Besianë Musmurati is currently chief of staff to the Secretary-General of the Democratic Party in Kosovo. In 2017-2020 she served as chief of staff to the former Minister of Health
Kosovo is literally the youngest country in Europe. The youngest country with the youngest population, where the median age is just 29 years old. This was the first thing I used to tell people about Kosovo during my time as a diplomat in Washington D.C. and Brussels. To understand Kosovo’s progress, you have to understand its history and its people.
To give you some perspective, about four decades ago, my father was sentenced to thirteen years in prison in Yugoslavia simply because he was a professor who was printing and distributing books in the Albanian language. This was the life of an average Kosovar family back then – facing oppression and economic uncertainty.
The 1998-99 war was the culmination of several decades of systematic oppression of Albanians in Kosovo. We declared independence in 2008 with the help of some of the world’s biggest western democracies, countries and allies that helped us build ourselves up during and after the war. Having this in mind, Kosovo is the most pro-American country in the world[1] and among the leading countries in the region where membership in the European Union is still widely popular[2]. We have emerged as a young democracy looking up to the West, however, we still face regional challenges.
Young democracies face great risks and volatility, which means that the leaders in charge can either push forward progress or hold it back. For this reason, I decided to quit my job as a diplomat and accept the position as a Chief of Staff to the Minister of Health in 2018. Promoting Kosovo as a diplomat was great, but I wanted to continue my public service in a position that would allow me to have a direct impact on the daily lives of my fellow citizens. Helping the Minister of Health, an ambitious and well-prepared Harvard alum, to reach policy and development goals was a perfect choice.
I joined his team as Chief of Staff because the healthcare system was never a priority of political parties in Kosovo. It was the first time ever that we had a young and bright politician who really wanted to improve a devastated sector, fight corruption and break up monopolies in healthcare. It was a decision based on a shared vision and common values and most definitely one I will never regret.
Back in 2013, I had conducted the first ever study on ministerial advisers in Kosovo, including the role of the chiefs of staff. I found out that the fine line between political staff and civil servants in Kosovo is quite clear, where the former is in charge of overall policy development, while the latter implement policies. I found out that Chiefs of Staff are the people who move things, shape policies, and are able to really have an impact on people’s lives.
Improving healthcare in Kosovo is a tough job. Kosovars, on average, live 10 years less than their European peers and approximately 80% of the households in Kosovo incur out-of-pocket (OOP) payments for healthcare. In this group, lower-income families spend a greater share of their consumption expenditures on healthcare, most of which is to buy drugs. OOP health payments increased the poverty headcount by 22.21%. This means that some people in Kosovo have to choose between their next meal or their prescribed drugs.
Seeing that high drug prices were exacerbating poverty, the Minister of Health decided to focus on this issue. Kosovo inherited the Semashko model of healthcare delivery, where the central government serves as the purchaser as well as the provider of healthcare services. This means that the Ministry of Health, through a List of Essential Medicines, provides people with free drugs when they access public healthcare institutions.
We found out that as a result of non-competitive behaviour, abuse of procurement procedures, and the lack of price regulation on the purchasing of medicinal products, for nearly two decades, millions of euros from the state budget were mismanaged. As a result, Kosovo’s citizens were paying at least €10 million more annually for the same drugs than their peers in the region.
After a thorough policy analysis and consultation with WHO experts, we established rules and methodologies which compared drug prices of the same products in different EU and regional countries and applied it to Kosovo. The results were astonishing.
Just in the first year, we saved €6 million although we procured the same amount of drugs. For example, a drug that was bought for €30 was now being bought for €2.8. The money saved was used to buy new beds for the public hospitals and to improve overall service.
The procurement of hemodialysis products marked one of the major fights against the abuse of public money. In 2018, the Ministry of Health of Kosovo dismantled a 20-year monopoly on hemodialysis drugs. By opening the market for free competition, in just one contract we managed to save over €2 million of taxpayer money.
Witnessing this, the Minister of Health introduced the first ever legislation in Kosovo for regulating drug prices. The effects of the policy which we introduced will ultimately enable the Ministry of Health in Kosovo to provide health protection and access to safe, effective and quality drugs – at a reasonable price without putting to risk the safety, effectiveness, and quality of products. It will help Kosovar families to have access to drugs without having to sacrifice their meals.
And ultimately, this is what good governance is all about. It is about introducing standards that increase the well being of people. I have been lucky to witness this first hand. Enthusiastic, hard-working leaders can bring about change. While they lead with vision and clear goals, chiefs of staff facilitate and amplify their reforms.
Kosovo’s long road to independence was shaped by leaders with integrity who stood up for freedom. They have successfully managed to create a democratic country that respects human rights as the young republic moves toward European integration. It is up to this generation of leaders to continue the progress with integrity. My story is one of many other chiefs of staff, who have worked aside great leaders and left a mark in their country.
[1] Rating World Leaders: What People Worldwide Think of the U.S., China, Russia, the EU and Germany Report, Gallup, 2020.
[2] Balkan Barometer 2020 Report, Regional Cooperation Council, 2020.