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Thursday, March 16, 2017
Consultation TOR Kenya’s Healthcare System
Terms of Reference – Analysis of the role the private sector plays in Kenya’s Healthcare System-Re-advertisement
Christian Aid (CA) is an international development agency which works with local partners to empower and mobilise poor and marginalised people to meaningfully engage in their own development. In Kenya, Christian Aid was registered in 1997 and initially centred on rural development, capacity building, particularly of church-based development agencies, and support for their community development work.
Currently the CA health programme in Kenya focuses on strengthening the health system by ensuring increased demand for health services through tackling unfair social norms hindering access and use of services, advocating for policy change, resource allocation and budget tracking. The program also seeks to support supply by improving citizen-state relationships, engagement and accountability.
The Kenya health system is characterized by a mix of public and private financing and delivery of health care. Kenya’s burden of disease has historically been mostly focused on communicable diseases. However, recent research shows a large and fast increase in the prevalence of non-communicable diseases such as cancers and cardiovascular diseases.
In 2010, Kenya adopted a new constitution which created a devolved government with 47 Counties. Each County operates as a Government with a relatively high degree of autonomy including decision making on provision of health care.
In 2012/13, the public sector accounted for 34% of the Total Health Expenditure (THE); the private sector for 40% and development partners accounted for 26% which has come down from 35% in 2009/10. In the latest national Ministry of Health (MOH) budget development partners accounted for 57.1% of the total health budget in FY 2014/15, compared with 59.8% in FY 2013/14. The country has a huge potential for growth in terms of private sector investment in healthcare provision.
Christian Aid seeks to harness the power of the private sector, balancing its significant power with that of other stakeholders and influencing business practices to meet the development challenges we face.
The overall objective of the research is to conduct a context analysis on the role of the private sector in the health care system in Kenya. The analysis will look at access, affordability, quality and standards and make a set of clear recommendations on how Christian Aid can strategically engage the private sector. These will include short term recommendations to inform Christian Aid’s current health strategy and long term recommendations to inform the health strategy beyond 2017.
Scope of Work
Activity 1: Provide analysis on the role the private sector plays in providing and funding healthcare in Kenya. Conduct a short literature review on what research already exists on this subject. Look at national statistics in achieving SDG goal 3, and indicator 3.8 on universal health coverage as a top line goal. Look, specifically at four types of private sector actors, 1) private hospitals / clinics, 2) private health insurance providers, 3) pharmacies and other commodity and equipment retailers 4) companies, including corporate foundations, who fund health care programmes. For each group, identify a maximum of 5 Key Actors.
For each key player please refer to:
Group 1: private hospitals / clinics / surgeries: Size, nature and location of business What type of a business are they: single provider, national chain, international company What is their core business activity, opportunities / challenges to their business? Number of patients treated by gender, age, other socioeconomic factors Was the patient covered by health insurance, or paying out of pocket, other means? Average payment out of pocket, or out of pocket supplement for those covered
Group 2: private health insurance providers, social health insurance (SHI) providers: Size, nature and location of business What type of a business are they: single provider, national chain, international company What is their core business activity, opportunities / challenges to their business? Number of individuals who are covered in their health care plans, by gender, age, other socioeconomic factors Are they covered via their employer, or has the person sought health coverage individually, or is insurance partly paid by government / donor grants? Average payment on a health insurance plan per month, any supplements that person needs to pay out of pocket when accessing health care facilities
Group 3: pharmacies and other medicine retailers: Size, nature and location of business What type of a business are they: single provider, national chain, international company? What is their core business activity, opportunities/challenges to their business? Turnover of sales of medicine, estimates of gender, age, and other socioeconomic factors of customers Are medicines paid for by individuals, or by health care providers, or government / donor grants or a combination? What is the average cost of medicine, and the most common medication bought?
Group 4: companies, including corporate foundations, who fund health care programmes: Size, nature and location of business What type of a business are they: Small and Medium Enterprise, national, international company? What is their core business activity? What are their drivers for funding healthcare programmes e.g. Corporate Social Responsibility? Strategic interest e.g. need for healthy workforce? What type of healthcare projects have they funded and where? Who are their current not for profit partners? Activity 2: Provide a list of common (supply and demand) private sector health interventions in Kenya. Include both best and poor practice examples and an analysis of lessons learned. Provide a list of collaborative interventions between the non-profit sector, the private sector and/or government. Analyse what worked well and why. Provide a set of clear recommendations that could inform CA’s health programmatic work beyond 2017. Activity 3: Analyse the policies, regulations and laws that impact on the role the private sector plays in the Kenyan health eco-system. Provide a set of clear recommendations that could inform CA’s next health strategy beyond 2017. Activity 4: Drawing from the analysis conducted in Activity 1, 2, and 3, identify suitable funding, programme and/or advocacy private sector partners (national and international) for 1) Christian Aid’s current health work and 2) CA’s health strategy beyond 2017. Provide a set of clear recommendations, based on sound evidence, to inform CA’s private sector partnership strategy.
In the proposal, the Consultant(s) should clearly explain the methodology to be used. However, as a minimum the consultant should:
Refer to key documents such as relevant national policies and laws, government development strategies, NGO reports on universal health coverage, and plans and UN Sustainable Development Goals, and World Health
Organization documentation on Universal Health Coverage and Access to Medicine
Familiarise themselves with CA policies and guidelines on relevant topics, such as CA’s Community Health and HIV Framework, country and programme strategies, annual reports (to be provided by CA).
Consult with target groups and other relevant stakeholders (e.g. key private sector players, relevant ministries, local government, other national and international development agencies) at various stages
Conduct visits to the possible geographical areas of operation, and with actors from the four groups, outlined above, in the private health care ecosystem
Provide a list of potential private sector partners (fundraising, programmatic and advocacy) and suggest how they might strategically contribute to the programme
Provide a list of people (with contact details) met during the study
The Consultant(s) will be expected to engage with CA staff throughout the assignment. Several meetings with relevant CA staff during the research and a debriefing should be considered as an important part of the methodology, including for example, a briefing on the ToR, a number of progress meeting to review emerging issues, trends and priorities and a debriefing, etc. The Consultant(s) should also be open to being accompanied by CA staff to meetings with key external stakeholders and should expect to present and discuss the findings of the research to an external and internal audience.
The Consultant(s) is/are expected to provide a detailed methodology for conducting a context analysis based on the TOR. The methodology/the proposal of the Consultant(s) should cover all the services described in the TOR.
A final report in which should be no more than 40 pages. The report should include an executive summary and a set of clear and detailed recommendations. The report should be broken into 4 chapters, reflecting the four activities outlined above. The content should be well structured and clearly written. The document should provide statistical information and refer to reliable materials/reports/documentation developed by local and international organizations, state agencies, private sector and others sources to make evidence to statements and conclusions in the report.
The Consultant(s) will be expected to present and discuss the findings of the research with key external stakeholders in a workshop, upon completion of the final report. The Consultant(s) will also be expected to attend an internal strategy development workshop with CA staff.
Duration and Location No. of days: 30
Educated to masters level or equivalent level of work experience
Significant experience and knowledge of the healthcare system in Kenya , with particular expertise in the private health sector
Sound knowledge of international development and the role civil society plays in the health sector in Kenya
Demonstrable experience and knowledge in research, including critical analysis, political economy analysis and policy and power analysis
Excellent communication skills – verbally and in writing. Confidence and ability to represent/ present to senior stakeholders across multiple sectors e.g. government, private sector, civil society
Ability to work collaboratively with other stakeholders e.g. with CA programmes and policy teams
How to Apply
Applications with non-returnable CVs and one sample of previous work related to this assignment should be submitted on or before via email to firstname.lastname@example.org Applications should be submitted on or before 20th March 2017.
All applicants should include the following: Cover letter – brief explanation about the consultant with particular emphasis on previous experience in this kind of work A technical and financial proposal (which should include all fees payable including professional fees) for this consultancy. The Technical Proposal should outline: interpretation of the TOR, methodology to be applied, and a detailed implementation plan for the consultancy. A copy of a report for previous work conducted Resume and relevant references. Note: Those who applied previously need not re-apply