Preliminary assessment of the second payment request of Romania

n the same date, in accordance with Article 12(3) of Law 24/2000 on the rules of legislative technique for the drafting of legislative acts, for the purpose of increasing the capacity for health management and human resources in health. Additionally, a number of Government Decisions shall enter into force in order to operationalize the changes in this law. Two Government Decisions concerning the establishment, organising and functioning of the National Institute for Health Services Management (INMSS) entered into force and operationalized the changes in Law No. 95 of 2006. On 3 October 2022, Government Decision No. 1183 of 29 September 2022 on the organisation and functioning of the INMSS and Government Decision No. 1184 of 29 September 2022 introducing the INMSS as a unit with financing from own sources or from subsidies raised by the State budget were published in the Official Journal and entered into force on the same date. Since INMSS is the public institution responsible for training, upskilling, medical education and professional development programmes in the field of health services management, these Government Decisions address the requirements in the description of the milestone concerning the continuous professional development of health professionals, the development and reinforcement of the body of health service management experts and the evaluation of health service management training programmes. Moreover, the Ministerial Order No. 3143 of 7 October 2022 approving the establishment of quality evaluation criteria for the endorsement of upskilling courses in health management or health services management was published in the Official Journal No. 983 from 10 October 2022 and entered into force on the same date. The Ministerial Order operationalized the changes in Law No. 95 of 2006 concerning the obligation of managers of health institutions to undertake regular upskilling courses in health management and health services management, in line with the quality criteria established through the Order of the minister of health. The main provisions of the newly introduced pieces of legislation shall: - adjust the competence criteria for enrolment in competitions for health management positions Government Ordinance No. 14 of 13 July 2022 adjusts in Article I(1), (3), (5), (7), (11) and (12) the competence criteria necessary for the enrolment in competitions of persons applying for the management positions of the County and Bucharest Public Health Directorates, the County Ambulance Services and the Bucharest-llfov Ambulance Service, the Public Hospitals and the National Health Insurance House. Therefore, graduation of certain studies and a minimum number of years of experience with defined related tasks has to be reached to fulfil the eligibility criteria for a position. Article I(7), (14), (20) and (23) of Government Ordinance No. 37 of 31 August 2022 also 46 includes provisions concerning criteria on education, specialisation and experience for the enrolment in competitions for different management positions in the health care institutions. - adjust the quality criteria for health service management training programmes The Annex to the Ministerial Order No. 3143 of 7 October 2022 on the establishment of quality evaluation criteria for the endorsement of upskilling courses in health management or health services management adjusts the general quality criteria through clarifying the definitions for different types of trainings. In the Annex of the Ministerial Order No. 3143/2022, the first section deals in Article I with initial training (long-term courses), asking for the tertiary level of education of the trainees, and in the first section in Article II with continuous training (short-term courses), asking for the graduation of master studies or PhD in health management or health services management and the qualification of specialist or primary doctor in public health or management. The second section of the Annex defines specific criteria for the assessment of the quality of training programmes focusing on institutional competence (Article I), logistics (Article II), personnel competences (Article III), educational effectiveness (Article IV), assessment of trainees by specialised personnel (Article V) and assessment of the training programme by the trainees (Article VI). The definition of the quality criteria adjusts the health service management training programmes to recognise the different professional merits and rewards of health professionals. - update the requirements for the continuous professional development of health professionals The requirements for the continuous professional development of health professionals were updated through Article IV(1) and (2) of the Government Emergency Ordinance No. 129 of 29 September 2022. As provided for in Article IV(2), the management staff has the obligation to provide proof of graduation of a short-term upskilling course in health management in two years from the date of entry into force of the ordinance or in two years from the date of their appointment, and every two years afterwards, under the sanction of dismissal from their post. In addition, Article II of the Annex to the Ministerial Order No. 3143/2022 sets out general criteria for the organization of training programmes and specifies the requirements for the admission of trainees to the continuous training programme in health management and health services management. - develop and reinforce the body of health service management experts Article I(13), (14), (15) of Government Ordinance No. 14 of 13 July 2022 explains the role of the National Institute for Health Services Management in providing professional training and drafting training curricula in the field of health services management in partnership with medicine and pharmacy universities, in designing and updating the database of experts in health services management and in contracting external experts for the interdisciplinary training needs. Also, Government Decision No. 1183 of 29 September 2022 sets the organizational and functional framework for the Institute, the public institution which contributes to the development and reinforcement of the body of health service management experts by running training, upskilling, continuous medical education and professional development programmes in the field of health services management. - develop the auditing and evaluation of health service management training programmes Article 5 of Government Decision No. 1183 of 29 September 2022 establishes that the National Institute for Health Services Management has a Scientific Council whose role is to propose and evaluate the research-development-training activities in the field of health services management. Also, Article 1 corroborated with Article 3 letters a) and b) of the Collaboration Protocol between the Ministry of Health and the Association University Alliance G6-UMF provides that the two parties will work together on the evaluation of the current human resources training programmes for 47 health services management and on the development of the mechanism for periodic evaluation and accreditation of programmes for initial and continuous training for human resources in health services management. Sections V and VI from the Ministerial Order No. 3143 of 7 October 2022 concern two types of assessment: evaluation of the participants by the training provider and evaluation of the training programme by the participants. The newly adopted legislation shall help professionalise the management of health services by developing competence criteria for specialised staff. Article I(1), (3), (5), (7), (11) and (12) of the Government Ordinance No. 14 of 13 July 2022 provides the competence criteria for the management positions of the Health Directorates, the Ambulance Services, the Public Hospitals and the National Health Insurance House, contributing to the professionalization of these functions. Article I(7), (14), (20) and (23) of Government Ordinance No. 37 of 31 August 2022 includes also provisions on competence criteria concerning education, specialisation and experience (graduation of university studies in medicine, law or economics, number of years of work experience, specialisation in certain medical fields) for different management positions (executive director, general manager, medical director) in the health care institutions. Furthermore, in line with the description of the measure, a centre of excellence in the field of health services management shall become operational and accredited training programmes for the concerned human resources in management (which include members of the hospital steering committees, heads of sections, heads of laboratories in health facilities, executive directors, chief doctors, managers) shall be carried out in collaboration with those academic institutions with a leading portfolio in the field of training and development of human resources responsible for the management of health services. Throughout the implementation period of the reform, the Ministry of Health is expected to benefit from technical assistance and consultancy provided by experts. Government Ordinance No. 14 of 13 July 2022, Article 1 (13-15) establishes the National Institute of Health Services Management which includes a centre of excellence for capacity building in the field of health services management which is operational within its organizational structure. The training programmes for the human resources in management positions are subject to target #361 (Q2/25). The Ministry of Health is benefitting from the technical assistance and consultancy provided by the experts of the World Health Organisation (WHO) for the period of the implementation of the reform of the health service management. In this sense, the authorities referred to the Memorandum of Understanding for Technical Assistance between Romania and the WHO for developing the quality criteria for health services management training programs in the Cover Note No. 20864 of 18 November 2022. Government Decision No. 1236 of 12 October 2022 approves this Memorandum. Commission Preliminary Assessment: Satisfactorily fulfilled Related Measure: Increased capacity for health management and human Number: 357 resources in health Name of the Milestone: Entry into force of legislation for the strategic framework for the development of human resources in health Qualitative Indicator: Entry into force of the legislation for the strategic framework for the development of human resources in health by Government Time: Q2 2022 Decision Context: 48 The objective of sub-reform 3.2 is to strengthen the capacity of the Romanian health system and to educate, recruit, retain and motivate a workforce ready to respond to the current and future health needs of the population. Milestone #357 requires the entry into force of the legislation for the strategic framework for the development of human resources in health by Government Decision. Milestone #357 is the first step of the implementation of the sub-reform, followed by milestone #358 on the adoption of the sectorial action plans for the development of human resources in health, milestone #359 on the setting up of a framework of differentiated recognition of professional merits and reward of health professionals. In addition, target #360 related to building and fully equipping two new skill development centres for public healthcare staff and target #362 on trainings on human resources management in health institutions complement the implementation process. 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: i) Cover note duly justifying how the milestone (including all the constitutive elements) was satisfactorily fulfilled; ii) Copy of the Government Decision No. 854 of 30 June 2022 on the approval of the Multi- Annual Strategy for the development of human resources in health 2022-2030, published in the Official Journal No. 663 on 1 July 2022, with the Multi-Annual Strategy incorporated in the annex of the Government Decision. The authorities also provided: iii) Substantiation Note to Government Decision No. 854 of 30 June 2022, published in the Official Journal No. 663 on 1 July 2022. Analysis: The justification and substantiating evidence provided by the Romanian authorities covers all constitutive elements of the milestone. Entry into force of the legislation for the strategic framework for the development of human resources in health by Government Decision. The law shall set out a new strategic framework for the development of human resources in health, in line with the overall objectives of the health system. With its Government Decision No. 854 of 30 June 2022, the Romanian Government approved the Multi-Annual Strategy for the development of human resources in health 2022-2030 (hereinafter referred to as “the Strategy”). The Government Decision, which includes the Strategy in its annex as mentioned in Article 1, entered into force on the date of its publication in the Official Journal, on 1 July 2022, in accordance with Article 12(3) of Law No. 24/2000 on the rules of legislative technique for the drafting of legislative acts. Chapter 3 of the Multi-Annual Strategy for the development of human resources in health 2022- 2030 describes the priorities and policies for the development of human resources for generating, managing and motivating the human resources in health, thus contributing to the promotion of health, sickness prevention and improving the quality of life of the population as main objectives of 49 the health system. Chapter 4 of the Multi-Annual Strategy for the development of human resources in health 2022-2030 analyses the context and chapter 6 lines out the directions of actions on how to address Romania’s need for health workers and the territorial distribution disparities, as well as how to improve the working conditions of the medical personnel. The strategic framework is compliant with the 2020 Country Specific Recommendations as specified in chapter 3 and it is structured around different priorities, directions of actions and specific objectives. The key elements on the strategic framework shall be: - The human resources in health – sourcing Direction of action 6.2 of the Strategy contains the elements related to sourcing of human resources. It focuses on improving the recruitment and retention mechanisms for medical personnel and trainers in the medical field through ensuring adequate working conditions, lining out transparent recruitment criteria and the creation of a centre of excellence in health service management capacity building and a consortium of health service management experts. Moreover, Direction of action 6.3 focuses on competency-based training to update medical and pharmaceutical university education and align it with EU standards. Direction of action 6.4 puts the emphasis on existing staff and aims to improve the framework for continuous medical education, adequate post-graduate training of healthcare staff, continuous professional development, as well as planning and retention of human resources in health through offering continuous education and professional development programmes. - The management of human resources in health Direction of action 6.2 of the Strategy concerns the strengthening of human resources management through regulation, retention, evaluation, and continuous development. The scope of training offers shall be increased, and a centre of excellence shall be created. The development of accreditation standards for health units, in order to implement a modern management of human resources in medical institutions is also envisaged. - The motivation management for human resources Direction of action 6.2 of the Strategy includes the improvement of the working environment for healthcare workers and the adequate funding of the healthcare sector. Direction of action 6.6 includes as an additional incentive performance- and output-based wage policies. Specific objective 6.6.6 awards incentives for staff providing health services in remote areas and/or for underrepresented specialities. - The health workforce governance Direction of action 6.1 of the Strategy describes in more detail how health workforce governance should be addressed. It focuses on strengthening the capacities of human resources in public institutions involved in health. This includes the creation and empowerment of a centre/directorate with responsibilities in human resources policies in the Ministry of Health. Processes in the health system shall be de-bureaucratised through the deployment and use of software in order to increase the efficiency of the workforce. The cooperation across all segments with regulators, national and local authorities should follow a patient-centred approach. Better collaboration shall be promoted on a regional, national and international level, for the development of human resources in health. This shall be achieved through updating the legislative framework for human resources in health to EU standards and according to the recommendations of the World Health Organisation, and by creating a legal framework for circular mobility of the medical personnel. Commission Preliminary Assessment: Satisfactorily fulfilled 50  Related Measure: Introd