Consultancy for feasibility assessment for the Health Equity Card and consider what aspects of the rural RBF could be applicable and helpful for the urban health facilities to include (Urban Voucher)

Cordaid seeks to engage an individual consultant for the following:

Title: Local Consultant to Conduct a Feasibility assessment on the Implementation of the Health Equity Card for the Urban Voucher Program

Background

The Government of Zimbabwe (GoZ) has received USD25 million additional financing under the Global Financing Facility (GFF) that will be implemented via the Health Sector Development Support Project Additional Financing V (HSDSP AFV). The Project Development Objective is to improve coverage and quality of an integrated package of Reproductive, Maternal, Neonatal, Child, Adolescent Health and Nutrition (RMNCAH-N) services, as well as strengthen COVID-19 response and institutional capacity to manage performance-based contracts, consistent with the government’s ongoing health initiatives.

The Ministry of Health and Child Care (MoHCC) together with Bulawayo and Harare Cities are implementing the Results Based Financing Urban Voucher program which aims to increase access to quality maternal health services among the urban poor pregnant women. In 2014, the program was piloted in 11 health facilities and under Additional Financing V it is currently being scaled up in a phased approach. The 1st phase of the scale up had a total of 12 facilities added in November 2021 whilst the 2nd phase, which is expected to commence in June 2022 will have an additional 12 bringing the total number of health facilities to 35. Prior to the scale-up in 2018, a Process Monitoring and Evaluation (PME) was conducted, and its results evidently showed the success of the Urban Voucher (UV) program. The program is anchored on three components i.e pay-for-quality, community involvement and the voucher as a mechanism to remove the financial barrier among the urban poor who cannot afford user fees. These features are key in facilitating the implementation of the National Health Insurance which- the MoHCC is interested in as part its plan to Universal Health Coverage. Considering this MoHCC and both Cities supported the adoption of the PME recommendations which included rolling-out the UV program, revising the means testing tool and strengthening the systems at all levels of care.

In the past few years there have been several engagements between MoHCC and City Health departments and other stakeholders on how the UV program can be fully institutionalised and harmonized with the Rural RBF program for sustainability. The UV program is designed to support the Government policy towards Universal Health Coverage by waivering user fees for Maternal, Neonatal, Child Health services (MNCH) for the poor using vouchers. During the implementation it was noted that offering basic primary health care services, not only MNCH was crucial to the urban poor for example Out-Patient Services which are charged at USD 5,00 or equivalent RTGS rate on the day. The Cities expressed interest in developing a Community Based Health Insurance (CBHI), starting with a pilot. Community Based Health Insurance (CBHI) are local mutual aid schemes that put in place arrangements for mobilizing, pooling, and managing resources for healthcare. They have been considered effective in reducing out of pocket expenditure and improving access to healthcare services. Knowles (2016) indicated that setting up CBHI was favourable since the health services in the city were heavily utilized by the population, more than half of the target population was burdened with out-of-pocket expenditure and absence of another prepayment scheme. Furthermore, Wietler and Chirimambowa (2019)’s feasibility assessment on CBHI indicated that the target population was willing to pay RTGS equivalent to USD 1,00 per family, however, they expected the benefits package to be exhaustive, covering referral, specialized services as well as drugs despite the low premium. In the current economic setting, the loss of value of the RTGS and inflation makes any projection of potential income of a CBHI difficult. Wietler and Chirimambowa (2019) recommended that if the cities decided to proceed with the set-up of a CBHI, they would need to identify technical and financial partners to assure the success of this scheme.

The CBHI is one of the various social protection schemes that the cities have been considering, another identified option is the conversion of the voucher package into a Health Equity Card (HEC) to cater for the poorest for the poor who might not even be able to contribute the smallest amount for CBHI. The Health Equity Card which will have a basic primary health care service benefit package for the household (women, children and men) and not limited to MNCH. The HEC will build on the progress that has been made under the Urban Voucher Scheme which included scaling up of the program, development a comprehensive screening mechanism and lobbying the councilors on the creation of a Health Services Fund. The funding for the HEC is expected to be pooled from a percentage of resident rates payments, Workers’ compensation Fund, health grants etc. The benefits package for those identified as poor will be highly dependent on the resource envelope and will be implemented in a phased approach starting with MNCH indicators and will be extended to other services. The idea/concept behind this is to try and develop a safety net that can cater for the poor by utilising the income from user fees to cross-subsidize the poor. Given the limited resources in the health care setting, a feasibility assessment needs to be conducted to determine if the voucher package can be converted into the Health Equity Card (HEC) for informed decisions/options to be made at policy level. In view of this, Cordaid in collaboration with Ministry of Health and Child Care and the City Health Departments would like to engage a Local Consultant with adequate background and experience to undertake the feasibility assessment towards development of the Health Equity Card.

Responsibilities

• Conduct desk review of key policy documents and international literature on similar financing mechanisms
• Conduct a costing and resource mapping analysis for implementing the Health Equity Card based on the package option(s) and coverage options envisioned by the City Authorities
• Present the draft documents to the Result Based Financing Technical Working Group (RBF TWG) members
• Finalize the draft documents depending on the comments provided by RBF TWG members.
• Submit the final document to MoHCC and World Bank for approval
• Support the development of a plan for operationalizing of the Health Equity Card Key Deliverables/outputs

• Feasibility assessment report which includes;
• A Defined package for the Health Equity Card
• Coverage (potential beneficiaries)
• Health Equity Fund Pool Framework (potential of pooled funds for strategic purchasing of HEC from Assisted Medical Treatment Orders, Workman Compensation Fund, RBF Vouchers, Donor funds, grants, etc)

• Health Equity Package Cost and Implementation cost different scenarios
• Proposed management structure and implementation matrix of the Health Equity Card including policies that can be put in place for its successful implementation

Required qualifications

• A Master’s Degree in Economics or Public Health Economics or a related discipline. A PHD in Health Economics will be an added advantage.
• Experience in conducting feasibility assessments/ evaluations and/or strategic documents on health care financing like health financing strategy or resource allocation in health care.
• A minimum of at least 10 years of experience in relevant work with the public health sector and/or teaching university is required.

• Experience in Operations Research on health economics is an added advantage
• Previous demonstrable track record, knowledge and experience working with Health sector Stakeholders regarding similar work.
• Excellent communication and project delivery skills.

Selection Criteria/Method

The Consultant shall be selected based on the qualifications and work experience through a competitive process. The selection criteria will be based on.

• Relevant work experience.
• Qualifications of the consultant.
• Availability for the required period

Working condition

The consultant developing the feasibility assessment of the Health Equity Card will be working under the direct supervision of the Team leader for Cordaid-Zimbabwe and Director Policy, Planning and Health Economics (MoHCC) and City Health Directorates. S/he will also work very closely with City Health Directorates and staff members within MoHCC and World Bank.

Reporting Structure

The Consultant will directly report to the Team Leader for Cordaid-Zimbabwe and the Voucher Management Team.

Duration of Contract

The duration of the contract shall be 30 working days

To apply

Qualified and experienced persons are encouraged to urgently apply and attach detailed CVs to: [email protected] and copy [email protected]

Deadline: 30 July by 2359hrs.

Cordaid does not ask for a fee at any stage of the recruitment process.

Cordaid is an equal opportunity employer and does not discriminate against any employee or job applicant based on race, political affiliation, religion, tribe, national origin, gender, physical or mental disability, health status or age.

Only short-listed candidates will be contacted