World Bank2023-06-292023-06-292023-06-29https://openknowledge.worldbank.org/handle/10986/39944Kosovo has gained a creditable reputation for prudent macro-fiscal management; yet necessary structural reforms and related fiscal pressures lie ahead. The country’s track record includes consistently high output growth rates, prudent fiscal deficits supported by fiscal rules, and one of the lowest public debt levels among peers. The Government was able to successfully weather the COVID-19 crisis and mitigate the impact of the ongoing inflationary crisis caused by the Russian invasion of Ukraine thanks to its healthy fiscal accounts and stable financial sectors. At the same time, however, the overlapping external shocks have highlighted the inherent volatility that mirrors Kosovo’s structural limitations - especially in health, energy, and education - and accentuates gaps in both human and physical capital. The objective of this Public Expenditure Review (PER) is to help the government identify means for improving the structure and quality of public services, enhance the equity of government spending, and take a holistic view of policies that will affect financing needs over time. To do so, the PER has analyzed fiscal issues that have not been explicitly detailed in, or are in the process of being incorporated into, the medium-term expenditure framework and the economic reform program. The most notable issues include the urgently needed energy investments, the ramifications of the new law on public salaries on the budget, the sustainability of the untargeted social protection system, and possible pathways of the cost of pensions in light of expected changes to eligibility criteria, and the health spending and health financing conundrum. The PER also looks back at past World Bank PER recommendations and their implementation record, in the attempt to shine a light on measures that remain valid and could still be implemented.en-USCC BY-NC 3.0 IGOWESTERN BALKANSPERPUBLIC SPENDINGEMPLOYMENTSOCIAL ASSISTANCEReportWorld Bank10.1596/39944