KR MoH KR 12/31/2018 1/9/2019 9 181217141296265 COM-18144253677 LLC "ПлюÑ? СБ" Students healthcare 12/24/2018 1/11/2019 18 yes 181201138417526 COM-18145388691 MoH KR MoH KR 12/31/2018 1/9/2019 9 181201138417526 COM-18145388691 MoH KR MoH KR 12/31/2018 1/9/2019 9 181201138417526 COM-18145312703 LLC "Юнит Реактив Фарма" MoH KR 12/29/2018 1/9/2019 11 yes Kyrgyz Research Institute of Health Resort 181217142432216 COM-18145033783 PE Karimkulova and Rehabilitation 12/27/2018 1/12/2019 16 yes 54 Annex 8. MHIF budget funding from Social Fund budget (Source: Social Fund budget execution reports for 2015-2017) year Budget (in thousand KGS) Actual (in thousand KGS) 2015 1735301,9 1735301,9 2016 1878780,5 1878780,5 2017 2167451,6 2167451,6 55