Preliminary assessment of the second payment request of Romania

anisation and functioning of ANDIS published in the Official Journal No. 676 on 6 July 2022; v) Substantiation Note for Government Decision No. 857 of 6 July 2022; vi) Copy of Government Decision No. 1506 of 19 December 2022 for the Implementing Rules of Government Emergency Ordinance No. 76 of 2 June 2022 for the setting up of ANDIS, published in the Official Journal No. 1234 on 21 December 2022; vii) Ministerial Order No. 459 of 17 February 2023 on the appointment of the President of ANDIS; viii) Ministerial Order No. 460 of 17 February 2023 on the renewed appointment of the members and alternate members of the Supervisory Board of ANDIS; ix) Ministerial Order No. 1697 of 27 June 2022 on the appointment of the members and alternate members of the Supervisory Board of ANDIS; x) Ministerial Order No. 2340 of 1 August 2022 for the approval of the Regulation for Organizing and Functioning of ANDIS, published in the Official Journal No. 832 on 24 August 2022; xi) Ministerial Order No. 2339 of 1 August 2022 for the approval of the positions chart of ANDIS; xii) CVs of 17 staff members of ANDIS; xiii) List of ANDIS personnel of 28 February 2023; xiv) Document with estimations on the training budget for ANDIS staff; xv) Copy of Law No. 66/2023 approving Government Emergency Order No 76/2022 on the establishment, organisation and operation of the National Agency for the Development of Infrastructure in Health, published in the Official Journal No. 255 on 28 March 2023. 41 xvi) Copy of Government Decision No. 276/2023, published in the Official Journal No. 267 on 30 March 2023. Analysis: The justification and substantiating evidence provided by the Romanian authorities covers all constitutive elements of the milestone. Entry into force of the legislative framework establishing the National Agency for Infrastructure Development in Health (ANDIS). The Government Emergency Ordinance No. 76 of 2 June 2022 on the establishment, organisation and functioning of the National Agency for the Development of Health Infrastructure was published in the Official Journal on 3 June 2022 and entered into force on the date of its publication, in accordance with Article 12(3) of Law No. 24/2000 on the rules of legislative technique for the drafting of legislative acts. It was complemented by the Government Decision No. 1506 of 19 December 2022 for the Implementing Rules of Government Emergency Ordinance No. 76/2022, published in the Official Journal on 21 December 2022 as well as by the Government Decision No. 857 of 6 July 2022 on the organisation and functioning of ANDIS, published in the Official Journal on 6 July 2022. Both Government Decisions entered into force on the date of their publication, in accordance with Article 12(3) of Law No. 24/2000 on the rules of legislative technique for the drafting of legislative acts. Law No. 66/2023 approved the Government Emergency Ordinance No. 76 and was published in the Official Journal on 28 March 2023 and entered into force on 31 March 2023, in accordance with Article 12(1) of Law 24/2000 on the rules of legislative technique for the drafting of legislative acts. The Council Implementing Decision Annex required that the legislative framework establishing the National Agency for Infrastructure Development in Health (ANDIS) shall set out the following functions for the Agency: Preparing and implementing priority public health infrastructure investment projects in a timely manner, in accordance with the specifications and within the framework of the approved budget. Article 3(3) letter c) of the Government Emergency Ordinance No. 76/2022 provides the objectives that ANDIS pursues with its activity. These are preparing and implementing investment projects of major importance for the health infrastructure in a timely manner, in accordance with the specifications and within the framework of the approved budget. Issuing instructions, recommendations and applicable methodological standards for the preparation, implementation and completion of public health infrastructure investment projects. Article 4(1) letter b) of the Government Emergency Ordinance No. 76/2022 provides that for developing health infrastructure, ANDIS has to draft and adopt instructions, guidance and recommendations approved by order of the president of ANDIS. These have to cover the preparation, implementation and completion of investment projects and will apply the relevant legal provisions. Article 4(1) letter d) provides that ANDIS shall develop methodologies on strategies for financing investment projects in health infrastructure, implementation of investment projects of considerable importance in health infrastructure from project design until commissioning of the investment objective achieved under the project according to the destination, prioritisation of investment projects of considerable importance in health infrastructure, management, supervision and commissioning of investment targets of considerable importance in health infrastructure according to the destination. 42 Providing specialised assistance in the field of investment projects in public health infrastructure to ministries, public hospitals or to other public authorities. Article 4(1) letter l) of the Government Emergency Ordinance No. 76/2022 specifies that ANDIS, when developing health infrastructure, will provide specialised assistance to ministries and institutions with their own health networks or to the public hospitals in those health networks for the implementation of the investment projects. Establishing and implementing the multiannual programme of priority investment projects in public health infrastructure Article 4(1) letter g) of the Government Emergency Ordinance No. 76/2022 specifies that ANDIS has to draft the multiannual programme of investment projects of major importance for the public health infrastructure and submits it for approval to the Government, through the Ministry of Health. Article 7(1) and (2) provide that ANDIS has to manage the major health infrastructure investments which are included in the multiannual programme, thus ensuring the implementation of the programme. Monitoring the implementation of public health infrastructure investment projects Article 4(1) letter h) of the Government Emergency Ordinance No. 76/2022 tasks ANDIS with monitoring the implementation of investment projects of major importance for the public health infrastructure. Article 2 letter b) defines the external beneficiaries as Ministries and institutions with their own health networks or public hospitals in their health network implementing considerable investment projects. Also, Article 4(2) letter c) refers to monitoring the implementation of investment projects in the public health infrastructure among the functions of ANDIS. ANDIS has to collect and publish data, information and reports related to the implementation of these projects. Setting-up a centre of excellence in the management of public health infrastructure investment projects Article 3(3) letter b) of the Government Emergency Ordinance No. 76/2022 provides that through its activity, ANDIS should ensure high quality and performance requirements for the public health infrastructure and become a centre of excellence in the management of objectives/investment projects. This should lead to a high-performance management, permanent improvement of the administrative capacity for implementing the investments and the transfer of knowledge and expertise in implementing investments, including those supported by the Union budget. Establishing partnerships and concluding financing agreements for investment projects in public health infrastructure Article 4(1) letter i) of the Government Emergency Ordinance No. 76/2022 provides that ANDIS should establish partnerships and conclude financing agreements for objectives/investment projects of major importance for the public health infrastructure, in particular those included in Romania’s recovery and resilience plan. The president of ANDIS shall be appointed and the recruitment of staff for the 15 key roles in the finalised ANDIS organisation chart shall be completed by the time the agency becomes operational The president of ANDIS was appointed through the Ministerial Order No. 459/2023 of 17 February 2023 and the organization chart was approved through the Government Decision No. 857/2022 of 6 July 2022. The key roles of staff concern the activities of analysis and planning, implementation and monitoring of projects, economic and logistics, legal and human resources, and procurement. 26 staff members were recruited, according to the list of ANDIS personnel of 28 February 2023, including for the key roles, so that the agency would be operational. Part of staff has been transferred from the Ministry of Health and central and local public authorities. The agency became 43 operational through the appointment of the president of ANDIS, the recruitment of staff for the 15 key roles and the completion of the ANDIS organisation chart. In addition to the requirements stemming from the description of the milestone, the description of the measure requires the setting up and rendering operational of ANDIS as a public institution with legal personality and subordinated to the Ministry of Health, able to manage major public health infrastructure projects, as well as to provide technical expertise at the request of local authorities. It also requires ANDIS’ endowment with a headquarters as well as staff training activities and consultancy and technical assistance for the projects falling under ANDIS’ portfolio. The setting up and operationalisation of ANDIS was ensured through Government Emergency Ordinance No. 76 of 2 June 2022 on the establishment, organisation and functioning of the National Agency for the Development of Health Infrastructure, the appointment of the president and the essential staff. Article 1(2) of Government Emergency Ordinance No. 76/2022 provides that ANDIS is a public institution with legal personality, subordinated to the Ministry of Health, and Article 5(1) refers to its role in managing major health infrastructure projects. Articles 4(1) letter l) and 4(2) letter d) refers to the provision of technical expertise to beneficiaries, including local authorities. The staff training activities are established in Article 4(1) letter q) of Government Emergency Ordinance No. 76/2022 and consist of training and upskilling programmes, conferences and experience sharing on health infrastructure investments. The consultancy and technical assistance activities for projects under ANDIS’ portfolio are mentioned in Article 4(2) of Government Emergency Ordinance No. 76/2022 and consist of guidance on financing opportunities, contracting and procurement, management, implementation and monitoring of projects. Finally, Government Decision No. 276/2023, published in the Official Journal No. 267 on 30 March 2023, establishes new headquarters for ANDI, setting up proper work conditions and spaces for a bigger number of employees. The new address is Piața Presei Libere, nr. 1, House of Free Press, Corp B, et. 4 Bucharest. Commission Preliminary Assessment: Satisfactorily fulfilled Related Measure: Increased capacity for health management and human Number: 356 resources in health Name of the Milestone: Entry into force of the legislative framework for the increased capacity for health management and human resources in health Qualitative Indicator: Entry into force of the legislative framework for the Time: Q2 2022 reform of the management of health service and of human resources Context: The objective of sub-reform 3.1 is to improve the knowledge, skills and competences of the employees responsible for the management of health services across the Romanian health system. Milestone #356 concerns several legislative changes developing competence criteria for specialist staff active in the management of health services, thereby establishing a framework for professionalisation of management. Milestone #356 is the first step of the implementation of the sub-reform and it will be followed by target #361 related to training on health service management. The sub-reform has a final expected date for implementation of 30 June 2025. Evidence provided: In line with the verification mechanism set out in the Operational Arrangements, the following evidence was provided: 44  i) Cover note duly justifying how the milestone (including all the constitutive elements) was satisfactorily fulfilled; ii) Copy of the Government Ordinance No. 14 of 13 July 2022 amending and complementing Law No. 95/2006 on the reform in the health sector, published in the Official Journal No. 711 on 15 July 2022; iii) Copy of the Government Ordinance No. 37 of 31 August 2022 amending and complementing Law No. 95/2006 on the reform in the health sector and Law No. 227/2015 on the Fiscal Code, as well as establishing some other measures in the health sector, published in the Official Journal No. 857 on 31 August 2022; iv) Copy of the Government Emergency Ordinance No. 129 of 29 September 2022 amending Article IV of Government Emergency Ordinance No. 44/2022 on establishing some measures within the health system, as well as for the interpretation, modification and complementing some legal acts, for the prolongation of some deadlines, and for establishing some measures in the health sector, published in the Official Journal No. 954 on 30 September 2022; v) Copy of the Government Decision No. 1183 of 29 September 2022 on the organisation and functioning of the National Institute for Health Services Management (hereinafter also referred to as “INMSS”), published in the Official Journal No. 961 on 3 October 2022; vi) Copy of the Government Decision No. 1184 of 29 September 2022 on the modification of annex 2 of Government Decision No. 144/2010 on the organisation and functioning of the Ministry of Health, published in the Official Journal No. 961 on 3 October 2022; vii) Copy of the Ministerial Order No. 3143 of 7 October 2022 on the establishment of the quality evaluation criteria for the endorsement of upskilling courses in health management or health services management, published in the Official Journal No. 983 on 10 October 2022. viii) Copy of Government Decision 1236 of 12 October 2022, approving the Memorandum of Understanding between the World Health Organisation and the Romanian Ministry of Health as the main grant beneficiary of the National Recovery and Resilience Plan for Romania, signed in Bucharest and Copenhagen on 10 June 2022, of Amendment No 1 to the Memorandum of Understanding signed in Bucharest and Copenhagen on 1 August 2022, and of Amendment No 2 to the Memorandum of Understanding signed in Bucharest and Copenhagen on 22 September 2022, published in the Official Journal No. 1035 on 25 October 2022. The authorities also provided: ix) Copy of Decision No. 12 of 29 June 2018 of the College of Doctors of Romania on the regulation of the national system of continuous medical education, of the criteria and rules for the accreditation of providers of continuing medical education, and of the procedural system for the evaluation and crediting of continuous medical education activities addressed to doctors, published in the Official Journal No. 683 on 6 August 2018; x) Collaboration Protocol No. 16679 of 22 September 2022 between the Ministry of Health and G6-UMF University Alliance Association. Analysis: The justification and substantiating evidence provided by the Romanian authorities covers all constitutive elements of the milestone. The amendments target the main law governing the health sector (Law No. 95 of 2006, as amended) On 15 July 2022, Government Ordinance No. 14 of 13 July 2022 amending and complementing Law 45 No. 95/2006 was published in the Official Journal and entered into force three days later, on 18 July 2022, in accordance with Article 12(1) of Law 24/2000 on the rules of legislative technique for the drafting of legislative acts. On 31 August 2022, Government Ordinance No. 37 of 31 August 2022 bringing further amendments to Law No. 95/2006 was published in the Official Journal and entered into force three days after its publication, on 3 September 2022. These Government Ordinances complemented Law No. 95/2006 with provisions regarding competence criteria for enrolment in competitions for health management positions as for certain management positions, a degree in a subject of study and/or a minimum number of years of experience with related tasks must be reached to fulfil the eligibility criteria for the respective position. Also, Article IV of Government Emergency Ordinance No. 129 of 29 September 2022 amended the provisions in Law No. 95/2006 concerning the requirements for upskilling courses for management positions. The new provisions refer to the obligation of managers to provide proof of graduating upskilling courses in two years after the entry into force of the Government Emergency Ordinance and every two years afterwards under the sanction of dismissal. It was published in the Official Journal on 30 September 2022, entering into force o