TA-4 Punjab: UHI: National Junior STTA – Research Associate- E4H Programme Punjab

Job title: TA-4 Punjab: UHI: National Junior STTA – Research Associate- E4H Programme Punjab

Company: Palladium Pakistan Pvt. Ltd

Job description: TORs: National Junior STTA – Research Associate (2 positions)Sustainable Financial Model of Sehat Sahulat Programme (A Universal Health Insurance Scheme)ProgrammeEvidence for Health (E4H) is a Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan’s healthcare system, thereby decreasing the burden of illness and saving lives. E4H provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments, and is being implemented by Palladium along with Oxford Policy Management (OPM).Through its flexible, embedded, and demand-driven model, E4H supports the government to achieve a resilient health system that is prepared for health emergencies, responsive to the latest evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H delivers TA across three outputs:Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.Output 2: Strengthened evidence-based decision-making to drive health sector performance and accountability.Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.Background and Problem StatementIn 2016, the Government of Punjab launched the Prime Minister’s National Health Programme (PMNHP), a health insurance initiative for vulnerable persons responding to rising healthcare costs and the associated risk of poverty from catastrophic medical expenses. This social health protection programme provided coverage for in-patient medical expenses. Initially targeting economically vulnerable individuals (through a proxy means test (PMT) score below 32.5 in the National Socio-Economic Registry (NSER) , the programme’s successful pilot led to its universal expansion in Punjab in 2021 through Sehat Sahulat Programme (SSP). With over 31 million families covered (127 million people), this is significant progress towards providing in-patient health service delivery in Punjab, contributing to the Universal Health Coverage (UHC) indicator of service capacity and access. However, the programme’s expansion has brought financial sustainability challenges to the forefront due to economic challenges and constrained fiscal space.Punjab: According to the contractual schedule, the provincial government could not pay its share of the premium to the State Life Insurance Company of Pakistan (SLIC). Shortly into the contract, the government shifted from paying the agreed premium amounts to paying estimated claims due plus administrative fees. In June 2023, the government implemented austerity measures to further reduce claim costs, restricting access to programme benefits.Khyber Pakhtunkhwa (KP): The SSP in Khyber Pakhtunkhwa was suspended multiple times throughout 2023 due to non-payment of premiums. Ultimately, the programme was suspended. Currently, the SSP in KPK was made operational soon after the new government took charge and made partial outstanding payments to SLIC.Federal Government: The Federal Government of Pakistan (GoP) has failed to pay any premium since the contract’s inception. Services were not suspended due to the joint nature of the contract. Essentially, the GoPb was paying the GoP premium share. This arrangement has now ceased, with Punjab not footing the bill anymore as it is struggling itself.Currently, there are ongoing discussions within the provincial government about the scope of the benefit package itself, as well as the beneficiaries and the empanelled hospitals. The P&SHD is committed to providing health coverage to as many people as possible, but given economic and fiscal constraints, the beneficiaries entitled to the package have been revised to those that score below 40-45 on the PMT. Changes have also been proposed and/or already made to the benefit package, with c-sections and normal deliveries now only available in public sector hospitals. Furthermore, there are co-payment mechanisms for surgical procedures that require patients to contribute up to 50 per cent of the cost if they opt for treatment in private sector hospitals. There is also a push to include a greater number of public sector hospitals compared to private sector establishments. At the moment, there are just over 200 public facilities as opposed to 165 private healthcare facilities empanelled. The push factor for this is to make drive most of the funds into public sector hospitals to bring costs down for the government.ObjectiveThe overall objective of phase 1 of the TA will be to provide the department with a report on the province’s current fiscal situation. Decision-makers will assess the current financial problems, the urgency of financial reform, and the requirement—if any—of reforms to the benefit package.Scope of Work and MethodologyThe Scope of Work and Methodology for the Technical Assistance assignment is designed to ensure the development and facilitation of actionable recommendations.Step 1:Develop a stakeholder engagement plan identifying key stakeholders, including government agencies, healthcare providers, policymakers, and beneficiary representatives. Schedule initial meetings to understand their perspectives and gather preliminary data.Next, the team is expected to collect detailed financial data on health expenditures from the Finance Department and financial management cell of the P&SHD and Specialised and Medical Education Department along with the Punjab Health Initiative Management Company. The team is expected to use WHO or IMF guidelines for fiscal space analysis preferably . The team is also expected to collect health insurance claim data from SLIC and comprehensively analyse what services are being claimed, distributed across private and public sector establishments, and cross-referenced with claimant PMT scores (if applicable). The team will also document the rationale for the criteria of PMT score 40 and/or below, adopted for beneficiaries.The consultants are expected to collect and analyse demographic projections and economic growth data from the Pakistan Bureau of Statistics and other relevant government and non-government institutions. Analyse data on current debt levels and fiscal policies affecting health financing. The team will also incorporate findings from the TA on review of Punjab Health Sector Strategy (2019-2030).Checkpoint 1: Complete the inception report with identified stakeholders and initial data collection with a rapid review of the current situation.Step 2:Conduct a detailed analysis of the costs of the current health insurance benefit package on Punjab’s budget (using its costings and understand what costing mechanisms have been used).Evaluate how health expenditures align with or exceed budget allocations and the implications for fiscal sustainability.Explore forecasting tools to provide a range of projections, highlighting potential fiscal pressures.Assess the overall budget structure, revenue streams, and expenditures across sectors to determine the available fiscal space for health spending on UHI.Explore opportunities for reallocating funds or increasing health spending efficiency.Conduct forecasting based on the current benefit package to understand the sustainability of funding these benefits in the long term under various economic conditions.Assess the fiscal space specifically in sustaining the current health insurance benefits, analysing revenue and spending to determine the feasibility of continued funding without additions or deletions.Do a fiscal analysis on how a budget can be pivoted from the tertiary and secondary healthcare facilities to the primary health care facilities.Analyse the efficiency savings by using more public facilities for treatment than private facilities.Checkpoint 2: Completion of a draft budget impact analysis reportStep 3:Conduct a stakeholder consultation workshop(s) to gather additional feedback from P&SHD, Specialised and Medical Education Department, SLIC, PHIMC, other officials as well, the finance department, and other relevant stakeholders, including donor agencies as well as other provincial departments from the country, including representatives from the Ministry of National Health Services, Regulation & Coordination (M/o) NHSR&C at the federal level.Prepare a final report with detailed financial recommendations and a roadmap for subsequent TA support required by the government in phases 2 and 3 of the larger support initiative to make SSP financially viable.Checkpoint 3: Completion of a final report with detailed and actionable recommendations.Expected Deliverables

• Inception Report: This should outline the scope of the TA, the objectives, the methodology, tools, frameworks used, the literature review conducted, and a detailed timeline.
• Budget Impact Analysis Report (Draft): This report should analyse how the existing benefit package impacts Punjab’s health budget, detailing expenditures and budget alignment. It should also include an assessment of the long-term sustainability of the current benefit package, including fiscal space analysis, financial forecasting, and debt sustainability analysis.
• Final Report: This report should comprehensively analyse all findings and recommendations and lay a roadmap for the next steps. It is expected that the consultants will include an analysis section on what the economic risks will be if the current financing model is continued, what may happen in the event of a fiscal shock or economic downturn, and what impact it may have on the health sector service delivery and UHC SCI scores if there is a collapse or further damage is done in such events. The report should also include the next steps for conducting subsequent TA, including the recommended scope and objectives for phases 2 and 3, elaborated at the beginning of this document.

Timeline and LOEThe level of effort for the role is 85 working days for each RA, from Jul 2024 to Jan 2025.RequirementsEducational & Technical Expertise:

• Bachelor’s degree in public health, Economics, Social Sciences, or a related field.
• Proven experience in healthcare research.
• Proven track record of conducting comprehensive literature reviews.
• Exceptional research skills with a strong foundation in both qualitative and quantitative methodologies.
• Strong analytical skills in data analysis, using relevant software for data analysis and reporting (e.g., STATA, SPSS, R).
• Understanding of ethical considerations in research and commitment to maintaining research integrity.
• Willingness to learn and adapt to new research methodologies, tools, and evolving project requirements.
• Strong organisational skills to manage research materials, assist in project planning, and ensure the smooth execution of research tasks.
• Excellent communication and writing skills, capable of translating complex research findings into clear and concise reports for diverse audiences.
• Capable of working collaboratively within a research team, sharing insights and contributing to achieving research goals.

Deliverables/KPIs:

• Conduct a literature review to identify global best practices in healthcare financing and care management, drawing insights from international development agencies and similar programs.
• Synthesize all research findings into detailed reports supporting strategic development of SSP’s financing model, ensuring recommendations are evidence-based and aligned with global best practices and local needs.
• Collaborate with the project team to integrate research insights into the Sustainable Financing Model Proposal, contributing to the overall strategy for SSP’s financial sustainability.
• Support the team in writing reports, preparing agendas, creating meeting content, developing visuals for data illustrations, and interpreting data, recording minutes and maintaining the project documentation.

Expected salary:

Location: Lahore, Punjab

Job posting date: Sun, 14 Jul 2024 04:11:57 GMT

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