Consultancy to support national health insurance health care benefits package development and implementation, Pretoria, South Africa, Home based

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The South African Government is preparing for implementation of National Health Insurance (NHI) to accelerate progress towards universal health coverage (UHC). This strategy is predicated on a defined and costed primary health care (PHC) health benefit package (HBP) that integrates community and facility-based service-delivery to address the full spectrum of prevention, promotion, treatment, rehabilitation, and palliation. It is a strategy anchored in the digital transformation of the health sector, through the development of a series of interoperable information systems for NHI Fund administration.[2]

The National Department of Health (NDoH) has developed the Service Benefits Framework (SBF) as the architecture for the NHI PHC HBP. The architecture reflects how current evidence-based clinical practice and health policy come together to define each of the services to be included in the PHC HBP. It defines · the conditions under which they are to be delivered [equity and quality], · the basis on which they are to be purchased [outcomes], · the average and/or minimum resources to be used in their delivery, and · the associated cost [efficiency].

The SBF does not duplicate or do away with the requirement for existing clinical and policy guidance; but confirms their consistency/coherence at service delivery level; and makes explicit the assumptions underpinning national planning.

As one element of the information systems established for NHI Fund administration, the role of the SBF is a tool to enable financial and operational planning, assess implementation, and inform course-correction and/or update policy as necessary, and achieve equity over time. A key feature of the SBF is the presentation of the data (the HBP) in various formats for defined stakeholders/users (e.g., citizens, facility managers, administrators, etc.) to facilitate meaningful engagement towards incremental health system strengthening. It is a tool designed to strengthen the governance arrangements associated with NHI implementation.

However, development of the first iteration of the NHI PHC HBP is yet to be initiated. A consultant is required to development the first complete iteration of the NHI PHC HBP and support preparation for its implementation in the field.

SCOPE OF WORK:

The consultant will lead a process of national health policy review that culminates in development of the first complete iteration of the NHI PHC HBP for review by the NHI Benefits Advisory Committee. The process will include a preliminary desk-top review followed by coordination of a multi-disciplinary team (MDT) review of the content of the Standard Treatment Guidelines (STG) for PHC, and population of the SBF database.

Lessons from the MDT review will also be used to update and refine the earlier preliminary policy review, and provide practical examples of where and why ongoing revision may be required, e.g. specific equity-efficiency trade-offs.

Evidence generated will be packaged in both policy (including initial scoping of regulations and standard operating procedures for regular improvements) and research format (journal paper for publication).

There will be a focus on integration and proof-of-concept implementation in the Contracting Units for PHC (CUPs).

1. Policy Review: (including scoping of contents for regulations and standard operating procedures for regular improvements of the HBP) o Referral Policy from PHC service providers to district (first level) hospitals o PHC Human Resource Policy as required for the accreditation of providers o Formulary emanating from the HBP § Essential Equipment List (EEL) § Essential Laboratory List (ELL) § Essential Medicines List (EML) o This will likely include a series of documents but also reference scopes of practice (that define who can deliver what service and implications for levels of care at which they work, e.g., CHWs, CHC vs Clinic, vs GP, vs retail pharmacy. The MDT process will constantly be balancing equity with efficiency considerations of referring a patient and is expected to provide significant evidence/examples as to why a particular cadre of worker should be available at a given level of care. o Harmonization with medical scheme prescribed minimum benefits (PMBs) at PHC service delivery level to manage the transition to NHI. o Linking to the chosen coding system/s Using the policy review result to inform Minimal Viable Product (MVP) specification for Online SBF

2. Support Health Systems Digital Information Chief Directorate to design the revised online SBF: · Development of MVP to perform a) data entry, b) data presentation, c) data analysis 3. Coordination of a MDT to populate the SBF (service, outcome, resource components) grounded into content of the STG PHC: · Populate SBF database · Develop MDT implementation report 4. Support NDOH to populate the SBF (cost component) to ensure HBP presented in user-defined formats and has cost summaries 5. Update policy review based on MDT learning 6. Finalise first complete iteration of the NHI PHC HBP · Data (the HBP) presented in different formats for defined users; · Analytics to support NHI fund implementation · Draft Standard Operating Procedures for regular improvements of the HBP 7. Draft research paper on implementation of NHI PHC HBP

Work Assignment Overview

Tasks/Milestone:

Deliverables/Outputs:

Timeline

Estimate Budget

Conduct PHC service delivery related policy review

Policy review report V1 developed to inform Minimal Viable Product (MVP) specification for Online SBF

Ongoing for 2 months

15%

Support design of the revised online SBF

MVP ready for a) data entry, b) data presentation, c) data analysis

Ongoing for 6 months

20%

Coordination of an MDT populate SBF with content of STG PHC (service, outcome, resource components)

1. SBF database populated with content(services) in the STG-PHC
2. MDT implementation report

Ongoing for 4 months

25%

Support NDOH to populate the SBF (cost components)

HPB presented in user-defined formats; cost summaries

Ongoing for 3 months

10%

Update policy review

Policy review report V2 (updated based on MDT learnings)

Ongoing for 3 months

10%

Finalise first complete iteration of the NHI PHC HBP

1. Data (the HBP) presented in different formats for defined users;
2. analytics to support NHI fund implementation
3. Draft Standard Operating Procedures for regular improvements of the HBP

Ongoing for 3 months

10%

Draft research paper on implementation of NHI PHC HBP

Minimum one research paper submitted for publication

Ongoing for 1 month

10%

To qualify as an advocate for every child you will have…

MINIMUM QUALIFICATIONS required:

Masters Any qualification in health management or health financing / MBA (Finance) Or Doctorate or PhD in health care management, health financing, or related areas

KNOWLEDGE/EXPERTISE/SKILLS required: · Minimum 5 years of post-qualification work experience. · Experience in the pilot MDT in 2020 is advantageous · Ability to deliver at very short notice and work under pressure. · Experience of working with senior government officials at central and or provincial level. · Good capacity building skills in health sector. · Demonstrated experience and skills in research and advisory, data analysis and policy drafting, related to related to national health planning, management and national health insurance · Demonstrable experience of working with South Africa government departments and agencies (sub-national agencies an advantage). · Excellent written and verbal communication of research in English

HOW TO APPLY:

Interested and qualified candidates are requested to submit their application to the following link: https://www.unicef.org/about/employ/?job= 552097by 22 June 2022.

This notice will also appear on http://www.unicef.org/about/employ/, http://www.unicef.org/southafrica, UN Job List, UN Jobs Please indicate your ability, availability and daily/monthly rate (in ZAR) to undertake the terms of reference above (including admin cost if applicable).

For every Child, you demonstrate…

UNICEF's values of Care, Respect, Integrity, Trust, and Accountability (CRITA).

To view our competency framework, please visit here.

UNICEF is committed to diversity and inclusion within its workforce, and encourages all candidates, irrespective of gender, nationality, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of the organization.

UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination. UNICEF also adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check.

Remarks:

Only shortlisted candidates will be contacted and advance to the next stage of the selection process.

Individuals engaged under a consultancy or individual contract will not be considered “staff members” under the Staff Regulations and Rules of the United Nations and UNICEF’s policies and procedures, and will not be entitled to benefits provided therein (such as leave entitlements and medical insurance coverage). Their conditions of service will be governed by their contract and the General Conditions of Contracts for the Services of Consultants and Individual Contractors. Consultants and individual contractors are responsible for determining their tax liabilities and for the payment of any taxes and/or duties, in accordance with local or other applicable laws.

The selected candidate is solely responsible to ensure that the visa (applicable) and health insurance required to perform the duties of the contract are valid for the entire period of the contract. The candidate may also be subject to inoculation (vaccination) requirements, including against SARS-CoV-2 (Covid).