National Consultant: In-depth analysis of the private health care sector engagement and governance

Purpose of consultancy

The objective of this consultation is to conduct an in-depth analysis of the governance framework of the private health sector in Tunisia, with emphasis on the mobilization of this sector in support of Universal Health Coverage (UHC). The consultant will use the Progression Pathway as an analytical framework to evaluate existing mechanisms and identify areas for improvement.

Background

The private health sector in Tunisia has experienced significant growth since the 1990s, employing more than 55.3% of doctors, 84% of dentists, 76% of heavy medical equipment, and contributing to 43% of health spending. It includes various structures and establishments such as medical offices, dental offices, paramedical offices, hemodialysis centers, medical laboratories, pharmacies, and monodisciplinary and multidisciplinary clinics, often equipped with advanced medical technologies. The expansion of private clinics is mainly motivated by simplifying procedures by eliminating prior authorizations for certain health activities, adopting specific regimes and tax incentives (direct and indirect), and an influx of patients, particularly from neighboring countries such as Libya. Although the private sector complements public health care, its involvement lacks systematic coordination, leading to regional disparities in access to quality and equitable services.

A recent social dialogue on national health policies, strategies, and plans organized by the Tunisian Ministry of Health identified key problems in the health system, including the lack of real coordination between different healthcare structures, a public system facing many difficulties, and a private sector which is developing in a poorly regulated manner. Similarly, the Tunisia Health System Profile developed by WHO in 2018 identified unrevised regulations, weak monitoring and evaluation, limited participation, and partnership with the private sector, as weaknesses in the health system's performance in the country.

The case of Tunisia offers an interesting case for understanding how the private sector can play a role in shaping health systems and what governance mechanisms countries should adopt to make this happen in a manner consistent with the principles of universal health coverage. The Progression Pathway for Governance of Mixed Health Systems can help government/policymakers understand what current governance arrangements and capacities are in place to work with the private health sector, and their strengths and weaknesses to prioritize areas for improvement. This will help the country define specific strategies and actions to improve private sector governance to improve equitable healthcare access, quality, and financial protection of the population.

The role of the consultant will be to conduct in-depth research and analysis and facilitate the dissemination and use of the results. By synthesizing and further analyzing the findings, this work aims to provide valuable information that can inform policymakers, development partners, and advocates on strategies to strengthen Tunisia's engagement with the private health sector.

Deliverables

Output 1: Submit a report on policies and governance structures relating to the private healthcare sector in Tunisia.

Deliverable 1

• Collect information regarding policies and governance structures relating to the private healthcare sector.
• Assess information provided by Tunisian health authorities using the Pathway for Mixed Health Systems Governance.

Output 2: Develop a list of key informants and a summary report of the interviews conducted.

Deliverable 2

• Conduct interviews with key informants representing a diverse range of stakeholders, including representatives from the public and private sectors, as well as partners and academics, to gather additional data needed to complete the Progression Pathway.

Output 3: Conduct a workshop report summarizing the main findings and recommendations.

Deliverable 3:

• Design and serve as lead facilitator of a workshop with relevant stakeholders. The workshop will be organized in collaboration with the General Directorate of Health (Sub-Directorate for Regulation and Control of Health Professions, the Medicines Agency and the Laboratory Unit) to present.
• Discuss preliminary findings from the implementation of the Progression Pathway.

Output 4: Submit a report on the results of the evaluation of the health system in Tunisia in terms of governance and mobilization of the private sector.

Deliverable 4

• Analyze the data collected and write a report on the results, describe Tunisia's journey in promoting its private health sector mobilization program and
• Present the implementation of the Progression Pathway as a case study comprehensive by supporting recommendations with solid evidence. The
• Draft summary report to be reviewed by WHO staff and the technical lead in MoH. Based on the data and information collected, the analysis and summaries, the report will provide recommendations for each governance behavior. The recommendations should be actionable and provide details on what change is recommended based on the practical steps of the Progression Pathway.

Educational Qualifications

Essential: Master’s degree in public health, medicine or other degrees deemed relevant to the field of consultation.

Desirable: PhD in public or global health or any related field

Experience

Essential: Minimum of 7 years of relevant experience in the field of health systems or private sector analysis.

Desirable:

• Relevant professional experience with WHO and/or UN agencies, or relevant non-governmental organizations.
• Knowledge of the Tunisian health system.

Skills/Knowledge

• Demonstrated knowledge of health and public health systems governance functions.
• Demonstrated skills in report writing, data management, literature reviews, research, website management and use of Microsoft Office applications.
• Excellent communication skills (oral and written), including conducting key informant interviews, preparing meeting presentations and facilitating.
• Strong intercultural communication skills and ability to work in a team.
• Conscientious, with the ability to take initiative and work independently under general direction and meet tight deadlines.

Languages and level required

Essential: Expert level of French. Working knowledge of English

Location

Tunisia and remote work.

Travel

No international travel is planned given the scope of the mission.

Medical clearance

The selected Consultant will be expected to provide a medical certificate of fitness for work.

Hiring Unit

Strengthening health systems Department

Remuneration and Expected duration of the contract (Maximum contract duration is 11 months per calendar year)

• Remuneration: TORs are classified at the national pay of NOD level.
• Expected duration of the contract: 45 days tentative starting from 01/08/2024

WHO Competencies

Enhanced WHO Global Competency Model: Enhanced WHO global competency model

Interested candidates are strongly encouraged to apply online through Stellis. For assessment of your application, please ensure that:

a) Your profile on Stellis is properly completed and updated.

b) All required details regarding your qualifications, education, and training are provided.

c) Your experience records are entered with elaboration on tasks performed at the time.

Additional information

• This vacancy notice may be used to identify candidates for other similar consultancies at the same level.
• Only candidates under serious consideration will be contacted.
• A written test may be used as a form of screening.
• If your candidature is retained for an interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review.
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• WHO is committed to workforce diversity.
• WHO has a smoke-free environment and does not recruit smokers or users of any form of tobacco.
• Applications from women and from nationals of non and underrepresented Member States are particularly encouraged.
• WHO prides itself on a workforce that adheres to the highest ethical and professional standards and is committed to putting the WHO Values Charter into practice.
• WHO has zero tolerance towards sexual exploitation and abuse (SEA), sexual harassment, and other types of abusive conduct (i.e., discrimination, abuse of authority, and harassment). All members of the WHO workforce have a role to play in promoting a safe and respectful workplace and should report to WHO any actual or suspected cases of SEA, sexual harassment, and other types of abusive conduct. To ensure that individuals with a substantiated history of SEA, sexual harassment, or other types of abusive conduct are not hired by the Organization, WHO will conduct a background verification of final candidates.
• Consultants shall perform the work as independent contractors in a personal capacity, and not as a representative of any entity or authority. The execution of the work under a consultant contract does not create an employer/employee relationship between WHO and the Consultant.
• WHO shall have no responsibility whatsoever for any taxes, duties, social security contributions, or other contributions payable by the Consultant. The Consultant shall be solely responsible for withholding and paying any taxes, duties, social security contributions, and any other contributions which are applicable to the Consultant in each location/jurisdiction in which the work hereunder is performed, and the Consultant shall not be entitled to any reimbursement thereof by WHO.