ANNEX B- TERMS OF REFERENCE

DEVELOPMENT OF A PRIVATE SECTOR ENGAGEMENT STRATEGY

Summary: Private Sector Engagement Strategy

Title Strategic Guidance for engaging the private sector through Private Partnerships in health service delivery

PurposeThe purpose of this assignment is to develop Strategic Guidance on engaging and leveraging private (commercial) sector health service providers – with a focus on the HIV, Malaria and TB sectors.

Expected fee 89,965 USD maximum has been estimated for the TA and meetings combined (see separate budget)

Location Somaliland, Puntland South and Central Somalia

Duration 6 months (maximum)

Start Date

Reporting to

The firm/organization will be supervised by the Global Fund Programme Manager in the UNICEF Somalia Support Centre (USSC), and by Health Specialists in Mogadishu, Garowe and Hargeisa. The firm/organisation will be guided by the Ministries of Health HIV, Malaria and TB Coordinators/Programme Managers in Mogadishu, Garowe and Hargeisa.

Budget Code/WBS SC150396

Project and activity codes TBD

Contract Modality Individual Contract

1. BACKGROUND AND CONTEXT

The private sector is the dominant provider of healthcare in Somalia, having experienced significant growth at all levels, from conventional private for‐profit and not‐for‐profit health facilities, to large chains of general hospital settings providing specialized care. It is estimated that the private sector provides around 80% of the country’s medicines by importation and distribution through private retail outlets and pharmacies1. The private sector provides essential services that are often the first and only point of contact for consumers and patients seeking health advice and health products.

However, the private health sector in Somalia is largely unregulated and there is strong consensus that unregulated private health markets suffer from various forms of market failure that create adverse health outcomes arising from poor quality treatment and value for money to consumers and patients who pay out of pocket for services.

1 Federal Republic of Somalia, Ministry of Health and Human Services, Second Phase Health Sector Strategic Plan 2017-2021 (Final Draft).1 | P a g e

In 2015, Oxford Policy Management completed a study on behalf of UNICEF to provide information on the cost of private healthcare in Somalia, the characteristics of private healthcare users, and sources of private healthcare funding. The study found that the predominant users of private health facilities are unemployed or retired, housewives, children, and those lacking a formal education. Furthermore, the study indicates that the healthcare provided by private health facilities is not affordable, with medicine being the most expensive category for both inpatient and outpatient care. Wealth is correlated with a higher probability of repeat visits for the same healthcare need, which suggests potential for the exclusion of poorer patients suffering from chronic diseases requiring substantial follow-up as well as communicable diseases requiring regular visits such as tuberculosis.

Furthermore, in a DFID assessment of the private health sector found that while the sector is the dominant provider of health care services, it is largely unregulated in areas of training health personnel, drugs supply and treatment raising resulting in adverse health outcomes with patients receiving incorrect or dangerous treatments2. The study also finds the private sector to be largely fragmented, lacking formal professional networks or forums to cohesively engage with the public sector or donors on issues of reform, policy-making, regulation enforcement and quality control.

Nonetheless, there has been ongoing work to establish and provide resources for the effective functioning of health regulatory bodies such as health professions council, national pharmacy regulatory authority and public health inspectorate. There is now an opportunity to develop formal public private partnerships (PPP) in the provision of comprehensive integrated health services to sustainably improve health outcomes.

2. Public Private Partnerships (PPP)

PPPs are widely understood as one approach amongst many to accelerate improved performance of the health sector. The primary objective of a health sector PPP is to capture the advantages and efficiencies of private sector actors and direct these to improved access, quality affordability and general system-wide performance.

As has been observed in other low-income countries that have attempted to foster PPPs in the health sector, the degree to which the private sector is leveraged to improve access to quality care for Somalis will depend on how well the various levels of Government and stakeholders address the primary challenges of partnering with the private sector as identified in recent studies that have assessed the private health sector in Somalia:

- Health Financing and insurance : There is little interest, poor knowledge and perception of health insurance. When identifying ways to finance health care, the majority of patients indicate they would not use private insurance, but would be interested in using community insurance, bank loan, savings scheme3

- Quality of private health sector services : Weak regulatory framework and its enforcement.4

Policies in place that are most relevant to the work of the private health sector in the three regions include: lack of publicly available information as well as understanding by interviewees as to the status of proposed and existing laws and regulations; Weak licensing

2 DFID, Assessment of the Private Health Sector in Somaliland, Puntland and South Central, 2015.3 Assessing the cost of private healthcare in Somalia, p.2 UNICEF 2018.4 Assessment of the Private Health Sector in Somaliland, Puntland and South Central, HEART 2015.2 | P a g e

mechanisms for private sector (business registration, import licenses, license medical practitioners.

- Supply chain of private health products: Identify and address areas of serious public health concern, such as the supply of tuberculosis drugs in and by the private sector that risks accelerating the emergence of MDR-TB (21% of private facilities administer tuberculosis drugs, which should only be administered by or in partnership with public facilities due to increased risks of the emergence of MDR-TB, consequence of unregulated and mismanaged treatment of TB cases).

- Stewardship and governance: Government lacks basic information and data on the private health sector, business environment and consumer preferences, however recent research by OPM contracted by UNICEF has provided information on the cost of private healthcare services, characteristics of private healthcare users and the sources of private healthcare funding; Little or no dialogue between sectors; no mechanism for all sectors to participate in health policy and planning.

Research into PPPs by DFID in 2015 in Somalia indicated that the term and concept of PPP is not well understood by stakeholders in government, donor, private sector and non-government entities. The confusion surrounding the term PPP is exacerbated by the weak legal and regulatory framework in general and specifically the areas concerned with defining and governing PPPs. (DFID, pg. 14). This research also indicates that across the three zones, there are differing perspectives and levels of willingness to engage with the public services sector. Private healthcare providers are willing to engage in partnerships where there would be a resulting improvement in market share and profit. In Puntland, the government was most keen to take advantage of the strengths and goodwill in sections of the private sector to complement, enhance and reduce the burden on the public sector. In Somaliland, the government tended towards regulating rather than engagement with the private sector. In South Central region, limited government capacity led to little systematic engagement with the private sector (DFID, pg. 15).

While there is consensus in and outside government that the private health sector has an important role to play, it is less clear how to define appropriate roles and responsibilities for the public and private sectors. This Strategic Guidance will delineate strategic access to private sector services, identify collaboration spaces to leverage, prioritising TB treatment, MDR-TB issues, Malaria services provision, quality assurance, training of staff, national regulations, quality of drugs, data, registration etc.

3. JUSTIFICATION AND PURPOSE OF THE ASSIGNMENT

The purpose of this assignment is to develop strategic guidance for establishing public private partnerships (PPP) in the health sector in Somalia, Puntland and Somaliland, with a focus on HIV, TB and Malaria. This guidance will be a roadmap for engage private (commercial) health service providers through formal PPP in health systems strengthening by identifying the steps to be taken towards formal private sector participation and collaboration with state authorities and donors on issues of reform, policy-making, regulation enforcement and quality control to provide quality health services to the public.

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4. METHODOLOGY

The methodology will consist of:

4.1. Literature Review , on key challenges and effective strategies in working with private sector to achieve public health goals, and current policy, legislative and regulatory mechanisms in place to guide the operations of the private sector in health and comment on the key areas that are missing to enable formal governance and stewardship of PPPs. The literature reviewed should include but not be limited to: the 2015 DfID private sector study in Somalia; the UNICEF/Oxford Policy Management 2018 Somalia Private Sector Mapping and Usage Report; the Global Fund’s technical briefs and information notes5; Health Public/Private partnership strategies or policies in similar operational contexts with a view to utilizing the recommendations therein to advance the objectives of this project towards drawing up a road-map for public private partnerships. In addition to the literature review, the consultant should take stock of data accruing from existing private sector “mini pilots” during the life of the Global Fund’s New Funding Model (NFM) grants, to identify challenges, opportunities and real practices in implementing PPP in HIV, malaria or TB (through lit review if available or through key informant interviews – see below point 2).6

4.2. Key Informant Interviews (KII) with public and private service providers, and private sector service provider networks to understand the interests and incentives facing various players in the health sector space, the role that formal institutions and informal social, political and cultural norms play in shaping public policy and programs; and to identify challenges, opportunities and real practices. Through the KII (and workshops – see below), identify key leaders in the public, private and NGO/INGO sectors to create a critical mass of leaders who will champion and promote the PPP roadmap within their respective organizations. The KIIs will be held on two levels: 1) by Field Research Assistants based on questionnaires developed by the consultant for specific stakeholders; and then by 2) the consultant who will do follow-up, more comprehensive, and with additionally identified key stakeholders.

4.3. Government Stakeholder Workshop (1 day): Workshop with national, regional and district level government stakeholders in Mogadishu, Garowe, and Hargeisa with the following objectives:

a. Clarify the stewardship role of the national, regional and district Health authorities in formulating, enacting and enforcing the legal, policy and regulatory framework to enable proper governance of the health sector for accelerated improvements in quality of care and treatment, medicines management and to enhance skills of health sector personnel and the drive towards PPPs;

5 The Global Fund’s (2016), Technical Brief on Building Resilient and Sustainable Systems for Health; Malaria Case Management in the Private Sector; and Tuberculosis Briefing Note6 This would be a core building block in considering a broader PPP strategy that is feasible.

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b. Discuss strategies to improve quality of the private health sector including: health financing and insurance mechanisms; contracting out, training, and others;

c. Discuss the supportive legal, policy and regulatory mechanisms in place and those needed to enhance the regulatory framework for PPPs

d. Identify the most common policy options and interventions with examples from the region and other low-income settings and agree on how these can be adapted to the Somali context

4.4. Intersectoral workshop (2 days) with balanced representation from key stakeholders from the government, private sector, NGO and donor community to discuss the principle areas of health financing; quality of private health sector services; supply chain management; and stewardship/governance of PPPs, focusing on HIV, TB and Malaria. The workshop should be organized for the participants to:

a. Map different sector strengths and weaknesses and explore benefits of partnering – open dialogue where participants can challenge their misperceptions of each other and frankly discuss beliefs and fears of working with the opposing sector;

b. Share views on the benefits of partnering using existing examples form HIV, TB and Malaria and reach common ground on a number of areas including better use of existing resources; leveraging additional resources facilities, and infrastructure; greater innovation in policies, services, technologies including private sector expertise and know-how; better health policies and planning that integrate and reflect the perspectives of different sectors in health; and

c. Discuss the necessary activities that will lay the foundation for a sustainable policy dialogue with key leaders, champions etc. to develop a consensus roadmap of the key recommendations arising from the stakeholder workshop.

5. PROPOSED SUMMARY SCHEDULE

No.

ActivityWks 1-2

Wks 3-4

Wks 5-6

Wks 7-8

Wks 9-10

Wks 11-12

Wks 13-14

Wks 15-16

Wks 17-18

Wks 19-20

Wks 21-22

Wks 23-24

1.Consultant develops workplan and draft questionnaires for KII’s

2.MoH hires research assistants and pre-tests questionnaires

3. Consultant does desk review and matrix

4. Research Assistants gather information

5.Consultant verifies research assistant’s work

6. Consultant drafts detailed KII questions and proposes interview

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schedule

7.

Consultant travels to Somalia (FGS, PL or SL) and with fields research consultants conducts relevant KIIs with key stakeholders; conducts Government workshop; has follow up KIIs; then conducts inter-sectoral workshop with public and private sectors

8. Same as above (FGS, PL or SL)

9. Same as above (FGS, PL or SL)

10.Consultant draft 3 Private-Public Strategic Guidance

11. Revision and endorsement of 3 Private-Public Strategic Guidance

6. SPECIFIC TASKS AND EXPECTED DELIVERABLES AND TIMELINES

No. Tasks End product / deliverables

Estimated Days

Time frame

Payment instalment

1.

Workplan (should include regular progress meetings with the GF Unit at USSC) and draft questionnaires for Field Research Assistants

1. Workplan2. Draft Questionnaires for

Field Research Assistants

2By end October

N/A

2.Literature Review Conducted (Key Findings Matrix)

3. Key Findings Matrix 10By mid-November

20%

Field Research Assistants conduct 1st level KII’s and consultant analyses

4. Matrix analysis 5By mid-December

20%Consultant drafts proposed additional/further KII’s and workshops schedules

5. Draft KII and Field Visit schedule

1By end December

3.Consultant conducts 2nd level KII’s and Stakeholder Consultations (2)

6. Signed attendance sheets KII’s

7. Signed attendance sheets Workshops (2)

27By mid-March

30%

4.Draft Strategic Guidance Document including political economy analysis

10By end March

20%

5.Final Strategic Guidance Document including political economy analysis

4 By mid-April 10%

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TOTAL 100%

7. A note on the Guidance Document. The public health situation is different in Somaliland, Puntland and the South-Central region and therefore recommendations for interventions in the strategic guidance report should be localized to each region. The Strategic Guidance should prioritize strategic recommendations to include but may not be limited to:

7.1.1. Delineation of strategic access to private health sector services.

7.1.2. Collaboration spaces with private sector etc., prioritising TB treatment, MDR-TB issues, Malaria services provision, quality assurance, training of staff, national regulations, quality of drugs, data, registration etc.

7.1.3. Analysis of the political economy (to be done as part of literature review, KII’s and workshops) with attention given to understanding the interests and incentives facing various players in the health sector space, the role that formal institutions and informal social, political and cultural norms play in shaping public policy and programs. At macro and sector-level country, the analysis will provide an understanding of the broad political environment that informs planning processes and the strategic direction of the health sector and help gauge the feasibility of policy reform and institutional change and the contributions that the donor community can make as well as the entry points to strengthening the core functions of the state, delivery of services and collaboration with the private sector to build progressive change.

7.1.4. Mapping out the areas where regulatory actions ought to be applied and identify the actors at these different levels including target for regulation of different activities (procurement, stocking, distribution, dispensing and prescribing. Include the viability of the essential elements of regulation (organizational authority and capacity – implementation of efficient and accountable processes that are necessary for achievement of relevant outcomes related to drug quality and availability.

8. MANAGEMENT

The consultant firm will be supervised by the Global Fund Programme Manager in the UNICEF Somalia Support Centre (USSC), and by Health Specialists in Mogadishu, Garowe and Hargeisa. The firm will be guided by the Ministries of Health HIV, Malaria and TB coordinators/Programme Managers in Mogadishu, Garowe and Hargeisa.

The consultant firm should provide their own working tools to complete this assignment. The firm/organization should be willing to travel to all accessible areas of Somalia. The firm will be responsible for the insurance and security for its personnel while in Somalia.

9. TIMEFRAME

The consultancy will start 15th November 2018 and should be completed by 15th May 2019.

10. QUALIFICATIONS AND EXPERIENCE

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The consultant firm and/or principal members of the firm’s team of consultants for this assignment, will have a track record of at least five years’ developing, implementing and monitoring private sector engagement strategies preferably in the North African or Middle Eastern regions, including Malaria, TB and HIV interventions. Specific experience developing strategies with the private health sector with experience in countries of conflict will be an advantage.

Other qualifications include: Experience in facilitating consensus discussions among diverse stakeholders, aligning

leadership and stimulating ownership of strategy goals and initiatives as well as implementing PPP strategy in complex environments required.

Solid technical background, analytical, diplomacy and facilitation skills required on consultancy team.

Strong writing and reporting skills. Good communication skills and ability to work closely with national authorities and with

minimum supervision. Fluency in English with excellent facilitation skills. Knowledge of Somali operational

context and readiness to travel to Somaliland, Puntland and Central South Regions of the Federal Government of Somalia.

11. PROPOSAL EVALUATION APPROACH

The evaluation criteria will be split between technical and commercial (price proposal) part at the weight of 70/30 respectively. Proposals submitted in response to this RFP should include and will be evaluated against the following:

a) Technical evaluation - overall response (10 points) - strategy/methodology (30 points) - proposed team (30 points)

Only proposals that receive a minimum of 50 points out of 70 will be considered further.

Technical Evaluation Criteria

Item Technical Evaluation Criteria Max. Points Obtainable

1 Overall Response 10

1.1 Completeness of response and requested documentation 5

1.2Overall understanding of assignment, alignment of the proposal submitted with the TORs; application process fully complies with TORs.

5

2 Firm and Proposed Team 302.1 Firm’s range and depth of organizational experience with similar projects 102.2 Proposed team: their relevant experience and qualifications 10

2.3Samples of previous work with other UN agencies, International organizations, Government or any other implementing partners

5

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2.4 References with at least five past / present clients with detailed contacts 5

3Proposed methodology and approach demonstrating experience of engaging diverse groups of stakeholders, developing consensus on strategy, implementing and monitoring PPP strategy

30

3.1Proposed work plan and approach to engaging stakeholders and other tasks as per the ToR

15

3.2 Strategy for implementation, measuring, monitoring and evaluation 15

TOTAL TECHNICAL SCORES 70

Minimum technical score required: 50

b) Price Proposal (Commercial evaluation)The total amount of point allocated for the price component is 30. The maximum number of points will be allocated to the lowest price proposal that is opened and compared among those invited firms/institutions which obtain the threshold points in the evaluation of the technical component. All other proposal will receive points in inverse proportion to the lowest price, e.g.:

Score for price proposal X = (Max score for price proposal (30 points) * Price of lowest priced proposal) / Price of proposal X

Total obtainable Technical and Price points: 100

The Proposer(s) achieving the highest combined technical and price score will (subject to any negotiations and the various other rights of UNICEF detailed in this RFPS) be awarded the contract(s).

See attached template for financial proposal (Annex 1). Financial Proposal Template.

12. ASSURANCE AND RISK MITIGATION

Security is always an issue working in Somaliland, Puntland and South-Central Somalia. The firm will be under an institutional contract and will be responsible for the safety of its staff/consultants’ safety. However, in all three regions, the firm will be linked into the UN security system so that they receive regular security updates and are monitored by the UN security team. To further mitigate risks, in Somaliland, Puntland and South-Central Somalia, it is recommended that international consultants stay at UNDSS-cleared hotels/guesthouses. Puntland and South Central. If the firm does not have its own security arrangements, the firm will be referred to known security companies to support their transport to and from the facilities.

13. GENERAL TERMS AND CONDITIONS OF CONTRACT

UNICEF’s General Terms and Conditions of Contract will apply to any contract(s) awarded in connection with the RFPS.

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14. PAYMENT SCHEDULE

Payments are linked to deliverables and are only paid with submission of deliverables indicated in Section 6 above. Upon signature of the contract, the donor-specific reporting templates will be provided by UNICEF.

Proposed by:

Name: Bettina Schunter Title: HIV Programme Manager

Signature: ________________ Date: _____/____/____

Endorsed by:

Name: Chantal Umutoni Title: Chief of Health

Signature: ________________ Date: _____/____/____

Approved by:

Name: Jesper Moller Title: Deputy Representative

Signature: _________________ Date: _____/____/____

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ANNEX 1: BUDGET TEMPLATE

Add rows as necessary

No. DescriptionUnit Rate (USD)

Number of Units

Frequency (days/ months)

Total (USD)

Comments/ Explanations

Human Resources

 SUBTOTAL        Travel related costs

SUBTOTALTraining related costs

SUBTOTALWorkshop related costs

SUBTOTALData collection related costs

SUBTOTALCommunication related costs

SUBTOTALIndirect support costs

SUBTOTALTOTAL

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