Heath Financing Consultant Palladium

Palladium with funding from USAID is currently in the fourth year of implementing the Uganda Health Systems Strengthening (UHSS) Activity. UHSS aims to strengthen Uganda’s health systems through technical assistance to improve leadership, accountability, efficiency, and quality of health services in the key areas of leadership and governance, public financial management, and human resources for health and community health systems.

I. Introduction
Uganda has made significant progress in addressing the health needs of its population. For example, physical access to health facilities has improved from 86 percent of the population living within five kilometres of a health facility in FY 2016/17 to 92 percent in FY 2019/20, and under-five mortality declined from 53 to 42 deaths per 1,000 live births between 2016 and 2021, and antiretroviral therapy coverage increased from 56 percent in FY 2014/2015 to 82 percent in FY 2020/21. This progress has been achieved through investments made by the Government of Uganda with significant contributions from development partners. From 2000 to 2010, average international aid for health grew annually at 9.5 percent. In sub-Saharan Africa, net official development assistance for health more than doubled, from USD 18.5 billion in 2000 to USD 42.5 billion in 2010. However, this growth has since plateaued, yielding 1.7 percent on average since 2011. In Uganda, official development assistance for health has followed a similar trend, increasing from USD 147 million in 2000 to a peak of USD 964 million in 2016 and is expected to have plateaued since then.

For Uganda, these trends signal that the levels of development assistance for health are unlikely to increase at the rates adequate to meet its Sustainable Development Goals (SDGs). This will mean that the Government of Uganda (GoU)) needs to increase the levels of domestic health system funding and improve the efficiency of utilization of available resources.

In 2020, USAID Uganda Health System Strengthening (UHSS) Activity supported the Ministry of Health to conduct a health financing Transition Readiness Assessment of various health programs. Results showed that all programs that were assessed (RMNACH, Family Planning, HIV/AIDS, Malaria, Tuberculosis & Leprosy, Immunization, and Nutrition) currently face transition risks and vulnerabilities that need to be addressed to improve preparedness for transitioning from donor funding over the medium and long term.

With this background, it is necessary for the Ministry of Health to develop a Health Financing Transition and Sustainability Plan to outline effective approaches to prepare the high-risk programs for transitioning from external financing support. The transition plan will present a range of transition scenarios, and their corresponding funding and timelines (10-year horizon). The transition plan will also include a recommended M&E plan/framework with clear indicators to track progress towards transition. The consultant will build on the results of the Transition Readiness Assessment earlier conducted by UHSS as a baseline.

2. Objectives of the Consultancy
The overall objective of the consultancy is to support the Ministry of Health to develop a Health Financing Transition and Sustainability Plan. The plan will act as a guidance for the Government of Uganda and its health development partners on how to approach transitioning of the financing and management of health programs to enable the Government to sustain and continue to improve the current levels of coverage of key health programs.

The specific objectives include:
• Establish the current status of health financing in Uganda.
• Establish the short term, medium term, and long-term health system funding commitments by the Government of Uganda.
Establish the short term, medium term, and long-term health system funding commitments by the health development partners.
• Develop future coverage scenario projections for the next 10 years in consultation with key stakeholders, including the transition plan task force constituted by the MOH.
• Run donor funding reduction scenario projections and compare results to a status quo scenario that assumes donor funding and coverage levels remain constant over the next 10 years.
• Develop recommendations for the Government of Uganda to sustain effective coverage of the priority health programs in response to possible funding reductions by development partners.
• Lead validation meetings to gain consensus with stakeholders
• Lead dissemination meetings to share the transition and sustainability plan.

3.1. Review all documents relevant to the financing of the Ugandan health system
• Literature review of relevant policy/implementation documents, recent global, regional, and local un/published research.
Literature review of case studies of countries where similar transition plans have been developed to take stock of the processes used to draft such plans.

3.2. Conduct consultations
• The consultant will hold consultations with key stakeholders.
• Conduct key informant interviews with identified key resource persons both from Government, health development partners, civil society, and other stakeholders.
• Participate in meetings of the Health Financing Transition Task Force to agree on strategic objectives and content of the plan.

3.3. Draft a Health Financing Transition and sustainability Plan
• Building on the results of the Transition Readiness Assessment, literature review, and stakeholder consultations, develop a draft a Health Financing Transition and Sustainability Plan
The plan should clearly capture the current health system funding status, the funding projections of the different sources, the scenarios developed from the projections and recommendations for the Government of Uganda to mitigate the impact of possible funding reductions and sustain adequate health program coverage levels.
• Share the draft Health Financing Transition and Sustainability Plan with relevant stakeholders including Ministry of Health, Ministry of Finance, Planning, and Economic Development, health development partners, civil society, and the private health sector for validation, review, and input.

3.4. Final Plan
• Incorporate stakeholder input into the draft and produce the final Health Financing Transition and Sustainability Plan.
• Prepare a slide deck of the contents of the plan that will be used for presentations during dissemination of the plan.

4.0. Expected Deliverables and Output
The key deliverables expected from the consultant include the following:
• Inception report that outlines how the consultant intends to undertake the work of developing a Health Financing Transition and Sustainability Plan.
• Draft Health Financing Transition and Sustainability Plan (including executive summary).
• Final Health Financing Transition and Sustainability Plan with its slide deck.

Key deliverables
• Inception report
• Report of consultations completed
• Draft report of the Health Financing Transition and Sustainability Plan
• Final report of the Health Financing Transition and Sustainability

6.0. Qualification and experience of the consultant
• Graduate qualification in the public health field. Holder a master’s in public health, planning, health economics or health services administration.
• Demonstrated experience in the field of health services research.
• Evidence of undertaking assignments on health financing transition in Uganda or a country of a similar health system setting in the last 10 years.
• Excellent interpersonal and professional skills in interacting with government and development partners.
• A demonstrated understanding of health financing transition issues and the different policy levers available to manage the transition.
• Demonstrated experience in working with government, health development partners and other stakeholders in health care delivery programs.
• English language fluency is required.

7.0. Reporting
The consultant shall report directly to the Commissioner, Planning, Financing and Policy( MoH) for the strategic guidance and the Chief of Party, Uganda Health System Strengthening (UHSS) Activity for the contract management.

8.0. Duration of the assignment
This exercise will be carried out for a period of two months from the time of inception. The exercise is anticipated to require approximately 45 days of work.

Company Overview:
About Palladium – Palladium is a global leader in the design, development and delivery of Positive Impact – the intentional creation of enduring social and economic value. We work with governments, businesses, and investors to solve the world’s most pressing challenges. With a team of more than 3,000 employees operating in 90 plus countries and a global network of over 35,000 experts, we help improve economies, societies and, most importantly, people’s lives.

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