Consultancy to Develop Block Contracting at 2 Mission Hospitals ( Technical Design, Support Policy Process, Negotiation, Contract Adjustment and Evaluation)

HEALTH SYSTEMS STRENGTHENING FOR HUMAN CAPITAL DEVELOPMENT PROJECT

REQUEST FOR EXPRESSION OF INTEREST

(CONSULTING SERVICES – FIRMS SELECTION)

Title of Assignment: CONSULTANT TO DEVELOP BLOCK CONTRACTING AT 2 MISSION HOSPITALS (TECHNICAL DESIGN, SUPPORT POLICY PROCESS, NEGOTIATION, CONTRACT ADJUSTMENT & EVALUATION)

Reference Number: SZ-MOH-324012-CS-CQS

• PROJECT BACKGROUND

The Government of the Kingdom of Eswatini (GOE) through the Ministry of Health (MoH) entered into a loan agreement with the World Bank effective 10 December, 2020, to implement a project to improve the coverage and quality of key reproductive, maternal, neonatal, child and adolescent health (RMNCAH), nutrition and NCD services (hypertension and diabetes) in Eswatini. The project titled “Health System Strengthening for Human Capital Development (HSSHCD) Project” is a 5-year project under the MoH that focuses on strengthening the health system and ramping up investments in reproductive, maternal, neonatal, child and adolescent health services as well as nutrition and non-communicable diseases (hypertension and diabetes) to address critical human capital challenges, including stunting and child and adult mortality, applying a life course approach. The project has four components namely; Component 1: Improve health service delivery to increase the coverage and quality of health services to build human capital; Component 2. Increase community demand for RMNCAH, nutrition and NCD services; Component 3. Strengthen the MOH’s stewardship capacity to manage essential health and nutrition services and project activities and Component 4: Project Management and Monitoring and Evaluation.

• BACKGROUND TO THE ASSIGNMENT

The MoH has developed the National Health Sector Strategic Plan (NHSSP 2019-2023). The NHSSP2019-2023 aims to strengthen the governance and management capacity of MoH and the health sector to effectively and efficiently perform and discharge core health sector functions. The institutional development strategy mainly focuses on building a distinctive organizational culture, promoting values related to work processes and recognition systems, including institutional growth, efficiency, cost-effectiveness, responsiveness and sustainability. Strengthening primary healthcare and decentralization remain the main strategy for improved healthcare delivery which requires clear governance and enhanced management capacity at various levels of service delivery.

The MoH currently spends 14.1 percent of the annual recurrent budget for subventions of non-state actors. The services range from preventive, curative, to rehabilitative services. A bulk of the subvention goes to two mission hospitals, namely, Raleigh Fitkin Memorial (RFM) and Good Shepherd. These hospitals are independent from the Government and managed by boards of trustees comprising Government and church members. One of the key issues is that about 99 percent of the operations cost of the two facilities are funded by the Government. The hospitals use approximately 80 percent of the subvention to pay for staff costs. Other issues with the subvention system include but not limited to the following:

• Subventions are not aligned with the services or indicators produced by the hospitals, and the government doesn’t know whether they are providing too much or too little in relation to the services provided.
• This partnership uses a memorandum of understanding which has lower legal power than a signed contract.
• Subventions have no set targets for services to be delivered, therefore have no inbuilt carrot and stick arrangements to improve performance.
• This financing arrangement allows for limited accountability as supplementary budgets are often requested during implementation.

Block contracting is, therefore, proposed to improve the overall performance of these hospitals.

The GOE intends to apply part of the proceeds of this World Bank financing for the assessment and re-organization of the financing of two major sub-vented mission hospitals and contractual relationship with MoH as the parent Ministry.

• THE OBJECTIVES OF THE ASSIGNMENT

The objective of this assignment is to support the MoH to develop and implement block contracts in two mission hospitals by formulating a multi-year strategy with key indicators that can be monitored jointly by Government and the hospital boards and management through a block contract instrument. Coupled with joint monitoring and evaluation (M&E) by Government and the management of the mission facilities, the block contract will promote results-driven service provision that will be attached to the support and release of operational resources by Government and other partners.

• QUALIFICATIONS AND EXPERIENCE

The MOH is seeking a consultancy firm with technical experts with the stated minimum qualifications, expertise, and experience.

4.1 Qualifications of Consultancy Firm:

• The consultant should be a firm subject to their eligibility as stipulated in the “World Bank Procurement Regulations for IPF Bank Borrowers, July 2016 revised November 2017, August 2018 and November 2020”.
• The consultancy firm bidding for the assignment should have the necessary key staff required to carry out the services and have the financial and technical resources required to undertake the assignment.
• The consultancy firm should be able to demonstrate at least eight (8) years of experience in providing similar services.

4.2. Key staff:

The consultancy firm should provide the following key staff together with any additional staff necessary to complete the work defined under the TORs. Key staff should have the qualifications and experience as set out below:

• Team Leader The Health Specialist/Team Leader will be responsible for performing all tasks pertaining to situation analysis, stakeholder consultation, identification of priorities, improved hospital functionality, quality management system, key management tools and information relating to the ultimate objective and delivery of the block contracts. The Team Leader will report to the Principal Planning Officer and the Project Coordinator, and work hand in hand with the management of the two hospitals. The Team Leader will be responsible for submitting all progress reports and the agreed deliverables of the consultancy to the Principal Secretary, MOH via Principal Planning Officer and the Project Coordinator.

The key qualifications of the team leader will be as follows:

• At least a Master’s degree in Public Health, Health Economics, Health Management or equivalent qualification.
• At least 10 years of international experience and knowledge on sustainable hospital operations and health governance reforms in developing countries, including reimbursement mechanisms for hospital services.
• Specific experience on hospital operations, health sector reforms with non-state actors; experience in the Southern African Development Community (SADC) region will be an added advantage.

• Health Facility Management Specialist The Health Facility Management Specialist will be responsible for an in-depth efficiency improvement of the hospitals contributing significantly to the multi—year strategy. The hospital management specialist will also identify key strategic areas for restructuring the facilities to ensure accountability, transparency, and sustainability. The qualifications of the Health Facility Management Specialist should be as follows:

• At least a Master’s Degree in Health Management, Planning & Management, Public Health or equivalent qualification.
• At least five years’ experience in health systems strengthening and development with specific experience in health sector institutional reforms and hospital governance and management.

• M&E Specialist The M&E Specialist will be responsible for helping the Ministry of Health and Mission Hospitals with the design and development of the information systems that could be required to develop the proposed block contracts. .

• At least a Master’s degree in healthcare management or health information systems management or equivalent qualification
• At least five years’ experience in health information systems management, monitoring and evaluation and health information systems audit
• Technical capacities to evaluate and implement health information systems in hospitals, and to guarantee the integrity and reliability of data
• Technical capacities to extract critical information from great volumes of data
• Capacity and experience to design processes of reporting in hospital environments

All key staff should also have/be,

• Strong analytical skills and ability to interpret and analyze data and translate into key public policy.
• Excellent written and oral communication skills in English and ability to communicate complex issues in a clear and concise manner.
• Knowledge of Microsoft office package;
• Good leadership judgment and decision-making skills,
• Proactive, good communicator with integrity.

5.TIME FRAME OF THE ASSIGNMENT AND PAYMENT SCHEDULE

The consultancy will be implemented over a period of 12 months.

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• IMPLEMENTATION ARRANGEMENTS

MOH will be the executing agency, with the Senior Management Team providing the final technical and policy review and clearance. The Principal Planning Officer will be directly responsible for the day-to-day implementation of this consultancy. A consultancy firm will provide a team of three consultants with one team leader who will coordinate all their activities. A Governance, Management, and Decentralization technical working group will also be established by MOH to provide overall guidance to the consultancy and ensure coordination with Ministries and agencies concerned.

• FACILITIES TO BE PROVIDED BY THE CLIENT

The consultancy firm will be mainly based at Ministry of Health with scheduled visits to RFM hospital and Good Shepherd hospital. Generally, the Ministry of Health will provide the follo