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National Consultant – Costing of Essential Package of Health Services, Tripoli, WHO Libya

NOTE: This vacancy is open to Libyan nationals only. If you meet the position requirements listed below (education and years of relevant work experience) please follow the instructions ‘How to apply’ below.

1. Purpose of the Consultancy:

The purpose of this consultancy is to support the Ministry of Health (MOH) in costing of the essential package of health Services (EPHS) as a contribution to health systems strengthening to improve service delivery at primary care levels.

2. Background:

Prior to 2011, the Libyan health system had achieved good health outcomes but the performance drastically plummeted with the onset of the armed conflict which evolved into a protracted political crisis characterized by political instability, outbreaks of violence, and general worsening of people’s living conditions. The provision of health services in the public sector has been declining with deteriorating capacity of the health system over the past ten years of instability. This situation affects the health of the populations, particularly the most vulnerable residing in low economic potential rural areas that are severely under resourced, worsened by the COVID-19 pandemic. This weak health system further exacerbates the humanitarian situation in the country and hampers Libya’s path towards resilience and development towards Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) that can be achieved through strengthening of Primary Health Care (PHC).  As result there is a concerted effort by WHO to support Libyan Ministry of Health (MoH) in developing and implementing a set of initiatives to reverse the declining trends. This recovery set of initiatives consists of: a health workforce strategic plan, an Essential Package of Health Services (EPHS) for PHC, together with Health management information system for evidence-based management and governance of the health system. The timely availability of reliable health data is an integral element to health systems strengthening and is vital for designing and monitoring effective interventions, allocating resources, and establishing a cycle of evidence-based policymaking.

3. The purpose and objectives of the costing project:

In this context of a complex, relatively fragile State situation, the implementation of these excellent initiatives will be hampered by many forces, hence the need to pilot them in 5 selected Municipalities to monitor and evaluate their feasibility and to generate evidence on their effectiveness, gain experience in their implementation as well as confidence to scale them up nationwide towards a stronger health system by the end of the recovery phase in 2023. An element that has to be determined during this pilot phase is the cost of the essential care package, which is a critical component of not only feasibility but also sustainability of the essential care package. This evidence is required by a number of other reform strategies in health sector, notably the health financing strategy that is changing form tax-based financing towards a model in which citizens and other stakeholders will contribute, yet with effective social protection mechanisms for the poor and vulnerable. A robust financing study of the cost of the EPHS will inform discussions towards the required investments to achieve a sustainable UHC through the PHC strategy.

The main implementers of the EPHS will be the WHO, International Rescue Committee (IRC) Working in partnership with municipality health authorities, and communities, to increase the utilization of a range of health services to improve the health status of the Libyan people with a focus on non-communicable diseases, reproductive, maternal and child health, and emergency health care. The project will support the provision of essential health services, including diagnosis and management of non-communicable diseases (NCDs) including mental health disorders, antenatal care (ANC), intrapartum and postnatal care (PNC), vaccinations, growth monitoring, basic nutrition services, as well as child spacing services. As the EPHS is implemented and potentially expands in both scale and scope, an understanding of the actual costs of EPHS service delivery is critical to guide allocation of financial resources to PHC, as well as designing mechanisms of citizen contribution to the total health expenditure, while minimizing out of pocket expenditure which are key elements of the envisaged reforms.

4. General objective:

Support the national authorities in Libya in providing an analysis of the financial feasibility of the benefit package.

6. Specific objectives:

To determine the actual total and unit costs of EPHS implementation
To determine to the primary cost elements of EPHS implementation
To determine the main cost drivers in the implementation of the EPHS due to remoteness and low economic potential in sparsely populates regions
To determine the appropriate charges for EPHS by the private sector
To develop a framework for determining the public and private insurance premiums, for adequate pooling of risks yet sustaining the schemes, by minimizing adverse selection and moral hazard.

7. Work to be performed, Activities to be conducted (including but not limited to):

Coordinate data collection that are needed for cost analysis of the priority benefits package (BP)..
Analyze financial and economic data of the health system and establish a review on the implication of health services in the benefits package.
Analyze the health services consumption for the entire population and translate this to measure the size of the health financing that is necessary for the implementing the BP.
Lead participatory discussions on the BP especially in the area of financial and economic aspects.
Support defining the financial criteria of inclusion and exclusion of the benefits package after analysis of the national health system based on cost effectiveness and intervention prioritization tools.
Analyze the provision health system and the financial capacity of the health system and accordingly suggest adjustments in the criteria to be considered for the content of the benefits package.
Coordinate with other consultants and ensure the coherence.
Conduct interviews with main stakeholders when needed for the approach.
Present and maintain the discussions at national level regarding the intermediate and final output of the consultancy.

8. Expected outcomes:

Desk review of national documents and peer reviewed literature on cost of health services in Libya.
Costing of benefit packages services classified by programs and levels of care.
Assessments and appraisals of relevant service packages, taking into account the agreed standard criteria (grouped in three pillars: ‘necessity’, ‘quality’ and ‘sustainability’) and on the basis of existing evidence, using the EMRO regional list of interventions.
National consensus on the sources of data and the list of agreed interventions.
Lessons learned of this consultancy shared
Suggestions for future benefits package review shared

9. Deliverables

A methodological note about how the whole process will be conducted
A report detailing current and projected costing of interventions, assumptions adopted, priority interventions recommended according to the prioritization using cost effectiveness and the three pillars and national consensus.

A report about the financial and economic mechanisms for the monitoring of the benefits package implementation in the coming years.

Note: Specific operational timelines and schedule for deliverables will be established and confirmed with the selected candidate.

10. Qualifications:

Education
First level university degree in economics or equivalent, is required.

Experience
At least 5 years’ of relevant professional work experience in economics of health, at national and/or international level, is required.

Language
Excellent knowledge of English and Arabic, is required.

Functional Skills
Excellent communication and social skills,

11. Duration of consultancy:
126 work days – between May 2022 and October 2023 – schedule to be established and confirmed with the selected candidate.

12. How to apply: 

PROFILES SHOULD BE COMPLETED USING “WHO PERSONAL HISTORY FORM”. DULY COMPLETED FORM AND CV/RESUME SHOULD BE SENT WAITH A COVER LETTER TO THE FOLLOWING ADDRESS – EMACOLIYHR@WHO.INT

PLEASE REFFER TO THE POSITION TITLE IN YOUR APPLICATION EMAIL.

NOTE: This consultancy will require travel; when requested by WHO to travel on official business, travel related expenses are covered accordingly by WHO via applicable rates of per diem; as per applicable WHO policies.