International Consultant – Technical Assistance for the Ministry of Health Full-Time

Introduction

According to in the Ministerial Diploma 127/2002 of July 31st, the Ministry of Health (MOH) defines the organization of Health Care Services in four levels of care and 11 types of Health Facilities: (1) Primary Level: Rural Health Facilities – type I and II -, Health Facilities type A, B and C – with or without Maternity-; (2) Secondary Level: Rural, District and General Hospitals; (3) Tertiary Level: Provincial Hospitals; (4) Quaternary Level: Central and Specialized Hospitals.

MOH recognizes the need to review this legal instrument (Ministerial Diploma) due to the evolution of the services provided by the National Health Service, starting with the design of the Essential Package of Health Services at all levels of care, including the definition of the HRH framework and the revision of the Ministerial Diploma itself.

In April 2016, MOH held the first Primary Health Care National Meeting under the theme “Primary Health Care: The Foundation of Resilient Health Systems”. This meeting recognized the adequacy of the Health Services to the real health needs of the populations, considering the importance, benefits of high level interventions that allow the prevention and protection of the population against risks and health hazards, access to essential services for the entire Mozambican population, prioritizing the poorest and most vulnerable social groups, and reducing inequity in access to health care.

International experience has shown that Primary Health Care is cost – effective, comprehensive, integrated and constitutes an efficient approach to the organization of a Health System, resulting in better levels of health and user satisfaction, ensuring continued care and Universal Coverage.

Health System in Mozambique

The Government of Mozambique has committed to Universal Health Coverage, focusing on Primary Health Care (PHC), whose health services are provided by three sectors:

1. The Public Sector: The National Health System (NHS) is the most territory and technically comprehensive with a network of 1,596 health facilities, of which:  (a) 96% of the health facilities (1’532) refer to the primary care network. From those, 1’370 health facilities are in rural areas); (b) 50 district, rural and general hospitals that provide secondary level of care; (c) 8 provincial hospitals belong to the tertiary level of care and (d) 4 central hospitals and 2 psychiatric hospitals belong to the quaternary level of care;
2. The Private Sector: Which is divided in (a) Profitable, which has almost exclusive presence in urban areas and (b) the non-profitable, which consists of national and international NGOs with strong linkages with the public sector and community;
3. The “Community Sector’’: That comprises (a) Elementary Polyvalent Agents(APS) that partially covers rural areas without health facilities, and (b) Traditional Medicine Practitioners (TMP) who are widely accepted by communities, offering non-allopathic medicine.

The response capacity of the National Health System (NHS) is a major challenge. The NHS network covers about 60% of the population and the reference system is poorly functional, resulting in health facilities –with greater capacity of response – often congested.

The Primary Health Care National Meeting (RMCSP) recommended to strengthen the primary care workforce, the health infrastructure, the community involvement and to support the public policy reforms to better foster its implementation.

The MOH represented by its National Directorates and technical working groups will coordinate the design of the EPHS for each level of care.

Essential Package of Health Services (EPHS) for each level of care

The EPHS’s design for each level of care requires prioritizing and choosing a set of interventions that will help the country achieving its health goals and targets.

The EPHS is a set of promotional, preventive, curative and rehabilitative health interventions that should be available for the entire population. These services can be provided by the NHS, the private sector and/or in combination with other actors. Overall, EPHS aims to improve equity and efficiency of the health system by expanding access to the entire population – including vulnerable and risk groups – and reduce the financial burden of those who pay for services. The EPHS should comprise a wide set of Health and diagnostic services, the HRH framework by level of care and the costing of the services provided by level of care, as well.

The proposed EPHS should be aligned with the Health Policy, the Health Sector Strategic Plan and the Health Financing Policy from the perspective of Universal Coverage.

It should be emphasized that the definition process must be carried out in an interactive way, involving all stakeholders at all levels, covering the areas of management and assistance. The outcome of this process should take into account the following aspects:

1. Appropriate approach for prioritizing the essential health services: How should the benefit package be defined? How to allocate resources among a set of interventions, taking into account factors such as disease burden, principles and values of the Health System and economic conditions?
2. Monitoring of the implementation:To define the coverage expansion over the time. The EPHS should be aligned with the Health Policy, the Health Sector Strategic Plan (HSSP) and Health Financing Strategy.

The costing of the PECS should take into account the following aspects:

1. Feasibility analysis of the EPHS: To define the resources needed for the NHS to provide the EPHS against the reality, per each level of care;
2. Definition of actions and optionsthat will help to increase resources to cover the gap, in relation to the current situation;
3. Analysis of policy implications for the health financing, taking into consideration the current reforms underway.

In the medium and long term, the EPHS may need to be adapted due to changes in the demographic and epidemiological profile. Therefore, both the Human Resources framework and the infrastructures and services framework may need to be adjusted to the real needs of the patients.

Objectives

General Objective

Provide technical assistance to the Ministry of Health in designing the Essential Package for Health Services (EPHS) for each level of care, takin into account the multisectoral and community approach to move towards Universal Health Coverage, as well as including the definition of the Personnel (HRH) framework per levels of care and with its respective legal framework, and the costing of the package.

Specific Objectives

• Review the documents prepared by the working group and the National Directorates (as referred in the TORs introduction);
• Support the definition of the Essential Package of Health Services (EPHS) per level of care;
• Support in defining mechanisms and conditions for access to Reference and Counter-Referral Services;
• Support in the definition / revision of the Personnel (HRH) framework for type of health facility and level of care;
• Support in defining the Emergency Medical Services to be provided in the Health facilities and Reference Hospitals;
• Propose to the Reference group a preliminary draft of the Ministerial Diploma that will give legal coverage to the EPHS and the Personnel (HRH) framework;
• Costing the EPHS per levels of care, estimating the gap analysis.
• Develop the EPHS M&E plan.

Expected results (deliverables)

The consultancy will provide the following products:

1. EPHS for level of care;
2. Personnel (HRH) framework per level of care;
3. Mechanisms and conditions for access to referral and counter-referral services;
4. Ministerial Diploma 127/2002 of 31 July revised.

Methodology

The international consultant will submit a technical proposal, including a timeline.

In general terms, the methodology will have 4 phases:

• Desk review: (a) Analysis of the PHC literature and other levels of care; (b) Review of the legal environment, including CSP Regulations and Standards;
• Information analysis: (a) Harvesting information; (b) Interviews with key informants;
• Workshops;
• Preparation and submission of the EPHS proposal.

The Minister’s Consultative is the forum for the approval and/or endorsement of each of the stages. It is expected that the Consultancy will work closely with the MOH technicians in each of the stages of the exercise.

Reference Group

• The reference group – led by the Planning and Cooperation Directorate – will follow up on the progress of the consultancy, and will be in charge to coordinate the subsequent activities. Periodic meetings will be scheduled with the consultant/s, who will report and work closely with the Reference Group;
• The Reference Group is composed by: the DNSP, DNAM, DRH, DAF, DPC, DNF,CMAM, INS, HC Maputo, Reforms Unit, DNGC Quality, SEMMO, Legal advice department and/or other Directorates deemed appropriate their participation throughout the process, including Provincial Directorates;
• The Reference Group will provide all the relevant and available documents for this exercise and whenever requested; support the interviews schedule with key staff from National Directorates, subordinate and supervised institutions, Provincial Directorates and other sectors;
• The consultant/s will carry out the costing and feasibility analysis in close collaboration with a specific technical team (to be identified).

Requirements for International Consultant Technical Assistant

The work will be carried out by an expert that meets the following requirements:

• Post-graduation in Planning and Management of Health/Hospital services; Public Health; Health Economics, and/or related academic level;
• Minimum of 5 years of experience in costing of Health Services, National Strategic Programs and Plans;
• Proven national and / or international qualification and experience in health services planning and the designing of EPHSs in developing countries, similar to Mozambique;
• Knowledge of the National Health System (NHS) in Mozambique and the socio-economic, demographic and health context;
• Knowledge of costing methodologies and standardized costing modelling;
• Knowledge in the use of modelling and database programs will be an advantage;
• Proven experience in the area of ​​Health Systems and organization of Health Care;
• Demonstrated ability to lead, coordinate and team work spirit;
• Ability to produce strategic and normative documents;
• Immediate availability.

Use of Language skills

• Essential: Expert knowledge of Portuguese.
• Desirable: Knowledge of English is an advantage.

Knowledge and Skills

Excellent analytical and writing skills, good interpersonal and networking skills, facilitation skills and team player, advanced computer literacy skills including proficiency in word processing packages (e.g. Word) and presentation packages (e.g. Power point).

Duration of Consultancy

The consultancy will consist in maximum sixty (60) days to be used during the months of November and December 2019.

Remuneration:

A consultancy fee at P3-level and perdiem in line with the WHO travel rules for international consultants

Place of assignment (Duty station)

The consultancy will be based in Maputo, MOH (Planning and Cooperation Directorate).

CONSULTANCY MANAGEMENT

WHO will hire the consultancy and therefore the administrative issues will be managed by WHO.  However, the technically related aspects of the consultancy will be discussed with the reference group (led by the DPC). The results of this consultancy will be submitted for approval to the Technical Council (Permanent Secretary) and to the Advisory Council of the Minister