Health Governance & Financial Accounting Framework IDF Grant The objective of the grant will be to assist the Ministry of Health and Health Insurance Institute in developing their capacity to conduct complex policy analysis through resolving internal inconsistencies or deviations in the legal, governance and financial frameworks to better support the Long-term Health System Development Strategy. The main activities and (measurable) outputs expected from this IDF are described below.  While the focus of the activity will be developing local capacity in these areas, the expertise of international consultants will be critical both to provide advice on tools and techniques, and to bring best practice examples of similar reforms in other developing countries. i.   articulation of the national health strategy and the current and proposed legal framework.  this activity will involve building capacity for examining the national health strategy, existing health related legislation and the proposed package of legislation to identify differences or inconsistencies.  Processes will be developed to assist the policy and legal departments of the MOH and HII to resolve these issues in consultation with senior management of the Ministry of Health, the Health Insurance Institute, and other stakeholders, and develop suitable amendments to the legislative package.  Where necessary, the Ministry of Finance or Ministry of Local Government would also be consulted.   Through the interaction between the consultants and MOH/HII staff, the capacity to conduct similar types of analysis and policy development in the future will be enhanced.  The legal implications of proposed governance/accountability and financing/financial management changes would also be reviewed and modifications proposed, as appropriate. ii.   articulation of the national health strategy and the financial/financial management framework.  this activity will involve capacity building for examining the national health strategy, the existing health care financing and financial management relationships and the various proposals for changing these, and ensuring that they are consistent with that strategy, both in terms of the stated approach as well as the actual or likely impact.  Processes will be developed to assist the policy and economic departments of the MOH and HII to resolve these issues in consultation with senior management from the Ministry of Health, the Health Insurance Institute, and other stakeholders, and develop action plans for resolving these issues.  Where necessary, the Ministry of Finance or Ministry of Local Government may also be consulted, care will be taken to ensure that and any proposals are consistent with Albania's Medium-term Expenditure Framework.  This activity will also build capacity within the MOH/HII for the ongoing review of the health financing and financial management implications of proposed governance/accountability and legislative changes in the future, to ensure that consistency is maintained between all elements of the policy reform process. iii.   articulation of the national health strategy and the governance/accountability framework.   this activity will involve capacity building for examining options to ensure that the governance and accountability relationships within the health sector are consistent with the national health strategy.  Since the strategy envisions the devolution of MOH-managed health service delivery structures to autonomous service providers, and increasing emphasis on the purchaser-provider split, clear governance and accountability structures are essential.  Processes will be developed to assist the policy, economic and legal departments of the MOH and HII to work together to identify options, analyze these options with respect to the legal, financial management, accountability and legal implications, and present this analysis to senior management in Ministry of Health and the Health Insurance Institute.  Through the interaction between the consultants and MOH/HII staff, these staff should be able to conduct similar types of analysis and policy development in the future.  When necessary, the Ministry of Finance or Ministry of Local Government would also be consulted during this process, especially with respect the governance and accountability aspects of the Government's decentralization strategy, to ensure consistency with that strategy.   Because of the potential impact on health care providers and local governments, a number of explicit stakeholder consultations will be conducted by the MOH and HII, with guidance from the consultants.