Cost Benefit Analysis for the National Health Insurance Scheme — Gambia Essential Health Services Strengthening Project

REQUEST FOR EXPRESSIONS OF INTEREST

(CONSULTING SERVICES – INDIVIDUAL CONSULTANT)

Republic of The Gambia

Gambia Essential Health Services Strengthening Project

Grant No: D5970-GM

Project ID No: P173287

Ref:GM-GEHSSP-GM-378589-CS-INDV

The Gambia Ministry of Health has received financing from the World Bank toward the cost of the Gambia Essential Health Services Strengthening Project and intends to apply part of the proceeds for consulting services. The consulting services (“the Services”) includes services to cost the benefits package for the National Health Insurance Scheme of The Gambia.

The Ministry of Health Projects Coordination Unit now invites eligible consultants (“Consultants”) to indicate their interest in providing the Services. Interested Consultants should provide information demonstrating that they have the required qualifications and relevant experience to perform the Services. The shortlisting criteria are qualifications and experience of the individual.

The attention of interested Consultants is drawn to Section III, paragraphs, 3.14, 3.16, and 3.17 World Bank’s Procurement Regulations dated July 2017, revised in November 2017 and August 2018, and is open to all eligible bidders as defined in the guidelines (“Procurement Regulations”), setting forth the World Bank’s policy on conflict of interest. In addition, please refer to the following specific information on conflict of interest related to this assignment: the bank requires that firms or individuals involved in Bank IPF procurement shall not have a conflict of interest.

A Consultant will be selected in accordance with the Individual Consultant Selection (CS) method set out in the Procurement Regulations.

Further information can be obtained at the address below during office hours from Monday to Thursday 8am to 4pm. The terms of reference is also attached to this request.

Expressions of interest must be delivered in a written form to the address below by e-mail by 14 September 2023

The Gambia National Health Insurance Authority

Email [email protected]

Terms of Reference for

Individual Consultancy

Develop Tariffs for Provider Services and Medicines for The Gambia's National Health Insurance Scheme

• Background

The Government of The Gambia, through the Ministry of Health (MoH), established the National Health Insurance Authority (NHIA) based on the National Health Insurance Act of 2021. The NHIA aims to implement a National Health Insurance Scheme (NHIS) in The Gambia, providing quality, affordable, equitable, and accessible healthcare services to citizens and non-residents. As part of this initiative, there is the need to develop tariffs for provider services and medicines to be reimbursed under the scheme. This will require estimation of costs treatment, medications, consumables, imaging, and other healthcare inputs. The tariffs to be developed will inform effective reimbursement of providers and well as support the planning, budgeting, and sustainable funding of the NHIS.

• Objectives

The primary objective of this consultancy is to conduct a thorough analysis and costing of all inputs, procedures and processes required to deliver each benefit on the NHIS Benefits Package. The analysis and costing will provide detailed insights into the direct and indirect costs associated with delivering each service, with its associated medications, consumables. The costing to be undertaken to guide the setting of the tariffs will form the basis for the reimbursement of providers through the Fee for Service mechanism initially, and subsequently the Capitation and Diagnosis Related Grouping payment mechanisms.

• Scope of Work

The consultant's responsibilities will include, but are not limited to, the following:

• Reviewing and familiarizing themselves with the NHIS's Health Benefits Package, including coverage, services, and treatment guidelines.
• Assembling and leading the team that will be responsible for developing tariffs for provider services and medicines required to deliver the NHIS benefits package.
• Collaborating with relevant stakeholders, including the Directorate of Services of the NHIA, relevant Directorates of the MoH, healthcare providers (both public and private,) private health insurers and health professional associations.
• Deriving the components utilized for treatment of conditions for each healthcare service in the NHIS Benefits Package through field survey interviews and consensus of experts.
• Collecting and analyzing data related to delivery of healthcare services; cost structure and supply chains as pertain to the delivery of services in the NHIS Benefits Package.
• Identifying and categorizing cost components for each covered service, considering personnel, equipment, supplies and administrative overheads ensuring that there is no duplication of costs between items provided for in core Ministry of Health Budgets and those to be reimbursed by the NHIS .
• Conducting a geographic and facility type variance analysis to assess potential cost variations across different regions of The Gambia to advise the development of Realistic Tariffs.
• Based on the utilization and expenses data collected, calculate the cost per unit of components of care and applying statistical methods to account for uncertainties and variations in healthcare delivery costs.
• Recommending tariffs for each service, medicine and commodities required to deliver the NHIS Benefits Package for each provider type and level while maintaining quality and equitable access to healthcare services.
• Preparing a comprehensive report summarizing findings, methodologies, and actionable recommendations.
• Build the capacity of a core team within the NHIA and related institutions to undertake similar assignments.
• Identify the direct, indirect and overhead costs for each G-DRG.

• Deliverables

The consultant will be expected to deliver the following outputs:

• Inception Report
• Costing template for each service, medicine, and consumable with explanatory notes.
• Detailed cost breakdown for each service and treatment, medicines, and other consumables covered by the NHIS Health Benefits Package.
• Geographic variance analysis outlining potential cost differences across regions.
• Facility type variance analysis outlining potential cost difference between facilities by level and ownership.
• Sensitivity analysis report highlighting the impact of various factors on cost estimates.
• Recommendations for cost-effective measures aligning with the Universal Health Coverage objectives.
• Comprehensive report summarizing findings, methodologies, and recommendations for the development of service and medicines tariffs for delivering the NHIS Benefits Package.
• An NHIS Tariff List for Services, NHIS Medicines List and their associated manuals.

• Timeline

The consultant is expected to complete the assignment within 2 months from the project commencement date, as mutually agreed upon with the NHIA and may take about 30 working days.

• Reporting and Communication

The consultant will report directly to the Chief Executive Officer of the NHIA and maintain regular communication throughout the consultancy. Progress updates, data sharing, and collaborative discussions are essential components of this engagement.

• Qualifications

The consultant should possess the following qualifications and experience:

Education

• Advanced University Degree (Masters, PhD) in Health Economics, Economics, Finance, Cost Accounting, Actuarial Science or related field. An additional degree in a clinical health related field will be an advantage. Experience

• Proven experience in healthcare costing, economic evaluation, cost accounting, and public health, with at least track record of 3-years conducting similar assignments.
• Experience of working in a country setting similar to Gambia’s.
• Familiarity with the healthcare delivery system of The Gambia.
• Ability to assemble and work with a multidisciplinary team.
• Strong analytical skills and expertise in utilizing statistical analysis tools for accurate cost estimation.
• Excellent communication and interpersonal skills to effectively engage with diverse stakeholders with vested interests.

Interested applicants should submit a cover letter accompanied by their Curriculum Vitae and copies of relevant certificates and qualifications to:

The Gambia National Health Insurance Authority

Email [email protected]