The government assessed the effectiveness of the provision of public services in 7 areas (health care, transport, social sphere, education, ecology, culture and sports). For this, he interviewed employees of the central and local administration in selected areas, analyzed and drew conclusions.

One conclusion concerns the fact that some of those who were asked did not understand the type of public service being provided (they were not clear whether it was a public service or not) or noted that the questions did not match the activities they actually did are engaged in perform.

Another conclusion concerns the non-unitary understanding of some terms. “For example, at the level of the interviewees, such terms as “performance of public service”, “monitoring”, “evaluation” are ambiguously understood. At the same time, other respondents do not make a clear distinction between the strategy and the laws that regulate a specific service,” the Report says.

Respondents from the administrations of road and transport infrastructure or sports services had more difficulties in determining the relevant legal framework, the presence/absence of a quality standard and even some indicators related to the transparency of the provision of public services.

Auditors’ recommendations:

• State institutions can transfer the evaluation of the civil service to an external body after a certain period of time.

• Public institutions should make more efforts to develop an internal system for monitoring and evaluating the public service based on interim and final reports that measure the degree of achievement of performance indicators or goals proposed at the beginning of the year. The goals proposed at the various stages of planning must be realistically linked to the available financial resources, otherwise the achievement of goals associated with “no budget” goals will remain problematic.

• Public service funding should be based on forecasted budgets so that each institution providing a public service can set its goals and targets at the beginning of the year.

• The norm of the cost of providing a public service must be approved after consultation with entities in the territory providing the relevant public service, and constantly updated to cope with the increase in prices for goods and services.

• State institutions must ensure the replacement of movable and immovable property every 2-3 years, which provides an acceptable standard for the provision of public services. In addition, government agencies should also ensure continuous training of human resources to face the current challenges of the industry.

• Institutions providing public services should facilitate the access of vulnerable categories (people with disabilities, people with low income, elderly people, residents of rural areas who are at a great distance from the institution providing services, etc.). Accessibility must also take into account the digital component – ​​making the web pages of government institutions accessible so that the widest possible range of potential beneficiaries can access the information.

The sphere of health. Public health service

Currently, the quality of service provision is affected by many aspects: insufficient number of patronage nurses and medical mediators, the difficulty of filling available positions; representatives of local authorities assign other tasks to community nurses, which may affect their ability to focus on providing health services in the community; the level of wages is recognized as unsatisfactory, the infrastructure of assistance

there is a lack of communal medical services, as well as material resources necessary for the implementation of activities.

Many workers have to provide their own resources for aspects such as communication, transport, first aid kit and medication for primary intervention.

Current procedures do not include the use of instruments to measure beneficiary satisfaction or a formal register for registering petitions or complaints. The score related to the adequacy of the budget for the provision of community health services is lower than average in the case of county and local government representatives, according to the scores made on a scale of 1 to 10.

The interviewed representatives of the institutions claim that the budget allocated to the medical service of the community is not enough to provide for its needs and wants. In addition, representatives of the central structures emphasized that the community health care service experiences critical underfunding.

The costs of providing the service constantly exceed the allocated funds, and this is due to several reasons: insufficient salaries of the personnel involved (especially medical mediators). The level of wages affects the motivation and retention of qualified personnel and can affect the quality of services provided; limited material resources needed to carry out community health care activities; lack of necessary equipment and materials

it can put financial pressure on service providers who have to cover their costs from other sources or work in suboptimal conditions; visiting nurses cover transport costs at their own expense both within the city and beyond.

This can affect their personal budget and create an additional financial burden; no special budgets are allocated for the minimum equipment required for primary medical care. Basic medical infrastructure and equipment, such as first-aid kits, may be absent or inadequate, which may affect the ability to provide quality and safe services.

With a few exceptions, funds for the salaries of the staff involved (approximately 1,850 community nurses and 465 medical mediators) are transferred from the Ministry of Health to the municipalities. A small proportion of community nurses (about 30 out of 1,850 community nurses and about 8 medical mediators) are paid directly by municipalities, in the few cases where local governments have understood the role and importance of community nurses and have hired them themselves.

Of the 465 medical mediators, 16 are paid through the POCU project, and 440 are paid from the state budget, i.e. the Ministry of Health.

They are also trying to convince the mayors of the need to allocate funds for the public medical brigade.

See the detailed report here

Number of authors: Individual interviews were conducted through online platforms Zoom, Google Meet, audio was recorded with the consent of the respondents and fully transcribed. The conducted interviews were conducted according to the topic of discussion, depending on the respondent’s competence/field of knowledge. Thus, the topics of discussion in the interviews were different, depending on the experience of the type of respondent and related to the eight criteria for measuring the effectiveness of public services previously developed within the framework of the project. The distribution of interviews by levels of state power met the requirements of the specifications. In total, the qualitative study included 60 interviews at the national level, 63 at the county level and 64 at the local level.