June 13, 2021

APW (Health Insurance Implementing Partner)United Nations Pakistan – Islamabad

  • full-time
  • Government
  • Anywhere

To Apply, please follow the instructions given at the end

TERMS OF REFERENCE

Agreement for Performance of Work

Purpose

The purpose of this assignment is to support Ministry of Health in the one year pilot initiative on a Health Insurance scheme (known as the Sehat Sahulat) to provide outpatient essential package of health services including SRHR at primary health care level through private sector general practitioners in Islamabad Capital Territory (ICT).

Background

The SRHR Project/Initiative and the Sehat Sahulat Program (SSP)

In January 2019, World Health Organisation (WHO), signed a four-year donor agreement to implement the Initiative “Supporting country strategies to reduce maternal mortality and achieve Sustainable Development Goal (SDG) targets through a health systems approach” which is known as the Sexual Reproductive Health and Rights (SRHR) Initiative. The SRHR Initiative supports countries to make progress toward achieving universal health coverage (UHC) and meeting their SDG targets, particularly with reference to reduction of maternal mortality (SDG 3.1), universal access to sexual and reproductive health care services (SDG 3.7) and sexual and reproductive health and reproductive rights (SDG 5.6).

One of the activities in the Initiative’s 2020 workplan is to support the Ministry of National Health Services Regulation and Coordination to initiate pilot test of an Outpatient Health Insurance programme to provide access of SRHR services to poor families through private practitioners. The Ministry of National Health Services Regulation and Coordination in Pakistan has established a Health Insurance Programme known as Sehat Sahulat.

Sehat Sahulat Program (SSP) is a social health protection initiative of Federal government in Pakistan working to provide financial protection to poor and vulnerable families against catastrophic health expenditure. Through this program free of cost health insurance is provided to families to access cash less indoor health care services (only), both secondary and tertiary, from any empaneled hospitals across Pakistan. Currently, 9 million families in 93 districts of Pakistan have been enrolled in both Federal and Provincial programs and it is expected that a total of 15 million poor and under privileged families in all districts will be enrolled in the program during next two years.

Rationale

The existing Sehat Sahulat Program scheme of the government of Pakistan is and continues to play a vital role in Pakistan, providing invaluable coverage and financial protection to millions of poor households through the provision of inpatient services at secondary and tertiary (priority treatment) level and can be considered as a key building block as the country moves towards UHC[1]. However, Out-Patient services (OP) / or outdoor services at Primary Health Care (PHC) level which mainly includes sexual and reproductive health, maternal child health, family planning, neonatal care, nutrition, adolescent health, non-communicable diseases (NCDs), communicable diseases, palliative care etc. are not part of the existing model and this is a gap in the existing coverage and financial health protection scheme implemented by the government of Pakistan. Implementation of UHC in ICT provides an opportunity to address this gap.

Through innovation in management of a private sector network of service providers (general practitioners) in an area where no public sector PHC facility exists through a contracting out mechanisms, the proposed project for the first time in Pakistan intends to integrate Out-Patient services (OP) including reproductive and family planning services to the already existing Sehat Sahulat Program (a national health insurance program) at PHC level, thus envisioning to expand coverage and access to the poorest of communities and ensure equitable health service delivery in fragile settings in the country through the provision of financial protection. Through this initiative a system of referral-upward and referral-downward (gatekeeping) will also be developed and strengthened through which follow-up of the patients are to be ensured. The private sector in Pakistan is accessible and well trusted by people and must be a partner to play its role for effective delivery of essential healthcare services, where feasible. The private sector can be a major provider of essential services where public sector has capacity (human resources/coverage) constraints.

For this purpose, the Ministry of National Health Services Regulation and Coordination SSP would like to partner with a private sector service provider on SRHR in the implementation of this pilot project.

Objectives of the Assignment

The overall objective of the assessment is to strengthen the health system by extending the existing inpatient benefit package covered by Sehut Sahulat Program to include outpatient services through private sector general practitioners at primary health care level who will be paid through capitation. This extension includes a designated essential package of health services including SRHR services delivered through the implementing partner’s network of general practitioners.


Planned Timelines

Start date: 15th November 2020

End date: 31st December 2021


Work to be performed

The Implementing partner is expected to liaise with the Ministry of National Health Services Regulation and Coordination focal points on Health Insurance and SRHR, in undertaking this task.


Under this arrangement the implementing partner is expected to undertake the following:

    • To conduct training on SRHR, VCAT, business development, management and promotion, data collection and program orientation to private providers i.e. General Practitioners (GPs) for this project and issue partnership certificate.

    • To provide clinical quality assurance to all identified health facilities implementing this pilot including administering periodic client exit survey to gain insights and feedback to improve services at clinics.

    • To provide required medical, surgical, record keeping, reporting, stock management supplies, required in provision of quality services.
    • To provide branded signboards bearing logos of all partners to be fixed on walls outside the clinics of the GP/Private Provider.

    • Conduct demand generation interventions to make enrolled beneficiary families under this pilot aware of the programme.

    • Identify intervention and control families and train them on SSP benefits and inform them on the GP they have been linked to receive OPD services.


Deliverables

    • Inception report with detailed work plan
    • Report on engagement and training of GPs

    • Report on progress of implementation in the first quarter of the project including number of clients seen by GPs and services provided.


Timelines

    • First Deliverable (0% payment): Signing of contract
    • Second Deliverable (50% payment): Final Inception report with detailed work plan by 17th November 2020

    • Third Deliverable (40% payment): Report on engagement and training of GPs by 10th December 2020

    • Fourth Deliverable (10% payment): 12 months report on implementation of the Capitation component of the pilot by 17 November 2021.


Remuneration

Remuneration will follow the approved rates for APW (Senior specialist category) at maximum rate of PKR 30,000 per day for 210 days spread over the period between November 2020 to November 2021.


Technical Supervision

    • Responsible Officer(s): Technical Officer (SRHR) and National Professional Officer -RMNCAH

    • Manager: WHO Representative / Head of Office


Specific requirements

    • Qualifications required: Private sector service provider organization for sexual and reproductive health services especially family planning services with a network of clinics, social franchise providers; MCH Centers, Pharmacies and Mobile Health Units for outreach activities in all four provinces with penetration into the most strategic and rural tehsils in Pakistan. The organization should not only operate at scale but should also have a strong partnership with government bodies working towards common reproductive health (RH) goals.

    • Experience required: At least 5 years work experience in providing quality SRHR services and experience working with government.


To Apply:

Interested individuals/firms are required to submit their proposal at the below address by COB 28th October 2020. Note: Please mention the subject “APW (Health Insurance Implementing Partner) ” on the envelope.

Address: MNCH Unit, World Health Organization (WHO), Country Office, Park Road, Chak Shahzad, Islamabad.


[1] https://pmhealthprogram.gov.pk/publications/ILO_GIZ_Actuarial_Report.pdf

To apply for this job email your details to saadzafar659@gmail.com