Company: SHOPS Project Kenya
Job Location: Nairobi, Kenya
Scope of Work for CBHI Consultant
Background
Strengthening Health Outcomes through the Private Sector (SHOPS) Project is a global five-year USAID-funded project, which aims to expand the role of the private sector, including NGOs and for-profit entities in the sustainable provision and use of high-quality health information, products and services.
The SHOPS Project Kenya is centered on three main technical component areas aimed to:
(1) Strengthen the enabling environment for increased health care access in the private sector;
(2) Identify, expand and improve financing options for increased private sector health care coverage; and
(3) Initiate, implement, and scale up innovative and sustainable private sector health models for improved service delivery.
Approximately 80% of Kenyans lack health insurance or other health financing and risk protection mechanisms to allow them to access care, and prevent them from catastrophic healthcare spending. This puts low-income populations at financial risk delving deeper into poverty.
To make healthcare more affordable, health financing solutions are needed to help pay for treatment of communicable diseases as well as chronic health conditions.
Potential solutions include insurance, medical savings accounts, loans, vouchers, or any combination of these, often powered by innovative IT platforms.
In September 2012, SHOPS solicited expression of interest from organizations with innovative health financing schemes that could be scaled up through technical assistance.
SHOPS identified an NGO that provides technical support to initiate and manage community based health insurance (CBHI) schemes in Nyanza region.
The following technical assistance will be offered by SHOPS to the CBHI schemes;
1. An assessment of the CBHI schemes benefit packages, administration processes, provider contracting, financial and social Key Performance Indicators
2. Actuarial analysis to harmonize benefit packages
3. Present recommendations on streamlining administration processes, provider contracting and benefit packages
4. Assist the CBHI schemes prioritize the recommendations and develop a workplan for their implementation
5. Identify priority interventions which can be implemented within the stipulated timeframe with SHOPS support
SHOPS Project Kenya seeks a CBHI expert who can conduct the assessment of the CBHI schemes, present recommendations on the streamlining of schemes, assist the CBHI schemes develop a workplan and implement priority interventions identified for SHOPS support.
Scope of Work
The Consultant will be responsible for the following scope of work;
1. Design a methodology for the assessment of the 10 CBHI schemes and present to SHOPS for approval and in coordination with an actuarial consultant who will also be contracted by SHOPS.
2. Conduct the assessment at the NGO main offices and the 10 CBHI schemes. The assessment should include;
a. Review of administration processes at all CBHI schemes
b. Review of the client satisfaction around benefit packages offered by all the schemes
c. Review of the contracting arrangements and provider payment mechanisms used by the schemes
d. Review of social and financial performance indicators for all the schemes
e. Review of how CBHI schemes relate and are supported by their network NGO
3. Analyse the study findings and write a report for the assessment. The report will be reviewed by both the NGO and SHOPS.
4. Present the recommendations from the assessment to both the NGO and the CBHI schemes.
5. Develop, in collaboration with the NGO and the CBHI schemes, a joint workplan for implementation of the assessment recommendations
6. Work with the SHOPS team and the NGO to identify the priority interventions that can be
implemented feasibly with SHOPS support in the remaining period of the project year
7. Liaise closely with the NGO to get access to information required from CBHI schemes
Deliverables
The following deliverables are expected:
• Proposed methodology for the assessment of the CBHI schemes
• Assessment report including recommendations for streamlining the CBHI schemes
• Meeting report for presentation of recommendations
• Workplan for implementation of recommendations
• Report on implementation of priority recommendations
• Summative report at the end of the project year
• Level of Effort
This Consultancy is expected to take 39 days of the Consultant’s time.
There is an expectation of travel to Nyanza region to conduct the activities, therefore it is acceptable for 2 consultants to bid together to share the workload.
However the lead consultant will serve as SHOPS primary contact person and will be responsible for the full implementation of the scope of work.
How to Apply:
If interested please send your application letter and Curriculum Vitae, focusing on relevant work experience to shopskenyainfo@shopsproject.com
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